血清25羟维生素D、免疫球蛋白水平与小儿支气管肺炎严重程度及转归的关系研究

Relationship between serum 25-hydroxyvitamin D,immunoglobulins and disease severity,outcomes in children with bronchial pneumonia

目的探讨血清25羟维生素D[25-(OH)D_(3)]、免疫球蛋白(Ig)水平与小儿支气管肺炎严重程度及转归的关系。方法选取宝鸡市人民医院2018年1月至2021年1月收治的103例支气管肺炎患儿作为研究组,根据病情严重程度分为轻症组(n=65)和重症组(n=38),根据治疗1个疗程后转归情况分为转归良好组(n=80)和转归不良组(n=23),另选取同期健康体检儿童70例作为对照组,检测并比较所有受试者的血清25-(OH)D_(3)、IgE、IgM、IgA水平,采用Spearman相关性分析血清25-(OH)D_(3)、IgE、IgM、IgA水平与病情严重程度的关系,采用受试者工作特征曲线(ROC)分析血清25-(OH)D_(3)、IgE、IgM、IgA水平对转归的评估价值。结果研究组患儿的血清25-(OH)D_(3)、IgA水平分别为(21.57±3.67)nmol/L、(1.09±0.21)g/L,明显低于对照组的(30.25±4.39)nmol/L、(1.41±0.28)g/L,差异均有统计学意义(P<0.05);研究组患儿的血清IgE、IgM水平分别为(65.69±7.45)g/L、(1.74±0.42)g/L,明显高于对照组的(19.85±2.64)g/L、(0.97±0.16)g/L,差异均有统计学意义(P<0.05);治疗前,重症组患儿的血清25-(OH)D_(3)、IgA水平分别为(17.36±1.51)nmol/L、(0.85±0.13)g/L,明显低于轻症组的(24.03±2.39)nmol/L、(1.23±0.22)g/L,差异均有统计学意义(P<0.05);治疗前,重症组患儿的血清IgE、IgM水平分别为(77.66±3.15)g/L、(2.13±0.26)g/L,明显高于轻症组的(58.69±3.84)g/L、(1.51±0.19)g/L,差异均有统计学意义(P<0.05);治疗后,重症组患儿的血清25-(OH)D_(3)、IgA水平分别为(26.03±2.95)nmol/L、(1.23±0.17)g/L,明显低于轻症组的(29.38±4.01)nmol/L、(1.39±0.21)g/L,差异均有统计学意义(P<0.05);治疗后,重症组血清IgE、IgM水平分别为(26.07±4.59)g/L、(1.28±0.29)g/L,明显高于轻症组的(20.24±3.05)g/L、(1.04±0.13)g/L,差异均有统计学意义(P<0.05);经Spearman相关性分析结果显示,血清25-(OH)D_(3)、IgA水平与支气管肺炎患儿病情严重程度呈负相关(r=-0.631、-0.574,P<0.05),IgE、IgM与病情严重程度呈正相关(r=0.726、0.668,P<0.05);转归不良组患儿的血清25-(OH)D_(3)、IgA水平分别为(19.12±2.01)nmol/L、(0.98±0.13)g/L,明显低于转归良好组的(22.27±2.24)nmol/L、(1.12±0.19)g/L,差异均有统计学意义(P<0.05);转归不良组患儿的血清IgE、IgM水平分别为(74.42±4.21)g/L、(1.97±0.34)g/L,明显高于转归良好组的(63.18±3.53)g/L、(1.67±0.25)g/L,差异均有统计学意义(P<0.05);经ROC分析结果显示,血清25-(OH)D_(3)、IgE、IgM、IgA联合评估支气管肺炎患儿转归情况的曲线下面积(AUC)为0.871,高于四者单独评估的0.749、0.744、0.713、0.735。结论支气管肺炎患儿血清25-(OH)D_(3)、IgA水平降低,IgE、IgM水平升高,四者与疾病严重程度具有相关性,联合检测对评估患儿转归情况具有指导作用。

Objective To explore the relationship between serum 25-hydroxyvitamin D[25-(OH)D_(3)],immunoglobulin(Ig)and disease severity,outcome of children with bronchial pneumonia.Methods A total of 103 children with bronchial pneumonia admitted to Baoji People's Hospital were enrolled as study group between January 2018 and January 2021.According to disease severity,they were divided into mild group(n=65)and severe group(n=38).According to outcomes after one course of treatment,they were divided into good outcome group(n=80)and poor outcome group(n=23).A total of 70 healthy children undergoing physical examination during the same period were enrolled as control group.The levels of serum 25-(OH)D_(3),IgE,IgM,and IgA in all subjects were compared.Their relationship with disease severity was analyzed by Spearman correlation analysis,and their evaluation value for outcomes was analyzed by receiver operating characteristic(ROC)curves.Results The levels of serum 25-(OH)D_(3)and IgA in the study group were(21.57±3.67)nmol/L and(1.09±0.21)g/L,significantly lower than(30.25±4.39)nmol/L and(1.41±0.28)g/L in the control group(P<0.05).The levels of serum IgE and IgM in the study group were(65.69±7.45)g/L and(1.74±0.42)g/L,significantly higher than(19.85±2.64)g/L,(0.97±0.16)g/L in the control group(P<0.05).Before treatment,levels of serum 25-(OH)D_(3)and IgA in severe group were(17.36±1.51)nmol/L and(0.85±0.13)g/L,significantly lower than(24.03±2.39)nmol/L and(1.23±0.22)g/L in mild group(P<0.05);levels of serum IgE and IgM in severe group were(77.66±3.15)g/L and(2.13±0.26)g/L,significantly higher than(58.69±3.84)g/L and(1.51±0.19)g/L in mild group(P<0.05).After treatment,levels of serum 25-(OH)D_(3)and IgA in severe group were(26.03±2.95)nmol/L and(1.23±0.17)g/L,significantly lower than(29.38±4.01)nmol/L and(1.39±0.21)g/L in mild group(P<0.05);levels of serum IgE and IgM in severe group were(26.07±4.59)g/L and(1.28±0.29)g/L,significantly higher than(20.24±3.05)g/L and(1.04±0.13)g/L in mild group(P<0.05).Spearman correlation analysis showed that levels of serum 25-(OH)D_(3)and IgA were negatively correlated with disease severity(r=-0.631,-0.574,P<0.05),while levels of IgE and IgM were positively correlated with it(r=0.726,0.668,P<0.05).The levels of serum 25-(OH)D_(3)and IgA in poor outcome group were(19.12±2.01)nmol/L and(0.98±0.13)g/L,significantly lower than(22.27±2.24)nmol/L and(1.12±0.19)g/L in good outcome group(P<0.05);the levels of IgE and IgM in poor outcome group were(74.42±4.21)g/L and(1.97±0.34)g/L,significantly higher than(63.18±3.53)g/L and(1.67±0.25)g/L in good outcome group(P<0.05).ROC curves analysis showed that area un-der the curve(AUC)of serum 25-(OH)D_(3)combined with IgE,IgM and IgA for assessing outcomes of children with bronchial pneumonia was 0.871,which was greater than that of single index(0.749,0.744,0.713,0.735,respectively).Conclusion The levels of serum 25-(OH)D_(3)and IgA decrease,while levels of IgE and IgM increase in children with bronchial pneumonia.There is correlation between the four indexes and disease severity.Combined detection is of signif-icant guidance for assessing outcomes of children.