毛细支气管炎患儿血清TNF-α、VEGF、CK-MB及血浆D-二聚体水平的变化及临床意义

Changes and Significance of Serum TNF-α,VEGF and CK-MB Combined with Plasma D-dimer Levels in Children with Bronchiolitis

目的探究检测毛细支气管炎患儿血清肿瘤坏死因子-α(TNF-α)、血管内皮生长因子(VEGF)、血清肌酸激酶同工酶(CK-MB)、血浆D-二聚体水平变化与毛细支气管炎的关系及临床意义。方法 2015年10月至2016年10月于该院治疗的80例毛细支气管炎患儿及30例体检健康婴幼儿作为研究对象,80例毛细支气管炎患儿根据病情严重程度分为重症组(44例)与轻症组(36例),30例体检健康婴幼儿设为对照组。两组患儿均给予抗感染、化痰、平喘等常规治疗。分别于治疗前、治疗6d后采用酶联免疫吸附试验(ELISA)检测血清TNF-α、VEGF,乳胶增强免疫比浊法检测血浆D-二聚体水平,全自动生化分析仪检测CK-MB水平。结果治疗前,轻症组和重症组患者血清TNF-α、VEGF、CK-MB、D-二聚体表达水平均显著高于对照组,差异有统计学意义(P<0.05),Spearman等级相关性分析显示,血清TNF-α、VEGF、CK-MB、D-二聚体表达水平与毛细支气管炎密切相关,VEGF与毛细支气管炎的相关性最大(r=0.882,P=0.000),CK-MB、D-二聚体、TNF-α表达水平与毛细支气管炎的相关性分别为:r=0.844、0.798、0.678,P<0.001。治疗6d后,重症组和轻症组患儿血清TNF-α、VEGF、CK-MB、D-二聚体表达水平均显著低于治疗前(P<0.05)。其中重症组36例患儿病情缓解,各指标均显著低于治疗前(P<0.05),仅有8例患儿病情未缓解,上述各指标仍呈高表达状态,TNF-α、VEGF、CK-MB、D-二聚体表达水平均显著低于治疗前(P<0.05);轻症组所有患儿症状均得到缓解。治疗6d后,重症组TNF-α、VEGF、CK-MB、D-二聚体表达水平仍显著高于对照组(P<0.05)。结论患儿血清TNF-α、VEGF、CK-MB、血浆D-二聚体表达水平与毛细支气管炎的发生发展密切相关,病情严重时上述指标均呈高表达状态,病情缓解时上述指标表达水平下降,其水平的动态监测可用于毛细支气管炎病情严重程度及预后评价,具有一定的临床意义。

Objective To investigate the changes and clinical significance of serum tumor necrosis factor-α(TNF-α),vascular endothelial growth factor(VEGF)and serum creatine kinase muscle/brain(CK-MB)combined with plasma D-dimer in children with bronchiolitis.Methods 80 bronchiolitis children treated in the hospital from October 2015 to October 2016 and 30 healthy infants(control group)were selected.According to the severity of the disease,80 children with bronchiolitis were divided into severe group(44 cases)and mild group(36 cases).All children received the anti-infection,expectorant,antiasthmatic and other conventional treatment.The levels of following indicators before treatment and post-treatment 6 days were measured respectively,including serum TNF-αand VEGF(ELISA),plasma D-dimer(latex-enhanced assay),and CK-MB(automatic biochemical analyzer).Results Before treatment,the serum levels of TNF-α,VEGF,CK-MB and plasma D-dimer in severe group and mild group were significantly higher than those in control group,the difference was statistically significant(P<0.05);Spearman rank correlation analysis showed that serum TNF-α,VEGF,CK-MB,D-dimer levels were closely related to bronchiolitis,and VEGF had the highest relevance(r=0.882,P=0.000);The correlation values of the CK-MB,D-dimer and TNF-αwere 0.844,0.798,and 0.678,respectively(P<0.001);The serum levels of TNF-α,VEGF,CK-MB and plasma D-dimer at the post-treatment 6 days of severe group and mild group were significantly decreased(P<0.05);In the severe group,36 patients had relieved along with the decrease of each indicators(P<0.05),and for the 8 cases without remission,the levels of those indicators were lower than those before treatment(P<0.05),but still been highly expressed.In the mild group,all children were relieved.At the post-treatment 6 days,the serum levels of TNF-α,VEGF,CK-MB and plasma D-dimer in the severe group were still significantly higher than those in the control group(P<0.05).Conclusion The changes of serum TNF-α,VEGF,CK-MB and plasma D-dimer levels are closely related to the occurrence and development of bronchiolitis,and the study has showed that the expression levels are positively correlated with the disease severity,so the dynamic monitoring of level changes can be used to assess the severity and prognosis of bronchiolitis.