摘要
目的探讨血清基质金属蛋白酶(MMP)-9、分泌型卷曲相关蛋白5(SFRP5)、呼出气一氧化氮(FeNO)对哮喘急性发作期患儿的诊断价值。方法选取2021年12月至2023年12月在杨凌示范区医院治疗的82例哮喘急性发作期患儿作为急性发作期组,依据急性发作期病情严重程度分级标准并结合患儿的临床表现,将其分为轻度组33例、中度组28例和重度组21例。另选取同期于该院就诊的57例哮喘稳定期患儿作为稳定期组,50例于该院体检的健康儿童作为对照组。采用酶联免疫吸附试验检测血清MMP-9、SFRP5水平,FeNO水平检测仪检测FeNO水平。Spearman相关性分析血清MMP-9、SFRP5及FeNO水平与哮喘急性发作期患儿病情严重程度的相关性。多因素Logistic回归分析哮喘急性发作期的影响因素。绘制受试者工作特征(ROC)曲线分析血清MMP-9、SFRP5、FeNO对哮喘急性发作期的诊断价值。结果相较于对照组、稳定期组,急性发作期组血清MMP-9及FeNO水平明显升高,SFRP5水平明显降低,差异有统计学意义(P<0.05)。哮喘急性发作期患儿血清MMP-9及FeNO水平随着病情严重程度的增加逐渐升高(P<0.05),血清SFRP5水平随着病情严重程度的增加逐渐降低(P<0.05)。Spearman相关性分析结果显示,哮喘急性发作期患儿血清MMP-9及FeNO水平与其病情严重程度呈正相关(r=0.439、0.466,P<0.001),血清SFRP5水平与其病情严重程度呈负相关(r=-0.510,P<0.001)。急性发作期组近期呼吸道感染史、近期过敏原接触史占比与稳定期组比较,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,有近期呼吸道感染史、有近期过敏原接触史、血清MMP-9及FeNO水平升高是哮喘急性发作期的危险因素(P<0.05);血清SFRP5水平升高是哮喘急性发作期的保护因素(P<0.05)。ROC曲线分析结果显示,血清MMP-9、SFRP5、FeNO诊断哮喘急性发作期的曲线下面积(AUC)分别为0.810、0.860、0.832,而三者联合诊断的AUC为0.958,明显优于各自单独诊断(Z_(三者联合-MMP-9)=4.240,P<0.001;Z_(三者联合-SFRP5)=3.119,P=0.002;Z_(三者联合-FeNO)=4.051,P<0.001)。结论哮喘急性发作期患儿血清MMP-9、FeNO水平明显升高,血清SFRP5水平明显降低,三者联合对哮喘急性发作期具有较高的诊断价值。
Objective To investigate the diagnostic value of serum matrix metalloproteinase(MMP)-9,secreted frizzled-related protein 5(SFRP5),and fractional exhaled nitric oxide(FeNO)in children with acute asthma exacerbation.Methods A total of 82 children with acute asthma exacerbation treated at Yangling Demonstration Zone Hospital from December 2021 to December 2023 were enrolled as the acute exacerbation group.According to the severity grading criteria for acute exacerbation and in combination with clinical manifestations,they were further classified into a mild group(n=33),a moderate group(n=28),and a severe group(n=21).During the same period,57 children with stable asthma who visited the hospital were enrolled as the stable group,and 50 healthy children undergoing physical examination at the hospital were included as the control group.Serum MMP-9 and SFRP5 levels were measured by enzyme-linked immunosorbent assay,and FeNO levels were determined with the FeNO analyzer.Spearman correlation analysis was used to evaluate the relationships of serum MMP-9,SFRP5,and FeNO levels with disease severity in children with acute asth-ma exacerbation.Multivariate Logistic regression was used to analyze the influencing factors of acute asthma exacerbation.The receiver operating characteristic(ROC)curve was drawn to analyze the diagnostic value of serum MMP-9,SFRP5 and FeNO for acute asthma exacerbation.Results Compared with the control and sta-ble groups,serum MMP-9 and FeNO levels were significantly higher and serum SFRP5 levels were signifi-cantly lower in the acute exacerbation group(P<0.05).In children with acute asthma exacerbation,serum MMP-9 and FeNO levels increased progressively with increasing disease severity(P<0.05),whereas serum SFRP5 levels decreased progressively with increasing severity(P<0.05).Spearman correlation analysis showed that serum MMP-9 and FeNO levels were positively correlated with disease severity in children with acute asthma exacerbation(r=0.439 and 0.466,P<0.001),while serum SFRP5 levels were negatively corre-lated with disease severity(r=-0.510,P<0.001).The proportions of recent respiratory tract infection his-tory and recent allergen exposure history in the acute exacerbation group were significantly higher than those in the stable group(P<0.05).Multivariate Logistic regression indicated that recent respiratory tract infection history,recent allergen exposure history,elevated serum MMP-9,and elevated FeNO were risk factors for a-cute asthma exacerbation(P<0.05),whereas elevated serum SFRP5 was a protective factor(P<0.05).ROC curve analysis showed that the areas under the curve(AUC)of serum MMP-9,SFRP5,and FeNO for diagno-sing acute asthma exacerbation were 0.810,0.860,and 0.832,respectively,while the AUC of the combined di-agnosis of the three was 0.958,which was significantly better than the individual diagnosis of each(Z_(three combined-MMP-9)=4.240,P<0.001;Z_(three combined-SFRP5)=3.119,P=0.002;Z_(three combined-FeNO)=4.051,P<0.001).Conclusion In children with acute asthma exacerbation,serum MMP-9 and FeNO levels were significantly in-creased,whereas serum SFRP5 levels were significantly decreased.The combination of the three has high diag-nostic value for acute asthma exacerbation.
作者
尚朋娟
杨芳芳
赵秋妮
SHANG Pengjuan;YANG Fangfang;ZHAO Qiuni(Department of Pediatrics,Yangling Demonstration Zone Hospital,Xianyang,Shaanxi 712100,China;Department of Pediatrics,the First People's Hospital of Xianyang,Xianyang,Shaanxi 712000,China;Department of Pediatrics,Xingping People's Hospital,Xingping,Shaanxi 713100,China)
出处
《国际检验医学杂志》
2025年第24期3030-3035,共6页
International Journal of Laboratory Medicine
