呼吸道合胞病毒感染的毛细支气管炎病儿血清半胱氨酰白三烯、嗜酸性粒细胞阳离子蛋白、免疫球蛋白E及血清炎性因子检测的临床价值

Clinical value of CysLTs,ECP,IgE and serum inflammatory factors in children with RSV-infected bronchiolitis

目的探究呼吸道合胞病毒(RSV)感染的毛细支气管炎病儿血清半胱氨酰白三烯(CysLTs)、嗜酸性粒细胞阳离子蛋白(ECP)、免疫球蛋白E(IgE)及血清炎性因子检测的临床价值。方法选取湖北医药学院附属东风医院2017年1月至2018年1月收治的RSV感染的毛细支气管炎病儿100例作为观察组,并根据病儿病情严重程度分为轻症、中症、重症三组,检测各组血清CysLTs、ECP、IgE、白细胞介素-8(IL-8)及肿瘤坏死因子α(TNF-α)水平,并与同期30例健康体检儿童(健康对照组)血清标本检测结果进行比较,分析各个指标与病儿病情的相关性。另外,记录观察组病儿随访期间哮喘发生情况,比较哮喘发作组与未发作组治疗前血清CysLTs、ECP、IgE、IL-8及TNF-α水平及其与哮喘发生的相关性。结果健康对照组、轻症组、中症组及重症组血清CysLTs[(22.91±15.14)、(48.12±14.22)、(59.31±14.71)、(71.72±15.29)μg/mL]、ECP[(35.96±9.28)、(63.74±10.68)、(74.16±12.11)、(91.82±13.95)ng/mL]、IgE[(107.36±20.57)、(255.71±26.49)、(282.92±26.86)、(310.03±27.08)IU/mL]、IL-8[(14.35±5.26)、(31.74±7.19)、(40.41±7.48)、(52.48±8.37)pg/mL]及TNF-α[(49.21±19.64)、(107.35±25.93)、(122.47±24.58)、(139.14±26.51)pg/mL]差异有统计学意义(F=45.63、79.64、296.87、102.89、62.03,均P<0.001),且组间两两比较差异有统计学意义(均P<0.05)。Spearman相关性分析显示:CysLTs、ECP、IgE、IL-8及TNF-α水平与病儿病情严重程度均呈显著正相关(r=0.70、0.78、0.81、0.820、0.70,均P<0.001)。哮喘发作组病儿CysLTs[(53.12±13.94)μg/mL比(32.14±10.25)μg/mL]、ECP[(69.27±10.57)μg/mL比(37.18±7.22)μg/mL]、IgE[(264.63±18.66)IU/mL比(116.45±18.28)IU/mL]、IL-8[(35.73±6.48)pg/mL比(14.68±4.63)pg/mL]及TNF-α[(111.26±24.19)pg/mL比(56.74±15.47)pg/mL]水平均明显高于哮喘未发作组(均P<0.05),且与病儿哮喘发作均呈显著正相关(r=0.45、0.51、0.50、0.52、0.51,均P<0.001)。结论血清CysLTs、ECP、IgE及血清炎性因子水平可有效反映RSV感染的毛细支气管炎病儿的病情严重程度,并能有效评估病儿继发性哮喘的发生风险,具有重要临床意义。

Objective To explore the clinical value of detecting serum cysteyl leukotrienes(CysLTs),eosinophil cationic protein(ECP),immunoglobulin E(IgE)and serum inflammatory factors in children with bronchiolitis infected by respiratory syncytial virus(RSV).Methods One hundred children with RSV-infected bronchiolitis who were treated in Dongfeng Hospital of Hubei Medical Uni⁃versity from January 2017 to January 2018 were selected as the observation group,and they were assigned into three groups:mild,mod⁃erate and severe according to the severity of the disease.Detection of CysLTs,ECP,IgE,interleukin-8(IL-8)and tumor necrosis factorα(TNF-α)levels in the observation and control groups were compared with serum-related indicators of 30 healthy children(control group)during the same period,and the correlation between the indicators and the condition of the children was analyzed.In addition,the incidence of asthma during the follow-up period in the observation group was recorded,and the serum levels of CysLTs,ECP,IgE,IL-8 and TNF-αbefore treatment were compared between the asthmatic attack group and the non-attack group and their correlation with asthma.Results There were significant differences in serum CysLTs[(22.91±15.14),(48.12±14.22),(59.31±14.71),(71.72±15.29)μg/mL],ECP[(35.96±9.28),(63.74±10.68),(74.16±12.11),(91.82±13.95)ng/mL],IgE[(107.36±20.57),(255.71±26.49),(282.92±26.86),(310.03±27.08)IU/mL],IL-8[(14.35±5.26),(31.74±7.19),(40.41±7.48),(52.48±8.37)pg/mL]and TNF-αlevels[(49.21±19.64),(107.35±25.93),(122.47±24.58),(139.14±26.51)pg/mL]in children with mild,moderate,severe and control groups(F=45.63,79.64,296.87,102.89,62.03,all P<0.001),and the difference between two groups was statistically significant(all P<0.05).Spearman correlation analysis showed that CysLTs,ECP,IgE,IL-8 and TNF-αlevels were significantly positively correlated with the severity of the disease(r=0.70,0.78,0.81,0.82,0.70,all P<0.001).The levels of CysLTs[(53.12±13.94)μg/mL vs.(32.14±10.25)μg/mL],ECP[(69.27±10.57)μg/mL vs.(37.18±7.22)μg/mL],IgE[(264.63±18.66)IU/mL vs.(116.45±18.28)IU/mL],IL-8[(35.73±6.48)pg/mL vs.(14.68±4.63)pg/mL]and TNF-α[(111.26±24.19)pg/mL vs.(56.74±15.47)pg/mL]in the asthma attack group were signifi⁃cantly higher than those in the asthma attack group(all P<0.05),and were significantly positively correlated with the asthma attack in the children(r=0.45,0.51,0.50,0.52,0.51,all P<0.001).Conclusion Serum CysLTs,ECP,IgE,and serum inflammatory factor levels can effectively reflect the severity of RSV-infected children with bronchiolitis and evaluate the risk of secondary asthma in children,which has important clinical significance.