摘要
目的:探讨难治性癫痫儿童血浆激肽释放酶(KLK)、组织蛋白酶B(catB)表达及其临床意义.方法:选取2017 年 3 月至 2019 年 3 月河南中医药大学第五临床医学院收治的难治性癫痫患儿 43 例为研究对象,纳入研究组.选择同期在本院治疗的治疗有效癫痫患儿,同期在本院体检的健康儿童作为对照,分别纳入治疗有效组(n = 35)及对照组(n =50).①对 3 组受试儿血浆KLK、catB,白细胞介素(IL)-6、IL-8、肿瘤坏死因子(TNF)-α水平分别进行统计学分析.②分析研究组患儿血浆KLK、catB水平,分别与其血浆IL-8、IL-6、TNF-α水平的相关关系.③受试者工作特征(ROC)曲线的曲线下面积(AUC),对难治性癫痫的诊断截断值、诊断灵敏度及特异度.④采取多因素非条件 Logistic回归分析难治性癫痫临床诊断的独立影响因素.结果:①研究组患儿血浆 KLK、catB、IL-6、IL-8、TNF-α水平,均显著高于对照组、治疗有效组,并且差异均有统计学意义(P＜0.05).②研究组患儿血浆KLK、catB水平与其IL-6、IL-8、TNF-α水平,均呈正相关关系(r =0.625、0.628、0.657,0.634、0.619、0.664,P＜0.05).③血浆KLK、catB水平ROC曲线的AUC分别为 0.889、0.856,对难治性癫痫的诊断截断值分别为 3.99 U/mL、3.66 U/mL,二者单独诊断难治性癫痫的灵敏度分别为 72.10%、72.10%,特异度分别为 92.00%、94.00%;二者联合诊断的AUC为 0.950,灵敏度为 86.00%,特异度为 90.70%.④血浆 KLK 高表达(OR = 2.652,95%CI:1.668～4.218,P＜0.05),以及catB高表达(OR =2.635,95%CI:1.704～4.075,P＜0.05),均是导致患儿发生难治性癫痫的独立危险因素.结论:难治性癫痫儿童血浆KLK、catB水平高表达,对难治性癫痫患儿的临床诊断具有重要参考价值.
Abstract
Objective:To explore the expression and clinical significance of plasma kallikrein(KLK)and cathepsin B(catB)in management of children with drug-resistant epilepsy.Methods:A total of 43 children with drug-resistant epilepsy admitted to the Fifth Clinical Medical College of Henan University of Traditional Chinese Medicine from March 2017 to March 2019 were selected were selected as study subjects.They were included into research group.Meanwhile and in the same hospital,35 children with effective epilepsy treatment,and 50 healthy physical examination children were included into effective epilepsy treatment group and control group as control,respectively.①The levels of KLK,catB,interleukin(IL)-6,IL-8 and tumor necrosis factor(TNF)-α were statistically analyzed among three groups.②Levels of plasma KLK and catB,correlation analysis to levels of plasma IL-8,IL-6,and TNF-α,respectively.③Diagnostic for refractory epilepsy of cutoff value,diagnostic sensitivity,and specificity by area under curve(AUC)of the receiver operating characteristic(ROC)curve.④Identify independent influencing factors in the clinical diagnosis of refractory epilepsy by multiple factor unconditional logistic analysis.Results:①The levels of plasma KLK,catB,IL-6,IL-8 and TNF-α in research group were higher than those in effective epilepsy treatment group and control group,respectively,and the differences were all statistically significant(P＜0.05).②Serum KLK and catB levels were positively correlated with IL-6,IL-8 and TNF-α levels in research group(r =0.625、0.628、0.657,0.634、0.619、0.664,P＜0.05).③The AUC of the ROC curves of plasma KLK and catB levels were 0.889 and 0.856,respectively.cutoff values for diagnosis of refractory epilepsy were 3.99U/mL and 3.66U/mL,respectively.The sensitivity and specificity for diagnosing refractory epilepsy were 72.10%and 72.10%,and 92.00%and 94.00%,respectively.The AUC of combined of KLK and catB levels diagnosis for refractory epilepsy was 0.950,sensitivity was 86.00%and specificity was 90.70%.④High expression of plasma KLK(OR = 2.652,95%CI:1.668～4.218,P＜0.05)and high expression of catB(OR =2.635,95%CI:1.704～4.075,P＜0.05)were all independent risk factors for refractory epilepsy.Conclusion:The levels of KLK and catB in plasma of children with intractable epilepsy are highly expressed,which has important reference value for the diagnosis of intractable epilepsy.
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