Th2及Th17相关细胞因子在新生儿急性呼吸窘迫综合征中的表达及临床意义

Expression and Clinical Significance of Th2 and Th17 Related Cytokines in Neonatal Acute Respiratory Distress Syndrome

目的:探究辅助性T细胞(Th)2及Th17相关细胞因子在新生儿急性呼吸窘迫综合征(ARDS)中的表达及临床意义。方法:回顾性分析2022年11月—2023年11月在上饶市人民医院出生的80例ARDS患儿纳入研究组,将同期80例健康新生儿纳入对照组。比较研究组和对照组血清Th2及Th17相关细胞因子[白细胞介素(IL)-4、IL-6、IL-10、IL-17]差异;将研究组根据氧合指数(OI)分为轻度组(4≤OI<8,n=30)、中度组(8≤OI<16,n=26)、重度组(OI≥16,n=24),比较血清IL-4、IL-6、IL-10、IL-17差异,并与OI进行相关性分析;将研究组根据28 d生存状态分为存活组(n=57)和死亡组(n=23),比较IL-4、IL-6、IL-10、IL-17差异并使用logistic回归分析验证对预后的影响,使用受试者操作特征(ROC)曲线分析对预后的效能。结果:研究组IL-4、IL-6、IL-10、IL-17水平均高于对照组,差异均有统计学意义(P<0.05),不同OI水平ARDS患儿急性生理学和慢性健康状况评估Ⅱ(APACHEⅡ)评分、序贯器官衰竭评估(SOFA)评分及IL-4、IL-6、IL-10、IL-17比较,差异均有统计学意义(P<0.05);ARDS患儿OI与IL-4、IL-6、IL-10、IL-17均呈正相关(P<0.05);死亡组IL-4、IL-6、IL-10、IL-17水平均高于存活组,差异均有统计学意义(P<0.05),IL-4、IL-6、IL-10、IL-17均为ARDS患儿死亡的危险因素(P<0.05);IL-4、IL-6、IL-10、IL-17及联合检测预测ARDS患儿死亡的AUC分别为0.806、0.879、0.801、0.862、0.991。结论:Th2及Th17相关细胞因子在ARDS患儿中异常升高,与OI明显相关,检测ARDS患儿Th2及Th17相关细胞因子有助于诊疗评估。

Objective:To explore the expression and clinical significance of helper T cell(Th)2 and Th17 related cytokines in neonatal acute respiratory distress syndrome(ARDS).Method:A total of 80 children with ARDS born in Shangrao People's Hospital from November 2022 to November 2023 were retrospectively analyzed and included in study group,and 80 healthy neonates during the same period were included in control group.The differences in serum Th2 and Th17 related cytokines(IL-4,IL-6,IL-10,IL-17)were compared between study group and control group.According to the oxygenation index(OI),the children in study group were classified into mild group(4≤OI<8,n=30),moderate group(8≤OI<16,n=26)and severe group(OI≥16,n=24).The differences in serum IL-4,IL-6,IL-10 and IL-17 were compared and the correlation with OI was analyzed.The children in study group were divided into survival group(n=57)and death group(n=23)by means of the 28-day survival status,and the IL-4,IL-6,IL-10 and IL-17 were compared.logistic regression analysis was used to verify the influence on prognosis,and ROC curve was applied to analyze the efficiency on prognosis.Result:The levels of IL-4,IL-6,IL-10 and IL-17 in study group were higher than those in control group,the differences were statistically significant(P<0.05).There were statistically significant differences in acute physiology and chronic health evaluationⅡ(APACHEⅡ)score,sequential organ failure assessment(SOFA)score,IL-4,IL-6,IL-10 and IL-17 among ARDS children with different OI levels(P<0.05).OI in children with ARDS was positively correlated with IL-4,IL-6,IL-10 and IL-17(P<0.05).The levels of IL-4,IL-6,IL-10 and IL-17 in death group were higher than those in survival group,the differences were statistically significant(P<0.05).IL-4,IL-6,IL-10 and IL-17 were risk factors for death in ARDS children(P<0.05).The AUC of IL-4,IL-6,IL-10,IL-17 and combined detection for predicting death of ARDS children were 0.806,0.879,0.801,0.862 and 0.991,respectively.Conclusion:Th2 and Th17 related cytokines are abnormally elevated in ARDS children,which is significantly correlated with OI,detection of Th2 and Th17-related cytokines in ARDS children is helpful for diagnosis and treatment evaluation.