血清IRAK4、FOXO3a水平与新生儿支气管肺发育不良的关系

Relationship between serum IRAK4 and FOXO3a levels and neonatal bronchopulmonary dysplasia

目的探讨新生儿支气管肺发育不良(bronchopulmonary dysplasia,BPD)与血清白细胞介素-1受体相关激酶4(interleukin-1 receptor-associated kinase 4,IRAK4)和转录因子叉头框蛋白O3a(forkhead box O3,FOXO3a)表达水平之间的关系。方法选取2019年3月至2022年5月在海南省人民医院新生儿科出生且住院的260例新生儿作为研究对象,并将发生BPD的新生儿纳入研究组(n=99),未发生BPD的新生儿纳入对照组(n=161)。采用酶联免疫吸附试验检测两组血清IRAK4、FOXO3a表达水平,并分析BPD临床病理特征和血清IRAK4、FOXO3a水平之间的关系。采用受试者操作特征(receiver operating characteristic,ROC)曲线分析血清IRAK4、FOXO3a水平对BPD的预测价值。统计学方法采用t检验、方差分析、χ^(2)检验和Pearson相关性分析。结果研究组患儿IRAK4表达水平高于对照组[(1.07±0.33)与(0.65±0.18)ng/L,t=13.265,P<0.001],FOXO3a表达水平低于对照组[(0.53±0.15)与(0.83±0.24)g/L,t=11.164,P<0.001]。Pearson相关性分析结果显示,BPD患儿血清IRAK4、FOXO3a表达水平之间呈负相关(r=-0.582,P<0.001)。BPD患儿血清IRAK4、FOXO3a的表达水平与患儿性别、分娩方式无关(P值均>0.05);与胎龄、体质量、病情程度有关(P值均<0.05)。IRAK4表达水平随着胎龄、体质量的减少及病情程度的加重而升高,FOXO3a表达水平随着胎龄、体质量的减少及病情程度的加重而降低。血清IRAK4、FOXO3a表达水平预测BPD的曲线下面积(area under the curve,AUC)分别为0.813(95%CI:0.754~0.873)、0.791(95%CI:0.728~0.855);IRAK4、FOXO3a二者联合预测BPD的AUC为0.910(95%CI:0.870~0.949)。结论BPD患儿血清IRAK4呈高表达,血清FOXO3a呈低表达,二者联合检测对新生儿BPD有较高的诊断价值。

Objective To investigate the relationship between neonatal bronchopulmonary dysplasia(BPD)and serum interleukin-1 receptor-associated kinase 4(IRAK4)and transcription factor forkhead box O3a(FOXO3a)expression levels.Method A total of 260 neonates born and hospitalized in the Department of Neonatology,Hainan General Hospital from March 2019 to May 2022 were collected as the study subjects.The neonates with BPD were included into the study group(n=99)and neonates without BPD were included in the control group(n=161).The expression levels of serum IRAK4 and FOXO3a of the two groups were detected by enzyme-linked immunosorbent assay,and the relationship between clinicopathological characteristics of BPD and serum IRAK4 and FOXO3a levels was analyzed.The predictive value of serum IRAK4 and FOXO3a levels for BPD was analyzed by receiver operating characteristic(ROC)curve.Statistical methods included t-test,ANOVA,χ^(2) test and Pearson correlation analysis.Result The expression level of IRAK4 in the study group was higher than that in the control group[(1.07±0.33)vs(0.65±0.18)ng/L,t=13.265,P<0.001],and the expression level of FOXO3a was lower than that in the control group[(0.53±0.15)vs(0.83±0.24)g/L,t=11.164,P<0.001].Pearson correlation analysis results showed that there was a negative correlation between the expression level of serum IRAK4 and FOXO3a in neonates with BPD(r=-0.582,P<0.001).The expression level of serum IRAK4 and FOXO3a in neonates with BPD were not related to their gender and delivery style(all P>0.05);but they were related to gestational age,body mass,and severity of the disease(all P<0.05).The expression level of IRAK4 increased with the decrease of fetal age,body mass,and severity of the disease,while the expression level of FOXO3a decreased with the decrease of fetal age,body mass,and severity of the disease.The area under the curve(AUC)of serum IRAK4 and FOXO3a expression level in predicting BPD was 0.813(95%CI:0.754-0.873)and 0.791(95%CI:0.728-0.855),respectively;the AUC of combined prediction of IRAK4 and FOXO3a for BPD was 0.910(95%CI:0.870-0.949).Conclusion Neonates with BPD have high expression of serum IRAK4 and low expression of serum FOXO3a,and the combined detection has a high diagnostic value for the occurrence of neonatal BPD.