Th免疫应答指标对咳嗽变异性哮喘患儿哮喘控制情况的预测价值及其与复发风险的关系

Predictive value of Th immune response indicators for asthma control in children with cough variant asthma and its relationship with recurrence risk

目的:探究辅助型T细胞(Th)免疫应答指标对咳嗽变异性哮喘(CVA)患儿哮喘控制情况的预测价值及其与复发风险的关系。方法:选取2020年8月至2021年8月衡水市人民医院112例CVA患儿,均行常规西药治疗,根据治疗4周后哮喘控制情况分为控制良好组(n=85)和控制不良组(n=27),比较两组一般资料、治疗前肺功能指标[第1秒用力呼气量(FEV1)、FEV1/用力肺活量(FVC)]、Th免疫应答指标(Th1/Th2、IL-2、IFN-γ、IL-4、IL-10)水平,分析Th免疫应答指标与肺功能指标的相关性,预测CVA患儿哮喘控制情况的价值。治疗后随访6个月,统计控制良好组复发情况,比较复发与未复发患儿治疗前Th免疫应答指标,分析Th免疫应答指标与复发的关系。结果:控制不良组治疗前FEV1、FEV1/FVC及Th1/Th2、IL-2、IFN-γ水平均低于控制良好组,IL-4、IL-10水平均高于控制良好组(P<0.05);CVA患儿治疗前Th1/Th2、IL-2、IFN-γ水平与FEV1、FEV1/FVC呈正相关,IL-4、IL-10水平与FEV1、FEV1/FVC呈负相关(P<0.05);治疗前Th1/Th2、IL-2、IFN-γ、IL-4、IL-10水平预测CVA患儿哮喘控制不良的曲线下面积(AUC)均>0.7,联合预测的AUC(0.933)最大;良好组复发患儿治疗前Th1/Th2、IL-2、IFN-γ水平均低于未复发患儿,IL-4、IL-10水平均高于未复发患儿(P<0.05);治疗前Th1/Th2、IL-2、IFN-γ水平与CVA复发呈负相关,IL-4、IL-10水平与CVA复发呈正相关(P<0.05)。结论:Th免疫应答指标在CVA患儿哮喘控制情况预测方面具有一定价值,且与CVA复发密切相关。

Objective:To explore the predictive value of helper T cell(Th)immune response indicators for asthma control in children with cough variant asthma(CVA)and its relationship with the risk of recurrence.Methods:A total of 112 children with CVA in Hengshui City People's Hospital from August 2020 to August 2021 were selected,all received conventional western medicine treat-ment,and were divided into well-controlled group(n=85)and poorly-controlled group(n=27)according to their asthma control status after 4 weeks of treatment.compare the general data,pulmonary function indexes before treatment[forced expiratory volume in 1 se-cond(FEV1),FEV1/forced vital capacity(FVC)],Th immune response indexes(Th1/Th2,IL-2,IFN-γ,IL-4,IL-10)levels,ana-lyze the correlation between Th immune response indicators and pulmonary function indicators,and predict the value of asthma control in children with CVA.After 6 months of follow-up,the recurrence situation in the well-controlled group was counted,the Th immune response indexes before treatment were compared between the children with recurrence and those without recurrence,and the relation-ship between Th immune response indexes and recurrence were analyzed.Results:Before treatment,the levels of FEV1,FEV1/FVC,Th1/Th2,IL-2 and IFN-γin the poor control group were lower than those in the well-controlled group,and the levels of IL-4 and IL-10 were higher than those in the well-controlled group(P<0.05).Th1/Th2,IL-2,IFN-γlevels were positively correlated with FEV1,FEV1/FVC before treatment in children with CVA,and IL-4,IL-10 levels were negatively correlated with FEV1,FEV1/FVC(P<0.05);the areas under the curve(AUC)of Th1/Th2,IL-2,IFN-γ,IL-4 and IL-10 levels before treatment for predicting poor asthma control in children with CVA were all>0.7,and the combined predicted AUC(0.933)was the largest;before treatment,the levels of Th1/Th2,IL-2 and IFN-γin the relapsed children in the group were lower than those of the non-relapsed children,and the levels of IL-4 and IL-10 were higher than those of the non-relapsed children(P<0.05);The levels of Th1/Th2,IL-2,and IFN-γbefore treat-ment were negatively correlated with CVA recurrence,while IL-4 and IL-10 levels were positively correlated with CVA recurrence(P<0.05).Conclusion:Th immune response index has a certain value in predicting asthma control in children with CVA,and is closely related to the recurrence of CVA.