TIMP-1和IL-33水平与儿童RSV感染毛细支气管炎病情严重程度及预后的关系

Relationship between TIMP-1,IL-33 levels and disease severity,prognosis of children with RSV infection and bronchiolitis

目的探讨基质金属蛋白酶抑制因子-1(TIMP-1)、白细胞介素-33(IL-33)水平与儿童呼吸道合胞病毒(RSV)感染毛细支气管炎病情严重程度及预后的关系。方法选取2016年3月-2021年7月在江油市九〇三医院住院的462例RSV感染毛细支气管炎患儿为疾病组,另选取同期健康体检儿童133例为对照组。测定两组受试者TIMP-1、IL-33水平;绘制TIMP-1、IL-33单独及联合诊断毛细支气管炎的受试者工作特征(ROC)曲线;根据病情严重程度将毛细支气管炎患儿分为轻度组(n=128)、中度组(n=181)、重度组(n=153),比较不同病情严重程度毛细支气管炎患儿TIMP-1、IL-33水平,并分析其相关性;根据毛细支气管炎患儿治疗1周的疗效,将其分为显效组(n=289)、有效组(n=138)和无效组(n=35),比较不同预后组TIMP-1、IL-33水平。结果疾病组TIMP-1、IL-33水平高于对照组,差异有统计学意义(t=21.259、101.918,P<0.05)。ROC曲线显示,TIMP-1、IL-33单独诊断毛细支气管炎的曲下线面积(AUC)为0.816、0.851,截点值分别为124.40 ng/mL、313.45 pg/mL;两者联合诊断毛细支气管炎的AUC为0.919,高于单独诊断,差异有统计学意义(P<0.05)。中度组和重度组TIMP-1、IL-33水平高于轻度组,且重度组高于中度组,差异均有统计学意义(P均<0.05);TIMP-1、IL-33水平均与毛细支气管炎病情严重程度成正相关(r=0.742、0.815,P<0.05)。显效组和有效组TIMP-1、IL-33水平低于无效组,且显效组低于有效组,差异均有统计学意义(P均<0.05)。结论TIMP-1、IL-33水平与毛细支气管炎疾病的发生和进展有关,具有一定的诊断效能,且两者联合诊断价值更高;其对于毛细支气管炎患儿的预后评估具有重要意义。

Objective To explore the relationship between tissue inhibitor of metalloproteinase-1(TIMP-1),interleukin-33(IL-33)levels and disease severity,prognosis of children with respiratory syncytial virus(RSV)infection and bronchiolitis.Methods A total of 462 children with RSV infection and bronchiolitis admitted to the hospital were enrolled as disease group between March 2016 and July 2021 in Jiangyou 903th Hospital,while other 133 healthy children during the same period were enrolled as control group.The levels of TIMP-1 and IL-33 in both groups were detected.Receiver operating characteristic(ROC)curves of TIMP-1,IL-33 and their combination in the diagnosis of bronchiolitis were drawn.According to disease severity,bronchiolitis children were divided into mild group(n=128),moderate group(n=181)and severe group(n=153).The levels of TIMP-1 and IL-33 in bronchiolitis children with different severity were compared,and their correlation was analyzed.According to curative effect after 1 week of treatment,children with bronchiolitis were divided into markedly effective group(n=289),effective group(n=138)and ineffective group(n=35),and levels of TIMP-1 and IL-33in different groups were compared.Results The levels of TIMP-1 and IL-33 in disease group were higher than those in control group(t=21.259,101.918,P<0.05).ROC curves analysis showed that area under the curve(AUC)and cut-off values of TIMP-1 and IL-33 alone in the diagnosis of bronchiolitis were 0.816,0.851 and 124.40 ng/mL,313.45 pg/mL,respectively.AUC of combined detection was 0.919,greater than that of single index(P<0.05).The levels of TIMP-1 and IL-33 in moderate and severe groups were higher than those in mild group,which were higher in severe group than moderate group(P all<0.05).The levels of TIMP-1 and IL-33 were positively correlated with the severity of bronchiolitis(r=0.742,0.815,P<0.05).The levels of TIMP-1 and IL-33 in markedly effective group and effective group were lower than those in ineffective group,which were lower in markedly effective group than effective group(P<0.05).Conclusions The levels of TIMP-1 and IL-33 were related to the occurrence and progression of bronchiolitis.The diagnostic value of the combination of TIMP-1 and IL-33 was higher than that of single index.The two indexes were of great significance for prognosis evaluation of bronchiolitis children.