呼出气一氧化氮与Th17/Treg相关炎症因子水平对支气管哮喘急性发作患者再次发作的预测  

Level of fractional exhaled nitric oxide and Th17/Treg-related inflammatory factors and prediction of recurrence in patients with exacerbation of asthma

作　　者：杨晓雷 郑孝光 王强 孔娜娜 YANG Xiao-lei;ZHENG Xiao-guang;WANG Qiang;KONG Na-na(Department of Emergency Medicine,906th Hospital of PLA Joint Logistic Support Force,Ningbo,Zhejiang 315000,China)

机构地区：[1]解放军联勤保障部队第九〇六医院急诊医学科,浙江宁波315000

出　　处：《环境与健康杂志》2025年第2期117-125,共9页Journal of Environment and Health

摘　　要：目的探讨呼出气一氧化氮(FeNO)与Th17/Treg相关炎症因子水平对支气管哮喘急性发作患者再次发作的预测价值。方法选择2018年6月至2022年6月于解放军联勤保障部队第九〇六医院就诊的支气管哮喘急性发作患者120例为研究对象,根据治疗后1年内是否再次发作分为未复发组(n=78)和复发组(n=42)。比较两组临床资料、肺功能指标、FeNO水平、Th17/Treg及相关炎症因子水平。采用多元线性回归分析Th17/Treg相关炎症因子与FeNO水平的关系。分别在纳入或不纳入FeNO和Th17/Treg相关炎症因子的情况下,采用多因素logistic回归分析再次发作危险因素,基于此构建再次发作的预测模型。比较不同模型的受试者工作特征曲线的曲线下面积(AUC-ROC)、综合判别改善指数(IDI)和净重新分类指数(NRI)。采用Hosmer-Lemeshow检验比较不同模型的拟合优度。采用限制性立方样条法分析FeNO和Th17/Treg相关炎症因子与再次发作的剂量反应关系。采用非条件logistic回归模型分析FeNO和Th17/Treg相关炎症因子对再次发作的相乘交互作用,交互作用计算表分析其相加交互作用。结果与未复发组比较,复发组发病年龄、哮喘控制测试(ACT)评分、一秒用力呼气容积(FEV1)、FEV1/用力肺活量(FVC)、白细胞介素(IL)-10、转化生长因子(TGF)-β明显降低,差异有统计学意义(P<0.05);年龄、病程、哮喘家族史、过敏性鼻炎、嗜酸性粒细胞(EOS)、中性粒细胞(NEUT)、FeNO、Th17、Th17/Treg、IL-17明显增加,差异有统计学意义(P<0.05)。多元线性回归分析结果显示,随着IL-17增加(β>0),IL-10、TGF-β降低(β<0),FeNO水平升高的风险均明显增加,差异有统计学意义(P<0.05)。不含FeNO和Th17/Treg相关炎症因子的多因素logistic回归分析结果显示,病程、过敏性鼻炎、EOS、NEUT、FEV1/FVC、Th17/Treg是再次发作的独立影响因素,据此构建预测模型1;加入FeNO和Th17/Treg相关炎症因子后,Objective To explore the predictive value of exhaled nitric oxide and Th17/Treg-related inflammatory factors in patients with acute asthma attack.Methods 120 patients with acute attack of bronchial asthma in our hospital from June 2018 to June 2022 were chosen as the study objects,and were divided into non-recurrence group(n=78)and recurrence group(n=42)according to whether the attack occurred again within 1 year after treatment.The clinical data,pulmonary function indexes,fractional exhaled nitric oxide(FeNO)levels,Th17/Treg levels and related inflammatory factors were compared between the two groups.The relationship between Th17/Treg-related inflammatory factors and FeNO levels was analyzed by multiple linear regression.When FeNO and Th17/Treg-related inflammatory factors were included or not included,multivariate Logistic regression was used to analyze the risk factors for recurrence,based on which a prediction model for recurrence was constructed.The area under the curve of receiver operating characteristic curves(AOC-ROC),integrated discrimination improvement(IDI)and net reclassification improvement(NRI)of different models were compared.Hosmer-Lemeshow test was used to compare the goodness of fit of different models.The dose-response relationship between FeNO and Th17/Treg-related inflammatory factors and recurrence was analyzed by restricted cubic spline method.The multiplicative interactions of FeNO and Th17/Treg-related inflammatory factors on recurrence were analyzed with an unconditioned Logistic regression model,and their additive interactions were analyzed with a table of interaction calculations.Results The age of onset,asthma control test(ACT)score,forced expiratory volume in one second(FEV1),FEV1/forced vital capacity(FVC),interleukin(IL)-10 and transforming growth factor(TGF)-βsignificantly decreased(P<0.05),age,disease course,family history of asthma,allergic rhinitis,eosinophils(EOS),neutrophils(NEUT),FeNO,Th17,Th17/Treg and IL-17 significantly increased(P<0.05)in the relapsed group compared wi

关 键 词：呼出气一氧化氮 TH17/TREG 炎症因子 支气管哮喘 急性发作 再次发作 预测 

分 类 号：R994.6[医药卫生—毒理学]