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

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.