摘要
目的 探讨血清髓系分化初级反应蛋白88(MyD88)、肿瘤坏死因子受体相关因子6(TRAF-6)在儿童重度急性呼吸道感染辅助诊断和预后评估中的价值.方法 选取2020年1月—2022年6月南阳市中心医院儿童急性呼吸道感染患儿80例(急性呼吸道感染组).根据病原学检测结果分为非细菌感染组(42例)和细菌感染组(38例).根据患儿病情严重程度分为轻度组(28例)、中度组(20例)、重度组(32例).根据患儿预后情况分为预后良好组(58例)和预后不良组(22例).以同期80名体检健康儿童为正常对照组.采用多因素Logistic回归分析评估急性呼吸道感染患儿预后的影响因素.采用受试者工作特征(ROC)曲线评价各项指标诊断儿童重度急性呼吸道感染和评估预后的效能.结果 急性呼吸道感染组血清MyD88、TRAF-6水平显著高于正常对照组(P<0.001).细菌感染组血清MyD88、TRAF-6水平显著高于非细菌感染组(P<0.001).轻度组、中度组、重度组血清MyD88、TRAF-6水平依次升高(P<0.001).ROC曲线分析结果显示,血清MyD88、TRAF-6单项检测和联合检测诊断重度急性呼吸道感染的曲线下面积(AUC)分别为0.762、0.734、0.876.预后不良组细菌感染、下呼吸道感染、重度病情所占比例和白细胞(WBC)计数、反应蛋白(CRP)、MyD88、TRAF-6水平均显著高于预后良好组(P<0.05).多因素Logistic回归分析结果显示,重度病情、CRP升高、MyD88升高、TRAF-6升高均是儿童急性呼吸道感染预后不良的危险因素[比值比(OR)值分别为1.693、1.864、3.218、2.869,95%可信区间(CI)分别为1.142～2.510、1.228～2.830、1.561～6.633、1.511～5.446,P<0.05].ROC曲线分析结果显示,血清MyD88、TRAF-6、CRP单项检测和联合检测判断急性呼吸道感染患儿预后的AUC分别为0.848、0.900、0.817、0.951.结论 急性呼吸道感染患儿血清MyD88、TRAF-6水平显著升高,联合检测对儿童重度急性呼吸道感染的辅助诊断和预后评估均有较高的临床价值.
Abstract
Objective To investigate the roles of serum myeloid differentiation primary response protein 88(MyD88)and tumor necrosis factor receptor-associated factor 6(TRAF-6)combined determination in the diagnosis and prognosis of severe acute respiratory tract infection in children.Method Totally,80 children with acute respiratory tract infection(acute respiratory tract infection group)in Nanyang Central Hospital from January 2020 to June 2022 were enrolled.According to the results of etiological diagnosis,they were classified into non-bacterial infection group(42 cases)and bacterial infection group(38 cases).According to the severity of patients'condition,they were classified into mild group(28 cases),moderate group(20 cases)and severe group(32 cases).According to the prognosis of children,they were classified into good prognosis group(58 cases)and poor prognosis group(22 cases).Totally,80 healthy children were enrolled as controls.Multivariate Logistic regression analysis was used to evaluate the prognostic factors of acute respiratory tract infection in children.Receiver operating characteristic(ROC)curve was used to analyze the diagnostic roles of serum MyD88 and TRAF-6 levels for severe acute respiratory tract infection in children.Results Serum levels of MyD88 and TRAF-6 in acute respiratory tract infection group were higher than those in control group(P<0.001).Serum levels of MyD88 and TRAF-6 in bacterial infection group were higher than those in non-bacterial infection group(P<0.001).Serum levels of MyD88 and TRAF-6 in mild,moderate and severe groups were increased in turn(P<0.001).The areas under curves(AUC)of serum MyD88 and TRAF-6 single and combined determinations for the diagnosis of severe acute respiratory tract infection were 0.762,0.734 and 0.876,respectively.The proportion of bacterial infection,infection site in lower respiratory tract,the proportion of severe disease and the levels of white blood cell(WBC)count,C-reactive protein(CRP),MyD88 and TRAF-6 in poor prognosis group were higher than those in good prognosis group(P<0.05).The severity of disease,elevated CRP,MyD88 and TRAF-6 were all risk factors for poor prognosis of children with acute respiratory tract infection[odds ratios(OR)were 1.693,1.864,3.218 and 2.869,95%confidence intervals(CI)were 1.142-2.510,1.228-2.830,1.561-6.633 and 1.511-5.446,P<0.05].The AUC of serum MyD88,TRAF-6 and CRP for the prognosis of children with acute respiratory tract infection were 0.848,0.900,0.817 and 0.951,respectively.Conclusions Serum levels of MyD88 and TRAF-6 in children with acute respiratory tract infection are elevated,and the combined determination has good evaluation value in the diagnosis and prognosis of severe acute respiratory tract infection in children.
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