摘要
目的评估中性粒细胞胞外诱捕网(NET)在儿童炎症性肠病(IBD)中的特征及其在诊断和疾病活动度监测中的作用。方法横断面研究。纳入2017年12月至2024年8月北京儿童医院医院收治的66例IBD患儿为研究对象,另选同期在本院完成胃肠镜检查且无异常的20名儿童为对照组。收集IBD和对照组的临床资料,根据临床评分和内镜评分将IBD患儿分为活动组和缓解组。留取IBD组和对照组的外周血,采用酶联免疫吸附法检测NET标志物中性粒细胞弹性酶(NE)、髓过氧化物酶(MPO)-DNA水平。比较NET标志物在对照组、不同IBD组中的含量,两组间比较采用独立样本t检验或Mann-WhitneyU检验等,多组间比较采用Kruskal-WallisH检验。采用Spearman法分析NET标志物与IBD活动程度的相关性。采用受试者工作特征(ROC)曲线分析实验室指标对IBD与对照组的诊断效能。结果IBD患儿66例,其中克罗恩病组36例,年龄(11.0±3.7)岁,溃疡性结肠炎(UC)组30例,年龄(8.3±5.0)岁;对照组20名,年龄(10.1±3.5)岁。IBD组外周血NE[958(771,1328)比303(196,501)μg/L]、MPO-DNA[0.11(0.09,0.18)比0.09(0.06,0.12)]均高于对照组(均P<0.05),而克罗恩病和UC两组之间NE[1008(863,1301)比807(567,1535)μg/L]、MPO-DNA[0.11(0.09,0.21)比0.12(0.09,0.14)]水平差异均无统计学意义(均P>0.05)。克罗恩病内镜活动组与缓解组的NE水平均高于对照组(均P<0.05);克罗恩病内镜活动组MPO-DNA水平高于对照组(P<0.05),而内镜缓解组MPO-DNA水平降至对照组水平(P>0.05)。UC内镜活动组与缓解组的NE水平均高于对照组(均P<0.05)。NET标志物与IBD的临床及内镜活动程度均无相关性(均P>0.05)。ROC曲线分析显示,NE联合MPO-DNA区分IBD与健康对照的曲线下面积为0.95,灵敏度为90.0%,特异度为89.4%。结论NE联合MPO-DNA区分IBD与健康儿童具有较高的灵敏度和特异度,是IBD潜在的诊断标志物。
ObjectiveTo evaluate the characteristics of neutrophil extracellular traps(NET)in children with inflammatory bowel disease(IBD)and its role in diagnosis and disease activity monitoring.MethodsA total of 66 IBD children admitted to Beijing Children′s Hospital from December 2017 to August 2024 were enrolled in this cross-sectional study,another 20 age-matched children who underwent gastrointestinal endoscopy during the same period in the same hospital and showed no abnormalities were selected as the controls.Clinical data of IBD and control group were collected.Children with IBD were divided into active group and remission group according to clinical score and endoscopic score.The peripheral blood of IBD and control group were collected,and the levels of NET markers,including neutrophil elastase(NE)and myeloperoxidase(MPO)-DNA were detected by enzyme-linked immunosorbent assay.The levels of NET markers in control group and different IBD groups were compared.Independent sample t-test or Mann-Whitney U test was used for group comparisons.Kruskal-Wallis H test was used for multiple group comparisons.Spearman correlation analysis was used to analyze the correlation between NET markers and IBD activity.The efficacy of laboratory indicators in diagnosing IBD and control group was evaluated using receiver operating characteristic(ROC)curve.ResultsThere were 66 children with IBD,including 36 in Crohn′s disease group with the age of(11.0±3.7)years,and 30 in ulcerative colitis(UC)group with the age of(8.3±5.0)years.The control group consisted of 20 children with the age of(10.1±3.5)years.Compared with control group,the levels of NE(958(771,1328)vs.303(196,501)μg/L)and MPO-DNA(0.11(0.09,0.18)vs.0.09(0.06,0.12))in peripheral blood of IBD group were significantly higher(both P<0.05).However,there was no significant difference in the levels of NE(1008(863,1301)vs.807(567,1535)μg/L)and MPO-DNA(0.11(0.09,0.21)vs.0.12(0.09,0.14))between Crohn′s disease and UC groups(both P>0.05).The NE levels in the endoscopic active group and remission group of Crohn's disease were higher than those in the control group(both P<0.05).The MPO-DNA level in the endoscopic active group of Crohn's disease was higher than that in the control group(P<0.05),while the MPO-DNA level in the endoscopic remission group of Crohn's disease was lower than that in the control group(P>0.05).The NE levels in the endoscopic activity group and remission group of UC were higher than those in control group(both P<0.05).NET markers were not correlated with the clinical activity and endoscopic activity of IBD(all P>0.05).ROC curve analysis showed that the area under the curve of NE combined with MPO-DNA for distinguishing IBD from controls was 0.95,with a sensitivity was 90.0%and a specificity was 89.4%.ConclusionThe combination of NE and MPO-DNA demonstrated high sensitivity and specificity for distinguishing pediatric IBD patients from healthy children,suggesting its potential as a diagnostic biomarker panel of IBD.
作者
孔琰
张添卓
安雪莹
吴捷
叶晓琳
Kong Yan;Zhang Tianzhuo;An Xueying;Wu Jie;Ye Xiaolin(Department of Gastroenterology,Beijing Children′s Hospital,Capital Medical University,National Center for Children′s Health,Beijing 100045,China)
出处
《中华儿科杂志》
北大核心
2025年第7期759-764,共6页
Chinese Journal of Pediatrics
基金
北京市自然科学基金(7244340)
首都卫生发展科研专项(2022-2-2094)。
关键词
炎性肠疾病
生物学标记
儿童
Inflammatory bowel diseases
Biological markers
Child
