血清嗜酸粒细胞来源神经毒素与阳离子蛋白对儿童早期喘息性疾病再发喘息的预测价值

Predictive Value of Serum Eosinophil-Derived Neurotoxin and Eosinophil Cationic Protein in Early Childhood Asthmatic Disease

目的探究血清嗜酸粒细胞来源神经毒素(EDN)和血清嗜酸粒细胞阳离子蛋白(ECP)对婴幼儿早期喘息再发喘息的预测价值。方法收集2016年7月至2017年3月上海交通大学医学院附属上海儿童医学中心呼吸内科住院的60例喘息患儿,分别测定血清EDN、ECP、免疫球蛋白E(Ig E)、嗜酸粒细胞(EOS)计数,随访观察1年,根据出院1年后患儿是否再发喘息分为复发喘息组(32例)和非复发喘息组(28例)。比较两组血清EDN、ECP、Ig E、EOS计数及预测再发喘息的曲线下面积。结果复发喘息组血清EDN、ECP、Ig E水平高于非复发喘息组[(30. 93±14. 94)μg/L比(23. 44±11. 51)μg/L,18. 43(13. 73,34. 52)μg/L比14. 1(8. 00,20. 92)μg/L,37. 25(20. 00,124. 20) k U/L比8. 71(4. 63,26. 35) k U/L](P <0. 05),两组血清EOS计数比较差异无统计学意义(P>0. 05)。EDN预测喘息患儿是否再发喘息的ROC曲线下面积为0. 643,EDN最佳诊断界值为28. 32μg/L,灵敏度为56. 2%,特异度为71. 4%。ECP预测喘息患儿是否再发喘息的ROC曲线下面积为0. 656,ECP最佳诊断值为23. 41,灵敏度为43. 7%,特异度为89. 3%。Ig E预测喘息患儿是否再发喘息的ROC曲线下面积为0. 767,Ig E最佳诊断值为19 k U/L,灵敏度为78. 1%,特异度为71. 4%。EDN、ECP、Ig E两两之间ROC曲线下面积比较差异均无统计学意义(P> 0. 05)。结论早期喘息患儿血清EDN、ECP和Ig E水平对再发喘息有一定预测价值,监测喘息患儿血清EDN、ECP和Ig E水平可为有哮喘倾向的患儿提供早期诊断及早期干预的依据。

Objective To discuss the predictive value of serum eosinophil-derived neurotoxin(EDN)and serum eosinophil cationic protein(ECP)in infant wheezing disease.Methods 60 children with wheezing in pediatric inpatients admitted to the Shanghai Children′s Medical Center,Shanghai Jiaotong University School of Medicine from Jul.2016 to Mar.2017.The EDN,ECP,immunoglobulin E(IgE)and eosinophil(EOS)of all the patients were detected.All enrolled children were followed up for a year,and classified as a recurrent wheezing group(32 cases)and a non-recurrent wheezing group(28 cases).The four indexes and the area of under receiver operating characteristic(ROC)curve between the recurrent wheezing group and non-recurrent wheezing group were compared.Results Serum EDN,ECP,and IgE levels in the recurrent wheezing group were higher than those in the non-recurrent wheezing group[(30.93±14.94)μg/L vs(23.44±11.51)μg/L,18.43(13.73,34.52)μg/L vs 14.11(8.00,20.92)μg/L,37.25(20.00,124.20)kU/L vs 8.71(4.63,26.35)kU/L](P<0.05),while there was no statistically significant difference in serum EOS between the two groups(P>0.05).The area under the ROC curve used by EDN to predict the recurrence was 0.643,the best diagnostic threshold for EDN was 28.32μg/L,with a sensitivity of 56.2%,and a specificity of 71.4%.The area under the ROC curve used by ECP to predict the recurrence was 0.656,the best diagnostic value of ECP was 23.41,with a sensitivity of 43.7%,and a specificity of 89.3%.The area under the ROC curve of IgE to predict the recurrence was 0.767,the best diagnostic value of IgE was 19 kU/L,with a sensitivity of 78.1%,and a specificity of 71.4%.There was no statistically significant difference in the area under the ROC curve between EDN,ECP,and IgE(P>0.05).Conclusion Level of serum EDN,ECP and IgE of early wheezing infants have certain predictive values for recurrence and can provide references for the early diagnosis and early intervention for asthmatic children.