黄光举, 张慧玉, 李娟, 李佳, 徐静. 肿瘤坏死因子相关激活蛋白、CD4+/CD8+、IL-4与儿童细菌性社区获得性肺炎经典炎症标志物的关系研究[J]. 蚌埠医学院学报, 2022, 47(4): 482-486. DOI: 10.13898/j.cnki.issn.1000-2200.2022.04.014
    引用本文: 黄光举, 张慧玉, 李娟, 李佳, 徐静. 肿瘤坏死因子相关激活蛋白、CD4+/CD8+、IL-4与儿童细菌性社区获得性肺炎经典炎症标志物的关系研究[J]. 蚌埠医学院学报, 2022, 47(4): 482-486. DOI: 10.13898/j.cnki.issn.1000-2200.2022.04.014
    HUANG Guang-ju, ZHANG Hui-yu, LI Juan, LI Jia, XU Jing. Relationship between CD40L, CD4+/CD8+, IL-4 and the classic inflammation biomarkers for bacterial pediatric community acquired pneumonia and the predictive performance in antibacterial therapy[J]. Journal of Bengbu Medical College, 2022, 47(4): 482-486. DOI: 10.13898/j.cnki.issn.1000-2200.2022.04.014
    Citation: HUANG Guang-ju, ZHANG Hui-yu, LI Juan, LI Jia, XU Jing. Relationship between CD40L, CD4+/CD8+, IL-4 and the classic inflammation biomarkers for bacterial pediatric community acquired pneumonia and the predictive performance in antibacterial therapy[J]. Journal of Bengbu Medical College, 2022, 47(4): 482-486. DOI: 10.13898/j.cnki.issn.1000-2200.2022.04.014

    肿瘤坏死因子相关激活蛋白、CD4+/CD8+、IL-4与儿童细菌性社区获得性肺炎经典炎症标志物的关系研究

    Relationship between CD40L, CD4+/CD8+, IL-4 and the classic inflammation biomarkers for bacterial pediatric community acquired pneumonia and the predictive performance in antibacterial therapy

    • 摘要:
      目的探讨肿瘤坏死因子相关激活蛋白(CD40L)、CD4+/CD8+、白细胞介素-4(IL-4)与儿童细菌性社区获得性肺炎(CAP)经典炎症标志物的关系及预测抗菌治疗效果的效能。
      方法选取300例儿童细菌性CAP患儿,均给予化痰、止咳、平喘及抗感染治疗, 其中43例治疗无效(观察组)及257例治疗有效(对照组),比较2组治疗前白细胞计数(WBC)、C反应蛋白(CRP)、降钙素原(PCT)及CD40L、CD4+/CD8+、IL-4,采用Pearson分析CD40L、CD4+/CD8+、IL-4与经典炎症标志物的关系及CD40L、CD4+/CD8+、IL-4之间的关系,采用logistic回归方程分析CD40L、CD4+/CD8+、IL-4与治疗无效的关系,采用受试者工作特征曲线(ROC)及ROC下面积(AUC)分析CD40L、CD4+/CD8+、IL-4预测抗菌治疗效果的效能。
      结果观察组WBC、CRP、PCT、CD40L、IL-4水平均高于对照组(P < 0.01),CD4+/CD8+低于对照组(P < 0.01);CD40L与WBC、CRP、PCT均呈正相关(r=0.720、0.433、0.832,P < 0.01),CD4+/CD8+与WBC、CRP、PCT呈负相关(r=-0.709、-0.449、-0.698,P < 0.01),IL-4与WBC、CRP、PCT呈正相关(r=0.889、0.760、0.723,P < 0.01);CD40L、CD4+/CD8+、IL-4均与治疗无效的相关性具有统计学意义(P < 0.01);CD40L与CD4+/CD8+呈负相关(r=-0.776,P < 0.01),与IL-4呈正相关(r=0.554,P < 0.01);CD4+/CD8+与IL-4呈负相关(r=-0.538,P < 0.01);单一指标中IL-4预测抗菌治疗效果的AUC最大为0.805,各指标联合预测抗菌治疗效果的AUC为0.867,敏感度达79.07%,大于任一单一指标(P < 0.01)。
      结论CD40L、IL-4、CD4+/CD8+与经典炎症标志物存在一定相关性,可在一定程度上反映细菌性CAP患儿病情程度,治疗期间进行动态监测可及早预测疗效,为细菌性CAP患儿后续治疗提供参考依据。

       

      Abstract:
      ObjectiveTo investigate the relationship between tumor necrosis factor-related activator protein(CD40L), CD4+/CD8+, interleukin-4(IL-4) and classic inflammatory biomarkers of bacterial pediatric community acquired pneumonia(CAP) and the predictive efficacy in antibacterial therapy.
      MethodsA total of 300 children with bacterial CAP were selected for treatment of phlegm removing, cough relieving, asthma reducing and anti-infection.The non-response cases were set as observation group(n=43) and the improved cases were set as control group(n=257).The white blood cell count(WBC), C-reactive protein(CRP), procalcitonin(PCT), CD40L, CD4+/CD8+ and IL-4 were detected before treatment.Pearson correlation analysis was used to analyze the relationship between CD40L, CD4+/CD8+, IL-4 and classic inflammation markers and the relationship between CD40L, CD4+/CD8+, IL-4.The logistic regression equation was used to analyze the relationship between CD40L, CD4+/CD8+, IL-4 and non-response treatment.The receiver operating characteristic(ROC) curve and the area under the ROC cure(AUC) were used to analyze the predictive efficacy of CD40L, CD4+/CD8+ and IL-4 of antibacterial treatment.
      ResultsWBC, CRP, PCT, CD40L and IL-4 in the observation group were higher than those in the control group(P < 0.01) and CD4+/CD8+ was lower than that in the control group(P < 0.01).CD40L was positively correlated with WBC, CRP and PCT(r=0.720, 0.433, 0.832, P < 0.01), CD4+/CD8+ was negatively correlated with WBC, CRP and PCT(r=-0.709, -0.449, -0.698, P < 0.01), IL-4 was positively correlated with WBC, CRP and PCT(r=0.889, 0.760, 0.723, P < 0.01).CD40L, CD4+/CD8+, IL-4 were all significantly correlated with treatment failure(P < 0.01).CD40L was negatively correlated with CD4+/CD8+, and positively correlated with IL-4(r=-0.776, 0.554, P < 0.01).CD4+/CD8+ was negatively correlated with IL-4(r=-0.538, P < 0.01).Among the single indicators, the maximum AUC of IL-4 predicting the effect of antibacterial treatment was 0.805, the AUC of each indicator combined to predict the effect of antibacterial treatment was 0.867, and the sensitivity was 79.07%, which was greater than any single indicator(P < 0.05).
      ConclusionsThere is a certain correlation between CD40L, IL-4, CD4+/CD8+ and classic inflammatory biomarkers, which can reflect the severity of disease in bacterial pediatric CAP to a certain extent.Dynamic monitoring will provide timely predictive value and better reference for the follow-up treatment of bacterial pediatric CAP.

       

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