咳嗽变异性哮喘患者血清LDH水平与气道炎症指标的相关性及对预后的评估价值分析

Correlation analysis between serum LDH level and airway inflammation index in patients with cough variant asthma and its prognostic value

目的 探讨咳嗽变异性哮喘(CVA)患者血清乳酸脱氢酶(LDH)水平与气道炎症指标的相关性及对预后的评估价值。方法 110例CVA患者,根据哮喘发作时的严重程度分为轻度(28例)、中度(56例)、重度(26例)。所有患者均接受布地奈德联合孟鲁司特治疗。比较不同严重程度CVA患者血清LDH及气道炎症指标[肿瘤坏死因子α(TNF-α)、白细胞介素-4(IL-4)、白细胞介素-12(IL-12)]水平,复发组与非复发组血清LDH水平及气道炎症指标;分析CVA患者血清LDH水平与气道炎症指标的相关性,血清LDH水平和气道炎症指标对CVA患者疾病复发的预测价值。结果 轻度患者LDH、TNF-α、IL-4、IL-12水平分别为(299.03±39.18)U/L、(121.98±20.03)ng/L、(76.26±7.22)ng/L、(77.02±13.19)ng/L,中度患者分别为(340.59±34.98)U/L、(147.32±23.27)ng/L、(87.95±6.63)ng/L、(65.59±8.00)ng/L,重度患者分别为(355.70±39.05)U/L、(175.29±28.74)ng/L、(94.78±6.10)ng/L、(51.65±10.02)ng/L。随着疾病严重程度增加,患者的血清LDH及TNF-α、IL-4水平均随之升高,IL-12水平下降,轻度、中度、重度患者血清LDH及TNF-α、IL-4、IL-12水平比较,差异有统计学意义(P<0.05)。线性相关分析显示,CVA患者血清LDH水平与IL-4、TNF-α水平呈正相关(r=0.647、0.378,P<0.05),与IL-12水平呈负相关(r=-0.439,P<0.05)。随访1年,110例患者中复发(复发组)21例(19.09%),非复发(非复发组)89例(80.91%)。复发组患者血清LDH(350.01±39.25)U/L、TNF-α(174.34±31.91)ng/L、IL-4(94.32±6.58)ng/L均高于非复发组的(329.70±42.36)U/L、(141.15±26.22)ng/L、(84.76±9.03)ng/L,IL-12(52.70±10.46)ng/L低于非复发组的(68.15±12.28)ng/L,差异有统计学意义(P<0.05)。依据受试者工作特征曲线(ROC)分析结果,血清LDH、TNF-α、IL-4、IL-12在CVA复发预测中的曲线下面积(AUC)分别为0.731、0.801、0.789、0.858,对于CVA复发的预测灵敏度均>61%,特异度均>68%,均可用于预测CVA复发。结论 气道炎症指标和CVA患者的血清LDH之间存在紧密关联,且血清LDH、TNF-α、IL-4、IL-12均可用于预测CVA复发,为其预后的评估提供帮助。

Objective To discuss the correlation between serum lactate dehydrogenase(LDH)level and airway inflammation index in patients with cough variant asthma(CVA)and its prognostic value.Methods A total of 110 patients with CVA were divided into mild patients(28 cases),moderate(56 cases),and severe(26 cases)according to the severity of asthma attack.All patients received budesonide in combination with montelukast.Serum LDH levels and airway inflammation indexes[tumor necrosis factor-α(TNF-α),interleukin-4(IL-4),interleukin-12(IL-12)]in patients with different severity of CVA were compared,as well as serum LDH levels and airway inflammation indexes between the relapse group and the non-relapse group.The correlation between serum LDH level and airway inflammation index in CVA patients,and the predictive value of serum LDH level and airway inflammation index for disease recurrence in CVA patients were analyzed.Results LDH,TNF-α,IL-4,and IL-12 levels were(299.03±39.18)U/L,(121.98±20.03)ng/L,(76.26±7.22)ng/L,and(77.02±13.19)ng/L in mild patients,(340.59±34.98)U/L,(147.32±23.27)ng/L,(87.95±6.63)ng/L,(65.59±8.00)ng/L in moderate patients,and(355.70±39.05)U/L,(175.29±28.74)ng/L,(94.78±6.10)ng/L,and(51.65±10.02)ng/L in severe patients.With the severity of the disease,serum LDH,TNF-αand IL-4 levels were increased,while IL-12 levels were decreased.There were statistically significant differences in serum LDH,TNF-α,IL-4 and IL-12 levels in mild,moderate and severe patients(P<0.05).Linear correlation analysis showed that serum LDH level in CVA patients was positively correlated with IL-4 and TNF-αlevels(r=0.647,0.378;P<0.05),and negatively correlated with IL-12 levels(r=-0.439,P<0.05).Of 110 patients,21 cases(19.09%)had relapsed(relapse group)and 89 cases(80.91%)had not relapsed(non-relapse group)at 1 year follow-up.Serum LDH of(350.01±39.25)U/L,TNF-αof(174.34±31.91)ng/L,and IL-4 of(94.32±6.58)ng/L in the relapse group were higher than those of(329.70±42.36)U/L,(141.15±26.22)ng/L,and(84.76±9.03)ng/L in the non-relapse group;IL-12 of(52.70±10.46)ng/L in the relapse group was lower than that of(68.15±12.28)ng/L in the non-relapse group;the differences were statistically significant(P<0.05).According to the results of receiver operating characteristic(ROC)curve analysis,the area under the curve(AUC)of serum LDH,TNF-α,IL-4 and IL-12 in the prediction of CVA recurrence were 0.731,0.801,0.789 and 0.858,respectively,and the sensitivity and specificity for the prediction of CVA recurrence were all>61%and>68%,which could be used to predict the recurrence of CVA.Conclusion Serum LDH level in patients with CVA is closely related to the level of airway inflammation index,and serum LDH,TNF-α,IL-4,and IL-12 can all be used to predict CVA recurrence and provide an assessment of its prognosis.