热性惊厥患儿外周血NOD样受体蛋白3炎症小体表达水平及临床意义

Expression level and clinical significance of NOD-like receptor protein 3 inflammasome in peripheral blood of children with febrile seizures

目的:探讨外周血NOD样受体蛋白3(NLRP3)炎症小体表达水平与热性惊厥患儿(FS)发生及预后的相关性。方法:选取90例FS儿童作为研究对象(FS组),其中52例单纯性热性惊厥患儿(SPS组);38例复杂性热性惊厥患儿(CFS组);另选取同期在我院因上呼吸道感染导致发热的25例患儿作为发热对照组及25名健康儿童体检者作为健康对照组。使用荧光定量PCR法检测各组外周血NLRP3炎症小体(NLRP3、ASC、Caspase-1)mRNA表达水平;比较各组间血清NLRP3、ASC、Caspase-1 mRNA表达水平等指标的差异;使用Pearson相关分析法探讨NLRP3 mRNA表达水平与FS患儿血清白细胞介素1β(IL-1β)、IL-6、肿瘤坏死因子α(TNF-α)等指标的相关性;并使用受试者工作特征(ROC)曲线评价NLRP3 mRNA表达水平对FS的诊断价值和预后判断效能。结果:FS组外周血NLRP3、ASC、Caspase-1 mRNA表达水平高于发热对照组和健康对照组(P<0.05),且CFS组高于SPS组(P<0.05)。FS患儿外周血NLRP3 mRNA表达水平与FS患儿血清IL-1β(r=0.351)、IL-6(r=0.339)、TNF-α(r=0.342)水平均呈正相关关系(P<0.05)。与预后良好组(n=68)相比,预后不良组(n=22)外周血NLRP3、ASC、Caspase-1 mRNA表达水平增高(P<0.05)。ROC曲线分析显示,NLRP3 mRNA表达水平诊断FS的曲线下面积(AUC)为0.724(95%CI:0.617~0.814),预测预后的AUC为0.715(95%CI:0.611~0.809)。结论:NLRP3炎症小体可能参与了FS的发生及发展,其检测对于临床诊治和预后判断有重要意义。

Objective:To investigate the correlation between the expression level of NOD-like receptor protein 3(NLRP3)inflammasome in peripheral blood and the occurrence and prognosis of children with febrile seizures(FS).Methods:90 children with FS were selected as FS group,including 52 children with simple febrile seizures(SPS group)and 38 children with complex febrile seizures(CFS group).In addition,25 children with fever caused by upper respiratory tract infection in our hospital during the same period were selected as the fever control group,and 25 healthy children were selected as the healthy control group.The mRNA expression of NLRP3 inflammasome(NLRP3,ASC,Caspase-1)in peripheral blood of each group was detected by fluorescence quantitative PCR.The differences of serum NLRP3,ASC,Caspase-1 mRNA expression in different groups were compared.Pearson correlation analysis was used to explore the correlation between NLRP3 mRNA expression and serum interleukin-1β(IL-1β),interleukin-6(IL-6),tumor necrosis factor-α(TNF-α)in children with FS.The receiver operating characteristic(ROC)curve was used to evaluate the diagnostic value and prognostic efficacy of NLRP3 mRNA expression in FS.Results:The expression of NLRP3,ASC and Caspase-1 mRNA in peripheral blood of FS group was higher than that of fever control group and healthy control group(P<0.05),and CFS group was higher than SPS group(P<0.05).The expression of NLRP3 mRNA in peripheral blood of FS children was positively correlated with serum NLRP3 level and IL-1β(r=0.351),IL-6(r=0.339)and TNF-α(r=0.342)levels(P<0.05).Compared with the good prognosis group(n=68),the expression of NLRP3,ASC and Caspase-1 mRNA in peripheral blood of the poor prognosis group(n=22)was increased(P<0.05).ROC curve analysis showed that the AUC of serum NLRP3 mRNA level in diagnosing FS was 0.724(95%CI:0.617~0.814),and the AUC of predicting prognosis was 0.715(95%CI:0.611~0.809).Conclusion:NLRP3 inflammasome may be involved in the occurrence and development of FS,and its detection is of great significance for clinical diagnosis,treatment and prognosis.