T细胞因子、血细胞炎症指标在合并艰难梭菌感染的炎症性肠病患儿中的表达及评估不良预后的价值  

Analysis of T cell cytokines and inflammatory blood cell indices in children with inflammatory bowel disease complicated by clostridium difficile infection:their expression and prognostic value

作　　者：张桂珍 宋云净 高凯杰 杨俊梅[1] 高健[1] 徐璐[1] 周莹[1] 甄明慧 方盼盼[1] 周娟娟 张冬雨 ZHANG Gui-zhen;SONG Yun-jing;GAO Kai-jie;YANG Jun-mei;GAO Jian;XU Lu;ZHOU Ying;ZHEN Ming-hui;FANG Pan-pan;ZHOU Juan-juan;ZHANG Dong-yu(Department of Laboratory Medicine,Zhengzhou University Affiliated Children′s Hospital,Zhengzhou Key Laboratory of Children′s Infection and Immunology,Zhengzhou 450018,Henan,China)

机构地区：[1]郑州大学附属儿童医院检验科、郑州市儿童感染与免疫重点实验室,河南郑州450018

出　　处：《广东医学》2024年第10期1312-1318,共7页Guangdong Medical Journal

基　　金：河南省重点研发与推广专项(科技攻关)(222102310328);河南省医学科技攻关联合共建项目(LHGJ20210673)。

摘　　要：目的探讨T细胞因子、血细胞炎症指标在合并艰难梭菌感染的炎症性肠病患儿中表达水平及对不良预后的评估价值。方法以2021年9月至2024年1月的118例合并艰难梭菌感染的炎症性肠病患儿作为研究对象,根据患儿临床应答情况划分为预后良好组(n=87)和不良预后组(n=31)。收集并对比两组患儿治疗前一般临床资料、T细胞因子[白细胞介素(IL)-6、IL-8、IL-10、IL-17、肿瘤坏死因子-α(TNF-α)]、血细胞炎症指标[中性粒细胞/淋巴细胞比值(NLR)、血小板/淋巴细胞比值(PLR)、淋巴细胞/单核细胞比值(LMR)、全身免疫炎症指标(SII)]的表达水平差异。通过Spearman相关性分析及多因素logistic回归分析筛选出合并艰难梭菌感染的炎症性肠病患儿不良预后的危险因素,并通过受试者工作特征(ROC)曲线评估各危险因素独立、联合预测患儿预后的价值。结果不良预后组患儿中应用活菌制剂比例显著低于预后良好组(P<0.05)。不良预后组患儿平均IL-6、TNF-α水平均显著高于预后良好组患儿,平均IL-10、IL-17水平均显著低于预后良好组患儿(P<0.05)。不良预后组患儿平均NLR、PLR、SII均显著高于预后良好组患儿,平均LMR显著低于预后良好组患儿(P<0.05)。Spearman相关性分析表明合并艰难梭菌感染的炎症性肠病患儿IL-6、TNF-α、NLR、PLR、SII水平均与不良预后呈显著正相关性(r=0.420、0.334、0.666、0.466、0.688,P<0.001),应用活菌制剂、IL-10、IL-17、LMR水平均与不良预后呈显著负相关性(r=-0.206、-0.345、-0.416、-0.470,P<0.001)。多因素logistic回归分析结果表明合并艰难梭菌感染的炎症性肠病患儿IL-6、TNF-α、NLR、SII水平较高,IL-10、IL-17水平较低均是不良预后的重要危险因素,独立及联合预测患儿不良预后的效能均较高(AUC=0.776、0.727、0.773、0.719、0.841、0.895、0.957)。结论合并艰难梭菌感染的炎症性肠病患儿促炎性T细胞因子�Objective To explore the expression levels of T cell cytokines and inflammatory blood cell indices in children with inflammatory bowel disease(IBD)complicated by Clostridium difficile infection(CDI)and their prognostic assessment value.Methods This study included 118 children with CDI and IBD treated at our hospital from September 2021 to January 2024.Based on clinical responses,patients were divided into a good prognosis group(n=87)and a poor prognosis group(n=31).Pre-treatment clinical data,levels of T cell cytokines[interleukin(IL)-6,IL-8,IL-10,IL-17,tumor necrosis factor-α(TNF-α)],and inflammatory blood cell indices[neutrophil-to-lymphocyte ratio(NLR),platelet-to-lymphocyte ratio(PLR),(lymphocyte-to-monoeyte ratio(LMR),systemic immune-inflammation ondex(SII)]were collected and compared between the groups.Spearman correlation and multivariate logistic regression analyses identified risk factors for poor prognosis,and ROC curves evaluated the predictive value of these factors.Results The proportion of children using probiotics in the poor prognosis group was significantly lower than that in the good prognosis group(P<0.05).The average levels of IL-6 and TNF-αwere significantly higher,while IL-10 and IL-17 were significantly lower in the poor prognosis group(P<0.05).NLR,PLR,and SII were significantly higher,and LMR was significantly lower in the poor prognosis group(P<0.05).Spearman correlation showed significant positive correlations between IL-6,TNF-α,NLR,PLR,SII and poor prognosis(r=0.420,0.334,0.666,0.466,0.688,P<0.001),while probiotics,IL-10,IL-17,and LMR were negatively correlated(r=-0.206,-0.345,-0.416,-0.470,P<0.001).Multivariate logistic regression indicated that high levels of IL-6,TNF-α,NLR,SII and low levels of IL-10,IL-17 were significant risk factors for poor prognosis,with high predictive efficiency(AUC=0.776,0.727,0.773,0.719,0.841,0.895,0.957).Conclusion Elevated pro-inflammatory T cell cytokines and inflammatory blood cell indices,along with reduced anti-inflammatory T cell cytokines,are c

关 键 词：艰难梭菌感染 炎症性肠病 T细胞因子 血细胞炎症指标 预后 

分 类 号：R574[医药卫生—消化系统] R394.2[医药卫生—内科学]