首次喘息婴幼儿再发喘息相关危险因素分析

发布时间：2018-05-16 10:46

本文选题：嗜酸性粒细胞衍生神经毒素 + 反复喘息　；参考：《天津医科大学》2017年硕士论文

【摘要】：目的:研究3岁及以下首次喘息儿童1年内再发喘息与出生因素、个人及家族过敏史、血清学因素、血清嗜酸性粒细胞衍生神经毒素(EDN)、嗜酸细胞百分比等因素的相关性,评价EDN、嗜酸细胞百分比对复发风险的预测价值,从而为儿童反复喘息寻找可靠客观的监测指标。方法:收集2015年10月~2016年1月天津市儿童医院感染科住院治疗的3岁及以下首次喘息儿童145例,按出院后随访其1年内是否再次发生喘息分为复发组(n=62)和对照组(n=83)。1.询问并记录所研究对象的年龄、性别、城/乡居住地、是否早产(胎龄37周)、分娩方式(顺产/剖宫产)、是否为头胎儿及住院治疗天数等一般资料。询问并记录所研究对象的的特应性疾病个人史,喘息性疾病、过敏性鼻炎以及其他过敏性疾病的家族史。所有入组患者行血清总Ig E(TIg E)水平检测,血清过敏原特异性Ig E(s Ig E)检测及食物特异性Ig G(食物不耐受)检测,血清EDN检测,末梢血常规,血清呼吸道病原九联抗体检测,鼻咽吸取液七项呼吸道病毒检测。所有研究对象均行胸片或胸CT、心电图、超声心动图等检查助除外心肺发育异常及气管支气管异物。通过比较复发组和对照组各要素之间的关系,评价各要素与喘息复发之间是否存在相关性。2.以EDN为参考,计算敏感度(sensiticivity)和特异度(specificity),评价EDN预测喘息复发的价值。3.以嗜酸性粒细胞百分比(E%)为参考,计算敏感度(sensiticivity)和特异度(specificity),评价其预测喘息复发的价值。结果:1.复发组平均月龄(6.66±7.01)月,男性患儿42例,女性20例,城居者40例,平均住院天数(6.32±2.14)d;对照组平均月龄(6.82±7.07)月,男性患儿53例,女性30例,城居者52例,平均住院天数(7.02±3.01)d,两组比较无统计学差异(P0.05)。2.复发组头胎儿28例,足月儿58例,顺产35例,对照组头胎儿36例,足月儿71例,顺产83例,两组患儿出生学因素无统计学差异(P0.05)。3.复发组湿疹史阳性46例,个人食物药物过敏史阳性4例,过敏性疾病家族史阳性11例;对照组湿疹史阳性38例,个人食物药物过敏史阳性5例,过敏性疾病家族史阳性10例,两组患儿过敏性疾病家族史及个人食物药物过敏史无统计学差异(P0.05);但复发组患儿湿疹史阳性率显著高于对照组(P0.05)且差异有统计学意义。4.复发组呼吸道合胞病毒(RSV)感染阳性20例,肺炎支原体感染5例,流感嗜血杆菌感染1例,乙型流感病毒4例;对照组RSV感染阳性11例,肺炎支原体感染5例,流感嗜血杆菌感染2例,乙型流感病毒1例。复发组RSV感染阳性率显著高于对照组(P0.05)且差异有统计学意义。5.复发组患儿血清TIg E为(43.71±80.44)IU/m L、过敏原s Ig E阳性8例(占12.90%),过敏原Ig G阳性32例(占48.39%),WBC为(9.16±3.76)×109/L,中性粒细胞百分比(N%)为(27.10±13.19)%,;对照组血清TIg E为(44.58±92.23)IU/m L、过敏原s Ig E阳性7例(占20.48%),食物特异性Ig G阳性44例(占53.01%),WBC为(8.99±2.86)×109/L,N%为(30.17±13.61)%。吸入性过敏原主要为尘螨、屋尘、霉菌等,食物不耐受主要为牛奶蛋白、蛋清/蛋黄等。各项指标2组间差别均无统计学意义。6.复发组和对照组患儿入院时血清EDN分别为(68.67±55.5)ng/m L和(27.36±19.51)ng/m L,复发组显著高于对照组,且差异有统计学意义(t=6.331,P0.05)。7.复发组和对照组患儿入院时血嗜酸性粒细胞E%分别为(3.10±2.54)%和(1.31±1.15)%,复发组显著高于对照组,且差异有统计学意义(t=5.68,P0.05)。8.以EDN为参考,诊断首次喘息发作患儿出现再次喘息的敏感度为72.69%、特异度为66.13%。ROC曲线下面积(AUC)=0.79,诊断的截断值为29.95 ng/m L。9.以嗜酸性粒细胞E%为参考,诊断首次喘息发作患儿出现再次喘息的敏感度为90.36%、特异度为51.61%。ROC的AUC=0.75,诊断的截断值为2.50%。10.复发组患儿血清EDN水平与嗜酸性粒细胞E%不存在统计学相关性(r=-0.02,P0.05)。11.可以用湿疹史、RSV感染、EDN和嗜酸粒细胞几个指标联合,计算其敏感度和特异度,评价其预测价值结论:1.RSV感染阳性率在复发组较高,RSV感染可能是喘息复发的危险因素。2.复发组患儿嗜酸性粒细胞百分比水平较高,提示其可能参与了小儿喘息复发的病生理过程.3.EDN在复发组患儿血清中水平较高,以其为预测小儿喘息复发的血清学标志物敏感度和特异度均较高。
[Abstract]:Objective: To investigate the correlation between the factors such as recurrent breathing and birth, allergy, serological factors, serum eosinophil derived neurotoxin (EDN) and eosinophils in 1 years of first wheezing children aged 3 years and below, and to evaluate the predictive value of EDN, eosinophil ratio, and recurrence risk for recurrent asthma in children. Methods: to search for reliable and objective monitoring indicators. Methods: 145 cases of first wheezing children aged 3 and below in Tianjin Children's Hospital infection department in January ~2016 October 2015 were collected and divided into recurrent group (n=62) and control group (n= 83) in 1 years after discharge. The age and sex of the subjects were recorded and recorded. City / town residence, preterm birth (37 weeks of gestational age), delivery mode (parturition / cesarean section), general information on the number of head fetuses and hospitalization days. Inquiries and records of the individual history of atopic diseases, asthmatic diseases, allergic rhinitis, and family history of other hypersensitivity diseases. All the patients were treated with serum total Ig E (TIg E) level detection, serum allergen specific Ig E (s Ig E) detection, food specific Ig G (food intolerance) detection, serum EDN detection, peripheral blood routine, serum respiratory pathogenic nine antibody test, seven respiratory tract virus detection in nasopharynx sucking fluid. All studies were performed on chest or chest CT, ECG, echocardiography and other examinations. By comparing the relationship between the recurrence group and the tracheobronchial foreign body, the correlation between the recurrent group and the control group was compared to evaluate the correlation between the factors and the recurrence of the wheezing recurrence..2. was used as a reference, the sensitivity (sensiticivity) and the specificity (specificity) were calculated, and the value of EDN to predict the recurrence of wheezing was.3. with eosinophils. The value of E% (sensiticivity) and specificity (specificity) was used to assess the value of its prediction of recurrent wheezing. Results: 1. the average monthly age of the recurrent group was (6.66 + 7.01) months, 42 male children, 20 women, 40 urban residents, average hospitalization days (6.32 + 2.14) d, and the average month of the control group (6.82 + 7.07) months, male children 53, female 30. The average length of hospitalization was 52 cases (7.02 + 3.01) d, the two groups had no statistical difference (P0.05) 28 cases of head fetuses in.2. recurrence group, 58 cases of full moon, 35 cases of spontaneous delivery, 36 cases of the head fetus in the control group, 71 cases of full moon, 83 cases, and no statistical difference in the birth learning factors of group two (3.01 cases of eczema in.3. relapse group, and personal food drugs) Sensitive history positive 4 cases, allergic disease family history positive 11 cases, control group eczema positive 38 cases, personal food and drug allergy positive 5 cases, allergic disease family history positive 10 cases, the two group of allergic disease family history and personal food and drug allergy history no statistical difference (P0.05), but the recurrence group of eczema positive rate was significantly higher than that in the recurrence group was significantly higher than that in the recurrent group. The control group (P0.05) and the difference were statistically significant in the.4. recurrent group, 20 cases of respiratory syncytial virus (RSV) infection, 5 cases of Mycoplasma pneumoniae infection, 1 cases of Haemophilus influenzae infection, 4 cases of influenza B virus, 11 cases of RSV infection in the control group, 5 cases of Mycoplasma pneumoniae infection, 2 cases of Haemophilus influenzae infection, 1 cases of influenza B virus, RSV in the recurrence group. The positive rate of infection was significantly higher than that of the control group (P0.05) and the difference was statistically significant (43.71 + 80.44) IU/m L, 8 cases of s Ig E positive in the allergen (12.90%), 32 cases of Ig G (48.39%), WBC was (9.16 + 3.76) and (27.10 + 13.19)%, while the control group was (44.58) (44.58. 13.19)%. IU/m L, IU/m L, allergens s Ig E positive (20.48%), food specific Ig G positive (53.01%), WBC (8.99 + 2.86) x 109/L, N% (30.17 + 13.61)%. Inhalation allergens are mainly dust mites, house dust, mould and so on, food intolerance is mainly milk protein, egg yolk and so on. There are no statistically significant difference between 2 groups of 2 groups. The serum EDN of hair group and control group were (68.67 + 55.5) ng/m L and (27.36 + 19.51) ng/m L respectively. The recurrence group was significantly higher than that of the control group, and the difference was statistically significant (t=6.331, P0.05) in.7. recurrence group and control group, the blood eosinophil E% was (3.10 + 2.54)% and (1.31 + 1.15)% respectively in the control group, and the recurrence group was significantly higher than the control group. And the difference was statistically significant (t=5.68, P0.05).8. with EDN as reference, the sensitivity of the first wheezing child to diagnose the first wheezing attack was 72.69%, the specificity was the area under the 66.13%.ROC curve (AUC) =0.79, the diagnostic truncation value was 29.95 ng/m L.9. with eosinophil E% as reference, and the diagnosis of the first wheeze attack in the children was again wheezing. The sensitivity was 90.36% and the specificity was 51.61%.ROC AUC=0.75. The diagnostic value of the truncated value was that there was no statistical correlation between serum EDN level and eosinophil E% in children with 2.50%.10. recurrence (r=-0.02, P0.05).11. could be combined with several signs of eczema, RSV infection, EDN and eosinophil, to calculate its sensitivity and specificity, and to evaluate its prediction. Value conclusion: the positive rate of 1.RSV infection is higher in the recurrent group. RSV infection may be a risk factor for recurrence of wheezing. The percentage of eosinophils in children with recurrent.2. is higher, suggesting that it may be involved in the physiological process of children's wheezing recurrence..3.EDN is high in the serum of the children in the recurrent group, so that it can be used to predict the recurrence of wheezing in children. The sensitivity and specificity of serological markers were high.

【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R725.6

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