毛细支气管炎患儿血清sRAGE、YKL-40与Th17_Treg失衡对喘息复发的预测价值研究  

Relationship between serum sRAGE,YKL-40 and Th17/Treg imbalance in children with bronchiolitis and its predictive value for recurrent wheezing after discharge

作　　者：洪爽 王建忠 田大伟 于海心 白小玲 杨召川[3] HONG Shuang;WANG Jianzhong;TIAN Dawei;YU Haixin;BAI Xiaoling;YANG Zhaochuan(Department of Pediatrics,Qinhuangdao Maternal and Child Health Hospital,Qinhuangdao,Hebei 066000,China;Department of Pediatrics,Zhuhai People′s Hospital,Zhuhai,Guangdong 519000,China;Department of Child Health,Children′s Medical Center of Qingdao University Affiliated Hospital,Qingdao,Shandong 266003,China)

机构地区：[1]秦皇岛市妇幼保健院儿科,河北秦皇岛066000 [2]珠海市人民医院儿科,广东珠海519000 [3]青岛大学附属医院儿童医学中心儿童保健科,山东青岛266003

出　　处：《临床肺科杂志》2024年第9期1391-1396,共6页Journal of Clinical Pulmonary Medicine

基　　金：河北省医学科学研究课题计划(No.20191182)。

摘　　要：目的 探讨毛细支气管炎患儿可溶性晚期糖基化终末产物受体(sRAGE)、壳多糖酶3样蛋白1(YKL-40)与辅助性T细胞17(Th17)/调节性T细胞(Treg)失衡的关系及对出院后发生反复喘息的预测价值。方法 选取我院收治的197例毛细支气管炎患儿为毛细支气管炎组,另选取100名体检健康婴幼儿为对照组。检测两组sRAGE、YKL-40水平,并分析其与Th17、Treg、Th17/Treg的相关性。出院后随访3年,根据患儿是否发生反复喘息分为反复喘息组和非反复喘息组。分析患儿出院后反复喘息影响因素及sRAGE、YKL-40的预测价值。结果 与对照组比较,毛细支气管炎组sRAGE和Treg降低,YKL-40和Th17、Th17/Treg升高(P<0.05)。毛细支气管炎患儿sRAGE与Th17、Th17/Treg呈负相关,与Treg呈正相关;YKL-40则反之(P<0.05)。母乳喂养和sRAGE升高为毛细支气管炎患儿出院后反复喘息的保护因素,哮喘家族史和免疫球蛋白E(IgE)、Th17/Treg、YKL-40升高为危险因素(P<0.05)。sRAGE、YKL-40联合检测预测毛细支气管炎患儿出院后反复喘息的曲线下面积(AUC)为0.897(0.846~0.936),大于sRAGE、YKL-40单独检测预测的0.799(0.736~0.853)、0.795(0.732~0.849)(Z=3.938、3.839,P均<0.001)。结论 毛细支气管炎患儿sRAGE降低、YKL-40升高与Th17/Treg失衡及出院后反复喘息有关,二者联合检测对出院后反复喘息具有较高的预测价值。Objective To investigate the relationship between serum soluble receptor for advanced glycation end products(sRAGE),chitosanase 3-like protein 1(YKL-40)and T helper cell 17(Th17)/T regulatory cell(Treg)imbalance in children with bronchiolitis and its predictive value for recurrent wheezing after discharge.Methods 197 children with bronchiolitis admitted to our hospital were selected as the bronchiolitis group,and 100 healthy infants who underwent physical examination were selected as the control group.The levels of sRAGE and YKL-40 were detected in the two groups,and their correlation with Th17,Treg and Th17/Treg was analyzed.After discharge,the patients were followed up for 3 years and were divided into the recurrent wheezing group and the non-recurrent wheezing group based on whether the patients experienced recurrent wheezing.The influencing factors of recurrent wheezing in discharged patients and the predictive value of sRAGE and YKL-40 were analyzed.Results Compared with the control group,the sRAGE and Treg in the bronchiolitis group decreased,while YKL-40,Th17 and Th17/Treg increased(P<0.05).sRAGE in children with bronchiolitis was negatively correlated with Th17,Th17/Treg,and positively correlated with Treg.YKL-40 was the opposite(P<0.05).Breastfeeding and elevated sRAGE were protective factors for recurrent wheezing in children with bronchiolitis after discharge,while a family history of asthma and elevated levels of immunoglobulin E(IgE),Th17/Treg and YKL-40 were risk factors(P<0.05).The area under the curve(AUC)of the combined detection of sRAGE and YKL-40 for predicting recurrent wheezing in children with bronchiolitis after discharge was 0.897(0.846~0.936),which was greater than 0.799(0.736~0.853)and 0.795(0.732~0.849)predicted by sRAGE and YKL-40 alone(Z=3.938,3.839,P<0.001).Conclusion The decrease of sRAGE and the increase of YKL-40 in children with bronchiolitis are associated with Th17/Treg imbalance and recurrent wheezing after discharge,and the combined detection of both has a high predictive va

关 键 词：毛细支气管炎 可溶性晚期糖基化终末产物受体 壳多糖酶3样蛋白1 辅助性T细胞17/调节性T细胞 反复喘息 预测价值 

分 类 号：R725.6[医药卫生—儿科]