MMP9、FeNO以及血清IgE与儿童哮喘急性发作严重程度的相关性分析

Correlation analysis of MMP9,FeNO,and serum IgE with the severity of acute attacks in children with asthma

目的研究呼出气一氧化氮(FeNO)、血清免疫球蛋白E(IgE)和基质金属蛋白酶9(MMP9)的水平与儿童哮喘急性发作之间的关系,为儿童哮喘的预防及治疗提供依据。方法选取沈阳市妇婴医院于2020年11月至2022年11月收治的98例支气管哮喘急性发作期儿童作为急性组,按照病情程度分成轻度组(n=32)、中度组(n=38)和重度组(n=28),按照2∶1的比例选出49例同期在门诊治疗的处于支气管哮喘缓解期的儿童作为缓解组,随机选取健康体检儿童49例作为健康对照组,分别对他们进行FeNO、MMP9和血清IgE及肺功能[用力肺活量(FVC)、1秒用力呼气量(FEV_(1))、FEV_(1)/FVC%、最大呼气流量(PEF)]检测。应用Pearson相关分析探讨哮喘急性发作期FeNO、MMP9及血清IgE和肺功能之间的联系,并对三者在支气管哮喘急性发作中的预测价值进行分析。结果急性组、缓解组和对照组的年龄、性别、体重指数和病程的比较,差异无统计学意义(P>0.05)。急性组FeNO、MMP9、血清IgE分别为(59.95±12.65)ppb、(4.87±1.44)pg/ml、(330.63±74.88)IU/ml,缓解组分别为(25.23±8.23)ppb、(1.21±0.02)pg/ml、(152.23±32.12)IU/ml,均高于对照组的(12.43±4.09)ppb、(0.53±0.24)pg/ml、(126.34±57.33)IU/ml,差异具有统计学意义(P<0.05)。急性期和缓解期FVC、FEV1、FEV1/FVC%、PEF均低于对照组,差异具有统计学意义(P<0.05)。支气管哮喘急性发作中度组FeNO、MMP9、血清IgE水平分别为(49.23±6.23)ppb、(1.21±0.02)pg/ml、(282.61±59.83)IU/ml,重度组分别为(67.43±10.09)ppb、(0.53±0.24)pg/ml、(356.49±70.82)IU/ml,均高于轻度组的(34.62±10.65)ppb、(4.87±1.44)pg/ml,(189.21±14.33)IU/ml,差异具有统计学意义(P<0.05)。在轻度组中FeNO、MMP9和血清IgE水平均较低,而在中度组中这些指标均较高,其中FVC、FEV_(1)、FEV_(1)/FVC%和PEF均较低,差异具有统计学意义(P<0.05)。FeNO以及MMP9与血清IgE水平呈正相关(P<0.05),FeNO、MMP9以及血清IgE水平与FVC、FEV_(1)、FEV_(1)/FVC%、PEF均呈负相关(P<0.05)。MMP9在支气管哮喘的诊断中表现出了显著的优势,当达到最大约登指数时,对应的截断值为1.17,曲线下面积(Area under curve,AUC)为0.83,敏感度和特异性也分别达到了90.13%和86.5%。结论支气管哮喘急性发作的儿童血清中的FeNO、MMP9以及血清IgE水平显著增高,随肺部功能恶化程度加重而上升,可能与支气管哮喘急性发作患儿肺功能损害程度有关。

Objective To explore the relationship between the levels of fractional exhaled nitric oxide(FeNO),matrix metalloproteinase 9(MMP9)and serum immunoglobulin E(IgE)and acute asthma attack in children,and to provide reference for the prevention and treatment of asthma in children.Methods A total of 98 children with acute exacerbation of bronchial asthma admitted to Shenyang Women and Children′s Hospital from November 2020 to November 2022 were collected as the acute group.According to the severity of the disease,they were divided into mild group(n=32),moderate group(n=38)and severe group(n=28).According to the ratio of 2∶1,49 children in the remission stage of bronchial asthma were collected as the remission group,and 49 healthy children were randomly selected as the healthy control group.FeNO and MMP9 were measured;serum IgE and pulmonary function[forced vital capacity(FVC),forced expiratory volume in one second(FEV_(1)),FEV_(1)/FVC%,peak expiratory flow(PEF)]were measured.Pearson correlation analysis was used to explore the relationship between FeNO,MMP9 and serum IgE and lung function in acute attack of asthma,and the predictive value of the three in acute attack of bronchial asthma was analyzed.Results There were no significant differences in age,gender,body mass index or disease duration among the acute group,the remission group and the control group(P>0.05).The levels of FeNO,MMP9 and serum IgE in acute group were(59.95±12.65)ppb,(4.87±1.44)pg/ml and(330.63±74.88)IU/ml,and those in remission group were(25.23±8.23)ppb,(1.21±0.02)pg/ml and(152.23±32.12)IU/ml,which were higher than those in the control group[(12.43±4.09)ppb,(0.53±0.24)pg/ml and(126.34±57.33)IU/ml].The difference was statistically significant(P<0.05).FVC,FEV_(1),FEV_(1)/FVC%and PEF in the acute and remission groups were lower than those in the control group,and the difference was statistically significant(P<0.05).The levels of FeNO,MMP9 and serum IgE in the moderate group were(49.23±6.23)ppb,(1.21±0.02)pg/ml and(282.61±59.83)IU/ml.The levels of FeNO,MMP9 and serum IgE in severe group were(67.43±10.09)ppb,(0.53±0.24)pg/ml and(356.49±70.82)IU/ml,which were higher than(34.62±10.65)ppb,(4.87±1.44)pg/ml and(189.21±14.33)IU/ml in mild group and the difference was statistically significant(P<0.05).In the mild group,FeNO,MMP9 and serum IgE levels were lower,while in the moderate group they were higher,among which FVC,FEV_(1),FEV_(1)/FVC%and PEF were lower,the difference being statistically significant(P<0.05).FeNO and MMP9 was positively correlated with serum IgE levels(P<0.05).FeNO,MMP9 and serum IgE level were negatively correlated with FVC,FEV 1,FEV 1/FVC%and PEF(P<0.05).MMP9 showed a significant advantage in the diagnosis of bronchial asthma.When the Youden index was the largest,the corresponding cut-off value was 1.17,the area under curve(AUC)was 0.83,and the sensitivity and specificity were 90.13%and 86.5%,respectively.Conclusion The serum levels of FeNO,MMP9 and serum IgE in children with acute exacerbation of bronchial asthma are significantly increased,and increase with the deterioration of lung function,which may be related to the degree of lung function damage in children with acute exacerbation of bronchial asthma.