急性发作期哮喘患儿血清MMP-9、MCP-1和TGF-β1水平变化及其临床意义

Changes and clinical significance of serum MMP-9,MCP-1 and TGF-β1 levels in children with acute asthma attack

目的探讨急性发作期哮喘患儿血清基质金属蛋白酶9(MMP-9)、单核细胞趋化蛋白1(MCP-1)、转化生长因子β1(TGF-β1)水平变化及其临床意义。方法选择急性发作期哮喘患儿60例(发作期组),其中病情轻度20例、中度18例、重度22例,缓解期哮喘患儿73例(缓解期组),接受保健检查的健康儿童40例(对照组),入组当日采集清晨空腹肘静脉血,采用双抗体夹心ELISA法检测血清MMP-9、MCP-1、TGF-β1。比较三组血清MMP-9、MCP-1、TGF-β1水平,分析血清MMP-9、MCP-1、TGF-β1水平与急性发作期哮喘患儿病情程度的关系。采用受试者工作特征(ROC)曲线评估血清MMP-9、MCP-1、TGF-β1水平对哮喘急性发作的预测价值。结果发作期组血清MMP-9、MCP-1、TGF-β1水平均高于缓解期组和对照组,且缓解期组血清MMP-9、MCP-1、TGF-β1水平均高于对照组(P均<0.05)。轻度、中度、重度急性发作期哮喘患儿血清MMP-9、MCP-1、TGF-β1水平逐渐升高,两两比较P均<0.05。血清MMP-9、MCP-1、TGF-β1水平与急性发作期哮喘患儿病情程度均呈正相关关系(P均<0.05)。ROC曲线分析显示,血清MMP-9、MCP-1、TGF-β1水平预测哮喘急性发作的曲线下面积(AUC)分别为0.884、0.858、0.809,最佳截断值分别为142.64 ng/L、42.21μg/L、47.74 ng/L,此时其诊断哮喘急性发作的敏感性分别为90%、88%、83%,特异性分别为92%、91%、84%。血清MMP-9、MCP-1、TGF-β1水平联合预测哮喘急性发作的AUC为0.931,其诊断哮喘急性发作的敏感性为93%、特异性为82%。结论急性发作期哮喘患儿血清MMP-9、MCP-1、TGF-β1水平明显升高,其水平变化与病情程度有关;血清MMP-9、MCP-1、TGF-β1可作为预测哮喘急性发作的重要生化指标。

Objective To investigate the changes and clinical significance of serum matrix metalloproteinase 9(MMP-9),monocyte chemoattractant protein-1(MCP-1)and transforming growth factor-β1(TGF-β1)levels in children with acute asthma attack.Methods Sixty cases of children with acute asthma attack(attack group,including 20 mild cases,18 moderate cases,and 22 severe cases),73 cases of children with asthma in remission(remission group),and 40 cases of healthy children receiving health examination(control group)were selected.Fasting elbow venous blood was collected in the morning on the inclusion day,and serum MMP-9,MCP-1 and TGF-β1 were detected by double-antibody sandwich ELISA.The serum levels of MMP-9,MCP-1 and TGF-β1 in the three groups were compared,and the relationships between the serum levels of MMP-9,MCP-1 and TGF-β1 and the severity of the disease in children with acute asthma were analyzed.The predictive value of serum MMP-9,MCP-1,TGF-β1 for acute asthma attack was assessed by using the receiver operating characteristic(ROC)curve.Results The serum levels of MMP-9,MCP-1,and TGF-β1 in the attack group were higher than those in the remission group and the control group,and the serum levels of MMP-9,MCP-1 and TGF-β1 in the remission group were higher than those in the control group(all P<0.05).The serum levels of MMP-9,MCP-1 and TGF-β1 in children with acute attack of mild,moderate and severe asthma increased gradually(all P<0.05).The serum levels of MMP-9,MCP-1 and TGF-β1 were positively correlated with the severity of acute asthma attack(rs=0.701,0.546,0.612,respectively,all P<0.05).ROC curve analysis showed that the area under the curve(AUC)of serum MMP-9,MCP-1 and TGF-β1 in predicting acute asthma attack was 0.884,0.858 and 0.809,respectively,and the optimal cut-off values were 142.64 ng/L,42.21μg/L and 47.74 ng/L,respectively.The sensitivities of MMP-9,MCP-1 and TGF-β1 in predicting acute asthma attack were 90%,88%and 83%,respectively,and specificities were 92%,91%and 84%,respectively.The AUC of serum TGF-β1,MMP-9 and MCP-1 combined in predicting the acute asthma attack was 0.931,with the sensitivity of 93%and specificity of 82%.Conclusion The serum levels of MMP-9,MCP-1,and TGF-β1 in children with acute asthma attack increse significantly,and the changes are related to the severity of the disease;the serum levels of MMP-9,MCP-1 and TGF-β1 can be used as important biochemical indexes to predict the acute asthma attack.