肥胖哮喘患儿急性期血清趋化素水平改变及其临床意义研究

Clinical value of serum chemerin in fat children with asthma at acute stage

目的探讨肥胖哮喘患儿血清趋化素(chemerin)水平改变及其临床意义。方法纳入120例哮喘急性发作期的肥胖患儿和90例健康肥胖患儿。分别于患儿入院当天和出院当天检测血清总氧化态(TOS)、总抗氧化态(TAS)、氧化应激指数(OSI)和chemerin水平。结果哮喘组患儿TAS明显低于对照组(2.1±0.5 umo L Trolox Eq/L vs.3.9±0.9 umo L Trolox Eq/L,P<0.05),而TOS(28.1±8.4umo L H2O2Eq/L vs.10.1±5.9 umo L H_2O_2 Eq/L,P<0.05)和OSI(15.5±5.7U vs 3.5±1.0U,P<0.05)明显高于对照组,哮喘组出院时TAS水平轻度升高(P>0.05),而TOS(28.1±8.4 umo L Trolox Eq/L vs.13.6±6.9 umo L Trolox Eq/L,P<0.05)和OSI(15.5±5.7 umo L Trolox Eq/L vs.5.5±1.8 umo L Trolox Eq/L,P<0.05)水平明显下降。在血清chemerin方面,入院时哮喘组明显高于对照组(3.8±0.9mg/L vs.2.4±0.7mg/L,P<0.05),哮喘组出院时chemerin水平明显下降(3.8±0.9 mg/L vs.2.4±0.7mg/L,P<0.05)。危重度亚组患儿入院时和出院时TOS(入院时:28.0±7.1 umo L H2O2Eq/L vs 31.2±9.2 umo L H2O2Eq/L,P<0.05;出院时:10.1±5.2 umo L H2O2Eq/L vs 13.4±4.7 umo L H2O2Eq/L,P<0.05)、OSI(入院时:13.2±5.3U vs 15.2±5.6U,P<0.05;出院时:5.1±1.2U vs 6.4±2.5U,P<0.05)和chemerin(入院时:3.3±0.6mg/L vs 4.2±0.8mg/L,P<0.05;出院时:2.2±0.3mg/L vs 2.7±0.5mg/L,P<0.05)水平均明显高于轻度亚组患儿。入院时chemerin水平诊断哮喘急性发作的AUC为0.818。相关性分析提示chemerin与哮喘急性发作(r=0.678,P<0.05)和严重分级(r=0.621,P<0.05)呈正相关。Logistics回归分析提示OSI(OR=1.11,P<0.05)和chemerin(OR=1.45,P<0.05)是哮喘急性发作发生的独立危险因素。结论新型脂肪因子chemerin通过调控体内氧化应激水平参与到肥胖患儿哮喘急性发作的病理生理学机制,chemerin水平可以作为肥胖患儿哮喘急性发作潜在标记物。

Objective To estimate the clinical value of serum chemerin in fat children with asthma at acute stage. Methods 120 obesity children with asthma at acute stage and 60 healthy fat children were enrolled in this study. The levels of TOS, TAS, OSI and chemerin were measured on the admission day and discharge day. Results The level of TAS in the asthma group was lower than that in the control group （2. 1 ± 0. 5 umol Trolox Eq/L vs. 3.9±0. 9 umol Trolox Eq/L, P 〈 0.05）, while the levels of TOS, OSI and chemerin （ ） in asthma group were higher than those in the control group （TOS： 28.1±8.4 umol H202 Eq/L vs. 10. 1±5.9 umol H202 Eq/L; OSI： 15.5 ±5.7U vs. 3.5±1.0U; Chemerin： 3.8±0.9mg/L vs. 2.4 ±0.7mg/L, P 〈0. 05）. The levels of TOS, OSI and ehemerin in the asthma group on discharge were significantly decreased compared with those on admission day. The contents of TOS, OSI and chemeriu in the critical subgroup on both admission day and discharge day were higher than those in the control group. ROC analysis showed that the AUC of chemerin for asthma diagnosis was 0. 818. Correlation analysis showed that chemerin was positively associated with acute stage of asthma and severity. Logistic regres- sion showed that OSI and chemerin were independent risk factors for acute stage of asthma. Conclusion New fatty factor chemerin may contribute to pathophysiological mechanism of asthma by mediating the levels of oxditive stress, which makes chemerin to be a marker for asthma with acute stage in fat children.