效应T细胞、调节T细胞失衡与支气管哮喘患儿病情程度的相关性及对疾病控制情况的预测价值
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摘要
目的研究效应T细胞(Th)、调节T细胞(Treg)失衡与支气管哮喘患儿严重性的相关性及对疾病控制情况的预测价值。方法选取2017年7月—2018年7月于温州中西医结合医院就诊的支气管哮喘患儿124例,根据患儿疾病严重程度分为轻度组(56例)和重度组(68例),采用流式细胞仪检测患儿Th、Treg水平,分析Th、Treg及其比值与疾病严重程度的相关性;随访2个月,根据患儿复发情况分为复发组(45例)和未复发组(79例),检测Th、Treg水平并绘制预测患儿复发情况的ROC曲线。结果重度组Th和Th/Treg显著高于轻度组,Treg显著低于轻度组(均P<0.05);Pearson相关分析显示,支气管哮喘严重程度与Th、Treg及其比值有较高的相关性(r=0.651、-0.681、0.786);复发组Th、Treg及其比值显著高于未复发组(均P<0.05);ROC曲线显示,Th、Treg及其比值对支气管哮喘患儿近期复发情况具有较高的预测效能,其AUC分别为0.511、0.617和0.773,其中Th/Treg的AUC值与Th和Treg差异有统计学意义(均P<0.05);Th/Treg预测的灵敏度为82.22%,高于Th和Treg单独预测(均P<0.05)。结论效应T细胞、调节T细胞失衡与支气管哮喘患儿疾病严重度存在明显的相关性,Th和Treg的比值对于预测患儿近期复发情况具有较高的诊断效能。
Objective To study the correlation between the imbalance of effector T cells(Th) and regulatory T cells(Treg) and the severity of bronchial asthma in children and its predictive value for disease control. Methods One hundred and twenty-four children with bronchial asthma from July 2017 to July 2018 were divided into mild group(56 cases) and severe group(68 cases) according to the severity of the disease. Th and Treg levels were detected by flow cytometry, and the correlation between Th, Treg and their ratio and the severity of the disease was analyzed. The children were followed up two months to observe the recurrence of the two groups. The children were divided into recurrence group(45 cases) and non-recurrence group(79 cases), Th and Treg levels were measured and ROC curves were drawn to predict the recurrence of the two groups. Results Th and Th/Treg in severe group were significantly higher than those in mild group, while Treg was significantly lower than that in mild group(P<0.05). Pearson correlation analysis showed that the severity of bronchial asthma was highly correlated with Th, Treg and their ratios(r=0.651,-0.681, 0.786); Th, Treg and their ratios in recurrent group were significantly higher than those in mild group(P<0.05). ROC curves showed that Th, Treg and their ratios had a high predictive power for the recent recurrence of bronchial asthma in children, AUC were 0.511, 0.617 and 0.773 respectively, and the AUC value of Th/Treg was significantly higher than that of Th and Treg(P<0.05). The sensitivity of Th/Treg was 82.22%, significantly higher than those of Th and Treg. Conclusion There is a significant correlation between the imbalance of effector T cells and regulatory T cells and the severity of bronchial asthma in children, and the ratio of Th to Treg has a higher diagnostic efficiency in predicting the short-term recurrence in children.
Objective To study the correlation between the imbalance of effector T cells(Th) and regulatory T cells(Treg) and the severity of bronchial asthma in children and its predictive value for disease control. Methods One hundred and twenty-four children with bronchial asthma from July 2017 to July 2018 were divided into mild group(56 cases) and severe group(68 cases) according to the severity of the disease. Th and Treg levels were detected by flow cytometry, and the correlation between Th, Treg and their ratio and the severity of the disease was analyzed. The children were followed up two months to observe the recurrence of the two groups. The children were divided into recurrence group(45 cases) and non-recurrence group(79 cases), Th and Treg levels were measured and ROC curves were drawn to predict the recurrence of the two groups. Results Th and Th/Treg in severe group were significantly higher than those in mild group, while Treg was significantly lower than that in mild group(P<0.05). Pearson correlation analysis showed that the severity of bronchial asthma was highly correlated with Th, Treg and their ratios(r=0.651,-0.681, 0.786); Th, Treg and their ratios in recurrent group were significantly higher than those in mild group(P<0.05). ROC curves showed that Th, Treg and their ratios had a high predictive power for the recent recurrence of bronchial asthma in children, AUC were 0.511, 0.617 and 0.773 respectively, and the AUC value of Th/Treg was significantly higher than that of Th and Treg(P<0.05). The sensitivity of Th/Treg was 82.22%, significantly higher than those of Th and Treg. Conclusion There is a significant correlation between the imbalance of effector T cells and regulatory T cells and the severity of bronchial asthma in children, and the ratio of Th to Treg has a higher diagnostic efficiency in predicting the short-term recurrence in children.
引文
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[12] NABIH E S,KAMEL H F,KAMEL T B.Association between CD14 polymorphism (-1145G/A) and childhood bronchial asthma[J].Biochem Genet,2016,54(1):1-11.
[13] WEI Y,LIU B,SUN J,et al.Regulation of Th17/Treg function contributes to the attenuation of chronic airway inflammation by icariin in ovalbumin-induced murine asthma model[J].Immunobiology,2015,220(6):789-797.
[14] 胡琦.IDO、Treg/Th17分化与中性粒细胞性哮喘[J].重庆医学,2016,45(34):4852-4854.
[15] 徐静,金晓洁,缪志海,等.支气管哮喘小鼠细胞免疫因子及Th17细胞水平的变化及发病机制研究[J].浙江医学,2018,40(3):221-223.
[16] 苗青,刘永革,王燕,等.不同致敏模式支气管哮喘患儿外周血T淋巴细胞亚群比较及临床意义[J].中国免疫学杂志,2018,34(1):84-90.
[17] JI N F,XIE Y C,ZHANG M S,et al.Ligustrazine corrects Th1/Th2 and Treg/Th17 imbalance in a mouse asthma model[J].Int Immunopharmacol,2014,21(1):76-81.
[18] HUANG F,YIN J N,WANG H B,et al.Association of imbalance of effector T cells and regulatory cells with the severity of asthma and allergic rhinitis in children[J].Allergy Asthma Proc,2017,38(6):70-77.
[19] 丁庆辉.孟鲁司特联合舒利迭治疗哮喘的临床疗效及对Th17、调节性T细胞平衡和IL-4、IFN-γ表达的影响[J].菏泽医学专科学校学报,2017,29(4):33-35.
[20] 肖钦文,李海梅,曾珠,等.Th17、Treg细胞失衡与哮喘-慢阻肺重叠综合征的相关性及金匮肾气丸干预后的影响研究[J].中药药理与临床,2018,34(2):5-9.
[21] YU J H,LONG L,LUO Z X,et al.Effect of PPAR γ agonist (rosiglitazone) on the secretion of Th2 cytokine in asthma mice[J].Asian Pac J Trop Med,2017,10(1):64-68.
[2] ITAGATI T,AOKI Y,MATOBA Y,et al.Clinical characteristics of children infected with enterovirus D68 in an outpatient clinic and the association with bronchial asthma[J].Infect Dis(Lond),2018,50(4):303-312.
[3] LIAO W,ZHOU L,ZHAO X,et al.Thermoneutral housing temperature regulates T-regulatory cell function and inhibits ovabumin-induced asthma development in mice[J].Sci Rep,2017,7(1):7123.
[4] MALOVRH M M,ROZMAN ,et al.Bronchial thermoplasty resulted in an increase of CD4+ CD25+ regulatory T cells in severe asthma patients[J].Eur Respir J,2016,48(suppl 60):PA4906.
[5] 中华医学会儿科学分会呼吸学组.儿童支气管哮喘诊断与防治指南(2016年版)[J].中华儿科杂志,2016,54(3):167-181.
[6] JIANG X G,YANG X D,LV Z,et al.Elevated serum levels of TNF-α,IL-8,and ECP can be involved in the development and progression of bronchial asthma[J].J Asthma,2018,55(2):111-118.
[7] VALEROMORENO S,PEREZMARIN M,MONTOYACASTILLA I,et al.Emotional distress in family caregivers of adolescents with bronchial asthma:analysis of its predictors[J].Arch Argent Pediatr,2018,116(2):e234.
[8] SZILASI M E,PAK K,KARDOS L,et al.The alteration of irisin-brain-derived neurotrophic factor axis parallels severity of distress disorder in bronchial asthma patients[J].Front Neurosci,2017,11(23):653.
[9] 马娜,朱凤莲,陈莉,等.维生素D3对支气管哮喘患儿CD4+CD25+调节性T细胞和Th17细胞的影响[J].中华实用诊断与治疗杂志,2017,31(7):703-705.
[10] 高阳,杨帆.支气管哮喘患者外周血Th1、Th2与Th17细胞表达水平及临床意义[J].解放军医药杂志,2017,29(1):76-79.
[11] 任志红,赵璇.呼吸道病毒感染对哮喘患儿Th1/Th2细胞因子的影响[J].西南国防医药,2018,28(3):234-236.
[12] NABIH E S,KAMEL H F,KAMEL T B.Association between CD14 polymorphism (-1145G/A) and childhood bronchial asthma[J].Biochem Genet,2016,54(1):1-11.
[13] WEI Y,LIU B,SUN J,et al.Regulation of Th17/Treg function contributes to the attenuation of chronic airway inflammation by icariin in ovalbumin-induced murine asthma model[J].Immunobiology,2015,220(6):789-797.
[14] 胡琦.IDO、Treg/Th17分化与中性粒细胞性哮喘[J].重庆医学,2016,45(34):4852-4854.
[15] 徐静,金晓洁,缪志海,等.支气管哮喘小鼠细胞免疫因子及Th17细胞水平的变化及发病机制研究[J].浙江医学,2018,40(3):221-223.
[16] 苗青,刘永革,王燕,等.不同致敏模式支气管哮喘患儿外周血T淋巴细胞亚群比较及临床意义[J].中国免疫学杂志,2018,34(1):84-90.
[17] JI N F,XIE Y C,ZHANG M S,et al.Ligustrazine corrects Th1/Th2 and Treg/Th17 imbalance in a mouse asthma model[J].Int Immunopharmacol,2014,21(1):76-81.
[18] HUANG F,YIN J N,WANG H B,et al.Association of imbalance of effector T cells and regulatory cells with the severity of asthma and allergic rhinitis in children[J].Allergy Asthma Proc,2017,38(6):70-77.
[19] 丁庆辉.孟鲁司特联合舒利迭治疗哮喘的临床疗效及对Th17、调节性T细胞平衡和IL-4、IFN-γ表达的影响[J].菏泽医学专科学校学报,2017,29(4):33-35.
[20] 肖钦文,李海梅,曾珠,等.Th17、Treg细胞失衡与哮喘-慢阻肺重叠综合征的相关性及金匮肾气丸干预后的影响研究[J].中药药理与临床,2018,34(2):5-9.
[21] YU J H,LONG L,LUO Z X,et al.Effect of PPAR γ agonist (rosiglitazone) on the secretion of Th2 cytokine in asthma mice[J].Asian Pac J Trop Med,2017,10(1):64-68.
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