干扰素调节因子5、粒细胞-巨噬细胞集落刺激因子在细菌性肺炎病儿血清中的表达及预后价值

Expression and prognostic value of IRF5 and GM-CSF in serum of children with bacterial pneumonia

目的探讨干扰素调节因子5(interferon regulatory factor 5,IRF5)、粒细胞-巨噬细胞集落刺激因子(granulocyte-macro-phage colony-stimulating factor,GM-CSF)在细菌性肺炎病儿血清中的表达变化及疾病预后价值。方法选取2019年4月至2021年5月中国人民解放军联勤保障部队第九二八医院收治的细菌感染性肺炎病儿96例作为细菌组,同期非细菌感染性肺炎病儿88例作为非细菌组,另外选取健康体检儿童96例为对照组,收集检测三组病儿基本临床资料。检测血清中IRF5、GM-CSF及其组间差异;采用Pearson法分析细菌性肺炎病儿血清IRF5、GM-CSF水平与病情指标的相关性;应用受试者操作特征曲线(ROC曲线)分析IRF5、GM-CSF及二者联合预测细菌性肺炎预后的价值。结果细菌组血清IRF5水平[(38.85±13.86)ng/L]显著高于非细菌组[(11.15±4.37)ng/L]和对照组[(10.76±1.55)ng/L],且重症组高于轻症组(P<0.05);细菌组血清GM-CSF水平[(54.73±16.56)ng/L]显著低于非细菌组[(246.73±28.94)ng/L]和对照组[(250.64±55.67)ng/L],且重症组低于轻症组(P<0.05)。重症组气促、吐沫、三凹征、肺部明显湿啰音比例、C反应蛋白(C-reactive protein,CRP)、白细胞水平显著高于轻症组、非细菌组(P<0.05),轻症组、非细菌组CRP水平显著高于对照组(P<0.05),非细菌组CRP水平显著高于对照组(P<0.05)。血清IRF5水平与CRP、白细胞、临床肺部感染评分(clinical pulmonary infection score,CPIS)均呈正相关(r=0.34、0.36、0.41,P<0.05),血清GM-CSF水平与CRP、白细胞、CPIS均呈负相关(r=-0.40、-0.32、-0.45,P<0.05)。预后不良组血清IRF5水平高于预后良好组,血清GM-CSF水平低于预后良好组(P<0.05)。ROC曲线显示,IRF5、GM-CSF对预后预测的AUC分别为0.90、0.87,二者联合对预后预测的AUC为0.96,明显高于二者单独诊断,(Z联合vs.IRF5=2.86,P=0.004;Z联合vs.GM-CSF=2.24,P=0.025),其灵敏度、特异度分别为90.32%、90.77%。结论细菌性肺炎病儿血清IRF5水平升高,GM-CSF水平降低,二者在评估病情进展及疾病预后预测方面具有较高的价值。

Objective To investigate the expression changes of interferon regulatory factor 5(IRF5)and granulocyte-macrophage colony-stimulating factor(GM-CSF)in serum of children with bacterial pneumonia and their prognostic value.Methods From April 2019 to May 2021,Ninety-six children with bacterial pneumonia,who were admitted to The 928th Hospital of the Joint Logistics Support Force of the People´s Liberation Army of China,were included as the bacterial group.Meantime,88 children with non-bacterial pneumonia were included as the non-bacterial group.In addition,96 healthy children were chosen as the control group.The basic clinical data of the three groups were collected and detected.Serum IRF5 and GM-CSF were detected and the differences between groups were compared.Pearson´s correlation coefficient was applied to analyze the correlation between serum IRF5 and GM-CSF levels and disease indicators in children with bacterial pneumonia;ROC curve was applied to analyze the values of IRF5,GM-CSF and their combination in predicting the prognosis of bacterial pneumonia.Results The serum IRF5 level[(38.85±13.86)ng/L]in the bacterial group was obviously higher than that in the non-bacterial group[(11.15±4.37)ng/L]and the control group[(10.76±1.55)ng/L],and the severe group higher than the mild group(P<0.05);the serum GM-CSF level[(54.73±16.56)ng/L]in the bacterial group was obviously lower than that in the non-bacterial group[(246.73±28.94)ng/L]and the control group[(250.64±55.67)ng/L],and the severe group was lower than the mild group(P<0.05).The severe group had obviously higher proportions of shortness of breath,spit,three concave signs,the obvious moist rales in the lungs,and levels of C-reactive protein(CRP),white blood cell(WBC)than the mild group and the non-bacterial group(P<0.05),and the mild group and non-bacterial group had obviously higher levels of CRP than the control group(P<0.05),the level of CRP in the non-bacterial group significantly higher than that in the control group(P<0.05).Serum IRF5 level was positively correlated with CRP,WBC,and pulmonary infection score(CPIS)(r=0.34,0.36,0.41,respectively;P<0.05),and serum GM-CSF level was negatively correlated with CRP,WBC,and CPIS scores(r=−0.40,−0.32,−0.45,respectively;P<0.05).The serum IRF5 level in the poor prognosis group was higher than that in the good prognosis group,and the serum GM-CSF level was lower than that in the good prognosis group(P<0.05).The ROC curve showed that the AUCs of IRF5 and GM-CSF for prognosis prediction were 0.90 and 0.87,respectively,and the AUC of the combination of the two was 0.96,which was obviously higher than that of the two alone,(Z combined vs.IRF5=2.86,P=0.004;Z combined vs.GM-CSF=2.24,P=0.025),and the sensitivity and specificity were 90.32%and 90.77%,respectively.Conclusion Serum IRF5 level is increased and GM-CSF level is decreased in children with bacterial pneumonia,both of which have high value in evaluating disease progression and predicting disease prognosis.