2023 年第 3 期 第 18 卷

血γ干扰素和嗜酸性粒细胞百分比对重症哮喘患儿治疗后1年内复发的预测价值

Predictive value of blood interferon-γ and eosinophil percentage for recurrence of children with severe asthma within 1 year of treatment

作者：丁妞陈艳萍吴碧琛罗淑娟

英文作者：Ding Niu Chen Yanping Wu Bichen Luo Shujuan

单位：湖南省儿童医院呼吸内科，长沙410007

英文单位：Department of Respiratory Medicine Hunan Children′s Hospital Changsha 410007 China

关键词：支气管哮喘；γ干扰素；嗜酸性粒细胞；预测价值

英文关键词：Bronchialasthma;Interferon-γ;Eosinophils;Predictivevalue

• 摘要：

• 目的 探讨血γ干扰素和嗜酸性粒细胞百分比（EOS%）对重症哮喘患儿治疗后1年内复发的预测价值。方法 选择2019年1月至2021年1月到湖南省儿童医院进行诊治的120例哮喘患儿，根据患儿病情分为重症哮喘组（45例）和轻症哮喘组（75例）。选择同期到本院进行体检的100例健康儿童作为对照组。检测3组儿童血γ干扰素和EOS%，并且对气道功能进行检查。哮喘患儿均采用多索茶碱静脉滴注和布地奈德吸入治疗。重症哮喘患儿治疗好转后出院并进行1年随访，依据随访情况将患儿分为再发亚组和控制亚组。采用Logistic回归方法分析重症哮喘患儿随访1年内复发的影响因素。采用Pearson相关性分析方法分析重症哮喘患儿血清γ干扰素和外周血EOS%与气道功能指标的相关性。应用受试者工作特征（ROC）曲线分析血清γ干扰素和外周血EOS%对重症哮喘患儿随访1年内复发的预测价值。结果 轻症和重症哮喘组血清γ干扰素水平低于对照组，外周血EOS%高于对照组，重症哮喘组血清γ干扰素水平低于轻症哮喘组，外周血EOS%高于轻症哮喘组（均P＜0.05）。重症哮喘组用力呼气25%时瞬间流速（FEF25%）、用力呼气50%时瞬间流速（FEF50%）、用力肺活量（FVC）和第1秒用力呼气容积（FEV1）/FVC比值均低于轻症哮喘组和对照组（均P＜0.05）。45例重症哮喘患儿中，有19例随访1年内出现复发（再发亚组），26例未复发（控制亚组）。Logistic回归分析结果显示，血清γ干扰素水平（比值比=8.793，95%置信区间：3.198～24.176，P＜0.001）和外周血EOS%（比值比=7.591，95%置信区间：3.590～16.050，P＜0.001）是重症哮喘患儿随访1年内复发的独立危险因素。Pearson相关性分析结果显示，重症哮喘患儿血清γ干扰素水平与FEF25%、FEF50%、FVC和FEV1/FVC比值均呈正相关,外周血EOS%与FEF25%、FEF50%、FVC和FEV1/FVC比值均呈负相关（均P＜0.05）。ROC曲线分析结果显示，血清γ干扰素水平和外周血EOS%预测重症哮喘患儿随访1年内复发的曲线下面积分别为0.783和0.814，二者联合预测的曲线下面积为0.866，特异度为75.38%，敏感度为86.28%。结论 血γ干扰素水平和EOS%与重症哮喘患儿气道功能存在相关性，二者联合对重症哮喘患儿1年内复发有较好预测价值。

• Objective  To investigate the predictive value of serum interferon-γ and peripheral blood eosinophil percentage (EOS%) levels for recurrence of children with severe asthma within 1 year of treatment. Methods  A total of 120 children with asthma were selected from Hunan Children′s Hospital from January 2019 to January 2021. They were divided into severe asthma group (45 cases) and mild asthma group (75 cases) according to their conditions. One hundred healthy children undergoing physical examination in the hospital were selected as the control group. The serum interferon-γ and peripheral blood EOS% levels in three groups of children were tested, and airway function was examined. Children with asthma were treated with intravenous doxofylline infusion and inhaling budesonide. Children with severe asthma were discharged from the hospital after improvement and followed-up for 1 year. They were divided into recurrence subgroup and controlled subgroup based on the condition during follow-up. Logistic regression analysis was used to analyze the influencing factors of recurrence of children with severe asthma during 1-year follow-up. Pearson correlation analysis was performed to analyze the correlation of serum interferon-γ and peripheral blood EOS% levels with indices of airway function. Receiver operating characteristic (ROC) curve analysis was applied to analyze predictive value of serum interferon-γ and peripheral blood EOS% levels for recurrence of children with severe asthma within 1-year follow-up. Results  Compared to control group, the serum interferon-γ level in mild and severe asthma groups was lower and the peripheral blood EOS% level was higher; compared to mild asthma group, the serum interferon-γ level in severe asthma group was lower and peripheral blood EOS% level was higher (all P＜0.05). The forced expiratory flow 25% (FEF25%), forced expiratory flow 50% (FEF50%), forced vital capacity (FVC) and forced expiratory volume in the first second to FVC ratio (FEV1/FVC ratio) in the severe asthma group were lower than those in the mild asthma group and the control group (all P＜0.05). Among 45 children with severe asthma, 19 experienced recurrence within 1-year follow-up (recurrence subgroup) and 26 did not (controlled subgroup). Logistic regression analysis showed that the serum interferon-γ level (odds ratio=8.793, 95% confidence interval: 3.198-24.176, P＜0.001) and peripheral blood EOS% level (odds ratio=7.591, 95% confidence interval: 3.590-16.050, P＜0.001) were independent risk factors for recurrence of children with severe asthma within 1-year follow-up. Pearson correlation analysis showed that the serum interferon-γ level was positively correlated with FEF25%, FEF50%, FVC and FEV1/FVC ratio in children with severe asthma, while the peripheral blood EOS% level was negatively correlated with FEF25%, FEF50%, FVC and FEV1/FVC ratio (all P＜0.05). ROC curve analysis showed that areas under the curve of serum interferon-γ and peripheral blood EOS% levels were 0.783 and 0.814, respectively, in predicting recurrence of children with severe asthma within 1-year follow-up. The combined prediction of both had an area under the curve of 0.866, a specificity of 75.38%, and a sensitivity of 86.28%. Conclusion  Levels of serum interferon-γ and peripheral blood EOS% were correlated with airway function in children with severe asthma, and the combination was positively predictive of the disease recurrence within 1-year.