基于IFN-γ、IL-4水平探究坏死性小肠结肠炎与早产儿牛奶蛋白过敏的相关性

Exploration of the Correlation Between Necrotizing Enterocolitis and Cow's Milk Protein Allergy in Premature Infants Based on IFN-γand IL-4

目的通过测定患儿血清中β-乳球蛋白、酪蛋白特异性相关的细胞因子IFN-γ、IL-4水平,结合免疫球蛋白IgE和IgG4水平,探究早产儿坏死性结肠炎(NEC)与不同机制牛奶蛋白过敏(CMPA)的相关性。方法纳入81例NEC早产儿,根据皮肤点刺试验和牛奶回避/激发试验结果,按是否牛奶蛋白过敏分为NEC组37例和NEC+CMPA组44例,比较两组患儿血清IFN-γ、IL-4水平差异,并采用Spearman相关性分析探讨两种血清因子与NEC早产儿发生CMPA的相关性。根据IgE检查结果按发病机制将44例NEC+CMPA组患儿分为NEC+IgE组18例和NEC+非IgE组26例,比较两组患儿与NEC组血清IFN-γ、IL-4水平、IgE和IgG4水平差异,并探究早产儿NEC与不同机制CMPA的相关性。结果与NEC组相比,NEC+CMPA组患儿血清IFN-γ、IL-4水平均升高(P<0.001)。Logistic回归分析显示,血清IL-4(OR=2.475)、IFN-γ(OR=2.489)水平为NEC患儿发生CMPA的危险因素。Spearman相关性分析结果显示,IL-4(r=0.385)、IFN-γ(r=0.324)水平与NEC患儿发生CMPA呈正相关(P<0.05)。与NEC组相比,NEC+IgE组的IFN-γ水平降低,但差异无统计学意义(P>0.05),而IL-4水平升高,差异有统计学意义(P<0.001);NEC+非IgE组的IFN-γ水平升高(P<0.001),而IL-4水平差异无统计学意义(P>0.05)。结论NEC的发生与IgE介导和非IgE介导的CMPA引起的免疫反应均有关联。血清IL-4、IFN-γ水平与NEC患儿发生CMPA呈正相关。

Objective To explore the correlation between necrotizing enterocolitis(NEC)and different mechanisms of cow's milk protein allergy(CMPA)in preterm infants by determining the serum levels ofβ-lactoglobulin,and casein-specific related cytokines interferon gamma(IFN-γ)and interleukin 4(IL-4),combined with the levels of immunoglobulins IgE and IgG4.Methods A total of 81 preterm infants with NEC were included.They were divided into the NEC group(n=37)and the NEC+CMPA group(n=44)according to whether they had CMPA or not based on the results of skin prick test and milk avoidance/excitation test.The serum IFN-γand IL-4 levels were compared between the two groups.Spearman's correlation analysis was used to analyse the correlation between the two serum factors and the occurrence of CMPA in preterm infants with NEC.The 44 infants in the NEC+CMPA group were further divided into the NEC+IgE group(n=18)and the NEC+non-IgE group(n=26)according to the pathogenesis based on the results of IgE examination.The serum IFN-γand IL-4 levels,and the levels of immunoglobulins IgE and IgG4 were compared between the NEC+IgE,NEC+non-IgE,and NEC groups.The correlation between NEC and different mechanisms of CMPA in preterm infants was explored by Logistic regression analysis and Spearman's analysis.Results The serum IFN-γand IL-4 levels in the NEC+CMPA group were significantly higher than those in the NEC group(P<0.001).Logistic regression analysis showed that serum IL-4 level(OR=2.475),and serum IFN-γlevel(OR=2.489)were risk factors for CMPA in infants with NEC.The results of Spearman's correlation analysis showed a positive correlation between the levels of IL-4(r=0.385),IFN-γ(r=0.324)and the occurrence of CMPA in infants with NEC.Compared with the NEC group,the NEC+IgE group showed a decrease in IFN-γlevel,which was not statistically significant(P>0.05),but an increase in IL-4 level,which was statistically significant(P<0.001);while the NEC+non-IgE group exhibited a statistically significant increase in IFN-γlevel(P<0.001)but no significant difference in IL-4 level(P>0.05).Conclusion The development of NEC is associated with immune responses caused by both IgE-mediated and non-IgE-mediated CMPA.Serum IL-4 and IFN-γlevels are positively correlated with the occurrence of CMPA in infants with NEC.