呼吸道合胞病毒肺炎患儿外周血YKL-40与T淋巴细胞亚群的关系

Relationship between peripheral blood YKL-40 and T lymphocyte subsets in children with respiratory syncytial virus pneumonia

目的 探讨呼吸道合胞病毒(RSV)肺炎患儿外周血人软骨糖蛋白-40(YKL-40)与T淋巴细胞亚群的关系。方法 前瞻性选取本院收治的147例RSV肺炎患儿为研究对象,设为RSV组,根据严重程度分为高危组(n=43)和中低危组(n=104)。另选取同期健康儿童151例作为对照组。ELISA检测外周血YKL-40;流式细胞术检测T淋巴细胞亚群。RSV肺炎患儿外周血YKL-40水平与T淋巴细胞亚群的关系采用Pearson相关性分析;多因素Logistic回归分析发生高危RSV的影响因素。结果 与对照组比较,RSV组CRP和IL-6水平显著升高(P<0.05),达峰时间比(TPTEF/TE)及达峰容积比(VPEF/VE)显著降低(P<0.05)。与对照组比较,RSV组外周血YKL-40水平及CD8^(+)显著升高(P<0.05),CD3^(+)、CD4^(+)及CD4^(+)/CD8^(+)显著降低(P<0.05)。与中低危组比较,高危组CRP、IL-6水平及呼吸困难、喘息、病毒载量≥10^(6)拷贝/mL的占比显著升高(P<0.05),TPTEF/TE及VPEF/VE显著降低(P<0.05)。与中低危组比较,高危组外周血YKL-40水平及CD8^(+)显著升高(P<0.05),CD3^(+)、CD4^(+)及CD4^(+)/CD8^(+)显著降低(P<0.05)。RSV肺炎患儿外周血YKL-40水平与CD3^(+)、CD4^(+)及CD4^(+)/CD8^(+)呈显著负相关(r=-0.423、-0.417、-0.441,P<0.05),与CD8^(+)呈显著正相关(r=0.462,P<0.05)。多因素Logistic回归显示,结果显示,YKL-40(OR=1.297,95%CI:1.037~1.622)、CD4^(+)(OR=0.791,95%CI:0.639~0.979)、CD8^(+)(OR=1.286,95%CI:1.022~1.617)、CD4^(+)/CD8^(+)(OR=0.684,95%CI:0.514~0.911)为高危RSV发生的影响因素(P<0.05)。结论 RSV患儿外周血YKL-40水平升高、T淋巴细胞亚群异常,且RSV患儿外周血YKL-40水平与T淋巴细胞亚群存在显著相关性。

Objective To explore the relationship between peripheral blood human cartilage glycoprotein-40(YKL-40) and T lymphocyte subsets in children with respiratory syncytial virus(RSV) pneumonia. Methods A prospective study was conducted on 147 children with RSV pneumonia admitted to our hospital(RSV group),and they were grouped into a high-risk group(n=43) and a medium to low-risk group(n=104) based on severity. Another 151 healthy children from the same period were regarded as the control group. ELISA was applied to detect YKL-40 in peripheral blood. Flow cytometry was applied to detect T lymphocyte subsets. The relationship between peripheral blood YKL-40 levels and T lymphocyte subsets in children with RSV pneumonia was analyzed using Pearson correlation analysis. Multivariate logistic regression was applied to analyze the influencing factors of high-risk RSV occurrence. Results Compared with the control group, the levels of CRP and IL-6 in RSV group were significantly higher(P<0.05),and the ratio of time to peak tidal expiratory flow to total expiratory time(TPTEF/TE) and ratio of volume at peak tidal expiratory flow to expiratory tidal volume(VPEF/VE) were significantly lower(P<0.05). Compared with the control group, the RSV group had greatly higher peripheral blood YKL-40 level and CD8^(+)(P<0.05),and greatly lower CD3^(+),CD4^(+),and CD4^(+)/CD8^(+)(P<0.05). Compared with the medium to low-risk group, the high-risk group had greatly higher levels of CRP and IL-6,higher proportions of respiratory distress, wheezing, and viral load ≥10^(6) copies/mL(P<0.05),and greatly lower TPTEF/TE and VPEF/VE(P<0.05). Compared with the medium to low-risk group, the high-risk group had greatly higher YKL-40 and CD8^(+) levels in peripheral blood(P<0.05),and greatly lower CD3^(+),CD4^(+),and CD4^(+)/CD8^(+)(P<0.05). The peripheral blood YKL-40 level in children with RSV pneumonia was greatly negatively correlated with CD3^(+),CD4^(+),and CD4^(+)/CD8^(+)(r=-0.423,-0.417,-0.441,P<0.05),and greatly directly correlated with CD8^(+)(r=0.462,P<0.05). Multivariate logistic regression showed that YKL-40(OR=1.297,95% CI:1.037-1.622),CD4^(+)(OR=0.791,95% CI:0.639-0.979),CD8^(+)(OR=1.286,95% CI:1.022-1.617),and CD4^(+)/CD8^(+)(OR=0.684,95% CI:0.514-0.911) were the influencing factors for the occurrence of high-risk RSV(P<0.05). Conclusion Children with RSV have higher level of peripheral blood YKL-40 and abnormal T lymphocyte subsets, and there is a great correlation between peripheral blood YKL-40 level and T lymphocyte subsets in RSV patients.