支气管哮喘患儿上呼吸道菌群和炎症因子水平变化与病情严重程度的关系

Changes of upper respiratory tract flora and inflammatory factors in children with bronchial asthma and their relationship with the severity of the disease

目的探讨支气管哮喘患儿上呼吸道菌群和炎症因子水平变化情况并分析二者与患儿病情严重程度的关系,为临床评估支气管哮喘患儿病情严重程度提供参考指标。方法选取肇庆市第一人民医院2018年10月至2022年6月收治的支气管哮喘患儿103例作为研究组,另选同时间段在我院进行健康体检的健康儿童60例作为对照组,并根据病情严重程度将研究组患儿分为轻症、重症两个亚组。检测患儿上呼吸道菌群多样性与血清中C反应蛋白(CRP)、白细胞介素-6(IL-6)、肿瘤坏死因子(TNF)-α水平,分析以上指标与病情严重程度的关系。结果与对照组比较,研究组患儿呼吸道菌群Simpson指数,血清CRP、IL-6、TNF-α水平均显著升高,呼吸道菌群Shannon指数显著降低(t=52.413、35.293、36.088、34.930、29.248,均P<0.001)。重症组患儿呼吸道菌群Simpson指数,血清CRP、IL-6、TNF-α水平均显著高于轻症组,呼吸道菌群Shannon指数显著低于轻症组(t=11.599、11.898、12.699、11.335、12.309,均P<0.001)。Spearman相关性分析显示,呼吸道菌群Simpson指数、血清CRP、IL-6、TNF-α水平与病情严重程度均呈正相关(r=0.197、0.228、0.264、0.287,P=0.046、0.020、0.007、0.003),呼吸道菌群Shannon指数与支气管哮喘病情严重程度呈负相关(r=-0.270,P=0.006)。ROC曲线显示,呼吸道菌群Simpson、Shannon指数和血清CRP、IL-6、TNF-α水平以及联合检测对支气管哮喘患儿病情严重程度预测的曲线下面积(AUC)分别为0.615、0.658、0.634、0.654、0.668、0.863,联合检测对支气管哮喘患儿病情严重程度的预测价值更高。结论支气管哮喘患儿上呼吸道菌群多样性及炎症因子水平显著升高,且患儿病情程度越严重,其水平变化越显著,二者联合检测对患儿支气管哮喘严重程度具有较高预测价值。

Objective To explore the changes of upper respiratory flora and inflammatory factors in children with bronchial asthma(BA)and analyze the relationship of them with the severity of the illness,so as to provide reference indicators for clinical evaluation of the severity of BA in children.Methods A total of 103 children with BA admitted to the First People's of Zhaoqing City during October 2018 and June 2022 were selected as the observation group,with another 60 healthy children who underwent physical examination in our hospital during the same time period as the control group.The observation group was divided into two subgroups,mild and severe,according to the severity of the disease.The diversity of upper respiratory flora and serum levels of the inflammatory factors C-reactive protein(CRP),interleukin-6(IL-6),and tumor necrosis factor(TNF)-αwere detected,and the relationship between the above indexes and the severity of the disease was analyzed.Results Compared with the control group,the children in the observation group had significantly higher levels of Simpson's index,serum CRP,IL-6 and TNF-α,and significantly lower levels of Shannon's index(t=52.413,35.293,36.088,34.930,29.248;all P<0.001).The Simpson's index,serum CRP,IL-6 and TNF-αlevels of children in the severe group were significantly higher,while Shannon's index was significantly lower than those in the mild group respectively(t=11.599,11.898,12.699,11.335,12.309;all P<0.001).Spearman's correlation analysis showed that the Simpson's index,serum CRP,IL-6,and TNF-αwere positively correlated with the severity of the disease(r=0.197,0.228,0.264,0.287;P=0.046,0.020,0.007,0.003),and Shannon's index was negatively correlated with the severity of BA(r=−0.270,P=0.006).The receiver operating characteristic curve(ROC)showed that the areas under the curve(AUC)of respiratory flora diversity,inflammatory factor levels,and the joint detection of the two to predict the severity of BA in children were 0.615,0.658,0.634,0.654,0.668 and 0.863,respectively,and that the joint detection had a higher predictive value for the severity of BA in children.Conclusion The levels of upper respiratory flora diversity and inflammatory factors in children with BA significantly elevated,and as the severity of the disease became higher,the levels changed more significantly,with a certain degree of relevance;joint detection of the two has a high predictive value for the severity of BA in children.