血清嗜酸性粒细胞衍生神经毒素与儿童哮喘急性加重风险和严重程度的关系

Relationship between serum eosinophile-derived neurotoxin and acute exacerbation and severity of asthma in children

目的探讨血清嗜酸性粒细胞衍生神经毒素(EDN)与儿童哮喘急性加重风险和严重程度的关系。方法选取2018年6月—2020年6月期间衡水市妇幼保健院儿科收治的117例哮喘儿童,包括52例哮喘缓解期儿童和65例哮喘急性加重期儿童。另外,同期接受健康检查的70例健康儿童被纳入健康对照组。按哮喘急性加重严重程度将哮喘急性加重患儿分为轻度组、中度组和重度组。采用酶联免疫吸附法检测血清EDN水平。采用多因素Logistic回归和受试者工作特征(ROC)曲线分析血清EDN与哮喘急性加重的关系。结果与健康对照组相比,哮喘缓解组和急性加重组患儿血清EDN水平均升高,且急性加重组较缓解组升高更显著(P<0.05)。在哮喘急性加重儿童中,中度组和重度组患儿血清EDN水平较轻度组均升高,且重度组较轻度组升高更显著(P<0.05)。血清EDN(OR=1.172,95%CI=1.042~1.319,P=0.008)、EOS(OR=60.238,95%CI=1.223~2966.959,P=0.039)、IgE(OR=1.063,95%CI=1.014~1.115,P=0.011)、FEV_(1)/FVC(OR=0.881,95%CI=0.776~1.000,P=0.049)是哮喘急性加重的独立影响因素(P<0.05)。血清EDN水平区分重度和轻中度哮喘急性加重儿童的AUC为0.880(95%CI:0.778~0.982)。经Spearman法分析,哮喘急性加重儿童血清EDN和白细胞计数(WBC)、嗜酸性粒细胞(EOS)计数、EOS%、免疫球蛋白E(IgE)、C反应蛋白(CRP)呈正相关(P<0.05),与患儿1秒用力呼气容积占预计值的百分比(FEV_(1)%pred)、用力肺活量占预计值的百分比(FVC%pred)、FEV_(1)/FVC均呈负相关(P<0.05)。结论血清EDN上调与儿童哮喘急性加重风险和病情严重程度增加有关。血清EDN可能是儿童哮喘急性加重风险和病情严重程度监测的良好生物标志物。

Objective To investigate the relationship between serum eosinophile-derived neurotoxin(EDN)and acute exacerbation and severity of asthma in children.Methods A total of 117 children with asthma admitted to the Department of Pediatrics of the hospital from June 2018 to June 2020 were selected,including 52 children with asthma remission and 65 children with acute asthma exacerbation.In addition,70 healthy children who received health examination during the same period were included in the healthy control group.According to the severity of acute exacerbation of asthma,the children were divided into mild group,moderate group and severe group.Serum EDN levels were detected by enzyme-linked immunosorbent assay.Multivariate Logistic regression and receiver operating characteristic(ROC)curve were used to analyze the relationship between serum EDN and acute exacerbation of asthma.Results Compared with the healthy control group,the serum EDN level in both the asthma remission group and the acute exacerbation group was increased,and the acute exacerbation group was more significantly increased than the remission group(P<0.05).In children with acute asthma exacerbation,the serum EDN level in moderate group and severe group was higher than that in mild group,and the serum EDN level in severe group was more significantly higher than that in mild group(P<0.05).Serum EDN(OR=1.172,95%CI=1.042-1.319,P=0.008),EOS(OR=60.238,95%CI=1.223-2966.959,P=0.039),IgE(OR=1.063,95%CI=1.014-1.115,P=0.011),FEV_(1)/FVC(OR=0.881,95%CI=0.776-1.000,P=0.049)were independent factors of acute exacerbation of asthma(P<0.05).The AUC of serum EDN levels in children with severe and mild-to-moderate acute exacerbation of asthma was 0.880(95%CI:0.778-0.982).By Spearman analysis,serum EDN was positively correlated with white blood cell count(WBC),eosinophil(EOS)count,EOS%,immunoglobulin E(IgE),C-reactive protein(CRP)in children with asthma exacerbation(P<0.05).It was negatively correlated with the percentage of forced expiratory volume in 1 second to predicted value(FEV_(1)%pred),the percentage of forced vital capacity in the predicted value(FVC%pred)and FEV_(1)/FVC(P<0.05).Conclusion Upregulation of serum EDN is associated with increased risk of acute exacerbation and severity of asthma in children.Serum EDN may be a good biomarker for monitoring acute exacerbation and severity of asthma in children.