支气管舒张试验联合T淋巴细胞亚群检测对小儿哮喘的诊断价值

Diagnostic value of bronchodilation test combined with detection of T lymphocyte subsets in children with asthma

目的分析支气管舒张试验(BDT)联合T淋巴细胞亚群检测对小儿哮喘的诊断价值。方法选取2020年2月—2021年2月湖南省儿童医院呼吸内科诊治的哮喘患儿73例为观察组,同期医院体检健康儿童70例为健康对照组,检测并比较2组支气管舒张试验后肺功能指标、T淋巴细胞亚群水平,分析哮喘患儿BDT改善率与T淋巴细胞亚群水平的关系,受试者工作特征曲线(ROC)评估支气管舒张试验联合T淋巴细胞亚群检测对小儿哮喘的诊断价值。结果与健康对照组比较,观察组用力呼出25%肺活量瞬间流量(FEF_(25))、FEF_(50)、FEF_(75)、最大呼气流量(PEF)、FEV_(1)、FEV_(1)/FVC值及血清CD8^(+)、CD16^(+)CD56^(+)NK水平降低(P<0.05),CD4^(+)、CD4^(+)/CD8^(+)水平升高(P<0.05);与观察组缓解期比较,急性期FEF_(25)、PEF、FEV_(1)、FEV_(1)/FVC值及血清CD8^(+)、CD16^(+)CD56^(+)NK水平降低(P<0.05),CD4^(+)、CD4^(+)/CD8^(+)水平升高(P<0.05)。急性期患儿支气管试验FEF_(25)、PEF、FEV_(1)、FEV_(1)/FVC阳性率高于缓解期(χ^(2)/P=16.385/0.001、17.648/0.001、20.367/0.001、16.529/0.01);哮喘患儿BDT改善率与血清CD8^(+)、CD16^(+)CD56^(+)NK细胞水平呈正相关(P<0.05),与血清CD4^(+)、CD4^(+)/CD8^(+)细胞水平呈负相关(P<0.05)。哮喘患儿血清CD8^(+)、CD16^(+)CD56^(+)NK、BDT改善率与病情严重程度呈负相关(r/P=-0.592/0.001、-0.634/0.001、-0.742/0.001),血清CD4^(+)、CD4^(+)/CD8^(+)细胞水平与病情严重程度呈正相关(r/P=0.617/0.001、0.611/0.001)。ROC曲线显示,BDT联合T淋巴细胞亚群检测对小儿哮喘诊断的曲线下面积(AUC)为0.966。结论支气管舒张试验、T淋巴细胞亚群联合检测,可对哮喘患儿病情严重程度作出更加准确评估,为临床疾病诊断提供有效依据,具有良好的诊断价值。

Objective To analyze the diagnostic value of bronchodilation test(BDT)combined with T lymphocyte subset detection in children with asthma.Methods From February 2020 to February 2021,73 children with asthma diagnosed and treated in the Respiratory Department of Hunan Children's Hospital were selected as the observation group,and 70 healthy children with physical examination in the hospital during the same period were selected as the healthy control group.The lungs after the bronchodilation test in the two groups were detected and compared.Functional indicators,T lymphocyte subpopulation levels,analysis of the relationship between BDT improvement rate and T lymphocyte subpopulation levels in children with asthma,receiver operating characteristic curve(ROC)assessment of bronchodilation test combined with T lymphocyte subpopulation detection for children with asthma The diagnostic value.Results Compared with the healthy control group,the observation group's forced expiratory 25%vital capacity instant flow(FEF_(25)),FEF_(50),FEF_(75),maximum expiratory flow(PEF),FEV_(1),FEV_(1)/FVC values and serum CD8^(+),CD16^(+)CD56^(+)NK levels decreased(P<0.05),the level of CD4^(+),CD4^(+)/CD8^(+)increased(P<0.05).Compared with the remission period,the FEF_(25),PEF,FEV_(1),FEV_(1)/FVC and serum CD8^(+),CD16^(+)CD56^(+)NK levels of the observation group decreased in the acute phase(P<0.05),and the CD4^(+),CD4^(+)/CD8^(+)levels increased(P<0.05).The positive rates of FEF_(25),PEF,FEV_(1),FEV_(1)/FVC in children in the acute phase were higher than those in the remission phase(χ^(2)/P=16.385/0.001,17.648/0.001,20.367/0.001,16.529/0.01).The improvement rate of BDT in children with asthma was positively correlated with serum CD8^(+),CD16^(+)CD56^(+)NK cell levels(P<0.05),and negatively correlated with serum CD4^(+),CD4^(+)/CD8^(+)cell levels(P<0.05).The improvement rate of serum CD8^(+),CD16^(+)CD56^(+)NK,BDT in children with asthma was negatively correlated with the severity of the disease(r/P=-0.592/0.001,-0.634/0.001,-0.742/0.001),and serum CD4^(+),CD4^(+)/CD8^(+)cells The level was positively correlated with the severity of the disease(r/P=0.617/0.001,0.611/0.001).The ROC curve showed that the area under the curve(AUC)of BDT combined with T lymphocyte subgroup detection for the diagnosis of asthma in children was 0.966.Conclusion The combined detection of bronchodilation test and T lymphocyte subsets can make a more accurate assessment of the severity of the disease in children with asthma,provide an effective basis for the diagnosis of clinical diseases,and have good diagnostic value.