本文選題：嗜酸性粒細(xì)胞衍生神經(jīng)毒素 + 反復(fù)喘息��； 參考：《天津醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:研究3歲及以下首次喘息兒童1年內(nèi)再發(fā)喘息與出生因素、個(gè)人及家族過敏史、血清學(xué)因素、血清嗜酸性粒細(xì)胞衍生神經(jīng)毒素(EDN)、嗜酸細(xì)胞百分比等因素的相關(guān)性,評(píng)價(jià)EDN、嗜酸細(xì)胞百分比對(duì)復(fù)發(fā)風(fēng)險(xiǎn)的預(yù)測(cè)價(jià)值,從而為兒童反復(fù)喘息尋找可靠客觀的監(jiān)測(cè)指標(biāo)。方法:收集2015年10月~2016年1月天津市兒童醫(yī)院感染科住院治療的3歲及以下首次喘息兒童145例,按出院后隨訪其1年內(nèi)是否再次發(fā)生喘息分為復(fù)發(fā)組(n=62)和對(duì)照組(n=83)。1.詢問并記錄所研究對(duì)象的年齡、性別、城/鄉(xiāng)居住地、是否早產(chǎn)(胎齡37周)、分娩方式(順產(chǎn)/剖宮產(chǎn))、是否為頭胎兒及住院治療天數(shù)等一般資料。詢問并記錄所研究對(duì)象的的特應(yīng)性疾病個(gè)人史,喘息性疾病、過敏性鼻炎以及其他過敏性疾病的家族史。所有入組患者行血清總Ig E(TIg E)水平檢測(cè),血清過敏原特異性Ig E(s Ig E)檢測(cè)及食物特異性Ig G(食物不耐受)檢測(cè),血清EDN檢測(cè),末梢血常規(guī),血清呼吸道病原九聯(lián)抗體檢測(cè),鼻咽吸取液七項(xiàng)呼吸道病毒檢測(cè)。所有研究對(duì)象均行胸片或胸CT、心電圖、超聲心動(dòng)圖等檢查助除外心肺發(fā)育異常及氣管支氣管異物。通過比較復(fù)發(fā)組和對(duì)照組各要素之間的關(guān)系,評(píng)價(jià)各要素與喘息復(fù)發(fā)之間是否存在相關(guān)性。2.以EDN為參考,計(jì)算敏感度(sensiticivity)和特異度(specificity),評(píng)價(jià)EDN預(yù)測(cè)喘息復(fù)發(fā)的價(jià)值。3.以嗜酸性粒細(xì)胞百分比(E%)為參考,計(jì)算敏感度(sensiticivity)和特異度(specificity),評(píng)價(jià)其預(yù)測(cè)喘息復(fù)發(fā)的價(jià)值。結(jié)果:1.復(fù)發(fā)組平均月齡(6.66±7.01)月,男性患兒42例,女性20例,城居者40例,平均住院天數(shù)(6.32±2.14)d;對(duì)照組平均月齡(6.82±7.07)月,男性患兒53例,女性30例,城居者52例,平均住院天數(shù)(7.02±3.01)d,兩組比較無統(tǒng)計(jì)學(xué)差異(P0.05)。2.復(fù)發(fā)組頭胎兒28例,足月兒58例,順產(chǎn)35例,對(duì)照組頭胎兒36例,足月兒71例,順產(chǎn)83例,兩組患兒出生學(xué)因素?zé)o統(tǒng)計(jì)學(xué)差異(P0.05)。3.復(fù)發(fā)組濕疹史陽性46例,個(gè)人食物藥物過敏史陽性4例,過敏性疾病家族史陽性11例;對(duì)照組濕疹史陽性38例,個(gè)人食物藥物過敏史陽性5例,過敏性疾病家族史陽性10例,兩組患兒過敏性疾病家族史及個(gè)人食物藥物過敏史無統(tǒng)計(jì)學(xué)差異(P0.05);但復(fù)發(fā)組患兒濕疹史陽性率顯著高于對(duì)照組(P0.05)且差異有統(tǒng)計(jì)學(xué)意義。4.復(fù)發(fā)組呼吸道合胞病毒(RSV)感染陽性20例,肺炎支原體感染5例,流感嗜血桿菌感染1例,乙型流感病毒4例;對(duì)照組RSV感染陽性11例,肺炎支原體感染5例,流感嗜血桿菌感染2例,乙型流感病毒1例。復(fù)發(fā)組RSV感染陽性率顯著高于對(duì)照組(P0.05)且差異有統(tǒng)計(jì)學(xué)意義。5.復(fù)發(fā)組患兒血清TIg E為(43.71±80.44)IU/m L、過敏原s Ig E陽性8例(占12.90%),過敏原Ig G陽性32例(占48.39%),WBC為(9.16±3.76)×109/L,中性粒細(xì)胞百分比(N%)為(27.10±13.19)%,;對(duì)照組血清TIg E為(44.58±92.23)IU/m L、過敏原s Ig E陽性7例(占20.48%),食物特異性Ig G陽性44例(占53.01%),WBC為(8.99±2.86)×109/L,N%為(30.17±13.61)%。吸入性過敏原主要為塵螨、屋塵、霉菌等,食物不耐受主要為牛奶蛋白、蛋清/蛋黃等。各項(xiàng)指標(biāo)2組間差別均無統(tǒng)計(jì)學(xué)意義。6.復(fù)發(fā)組和對(duì)照組患兒入院時(shí)血清EDN分別為(68.67±55.5)ng/m L和(27.36±19.51)ng/m L,復(fù)發(fā)組顯著高于對(duì)照組,且差異有統(tǒng)計(jì)學(xué)意義(t=6.331,P0.05)。7.復(fù)發(fā)組和對(duì)照組患兒入院時(shí)血嗜酸性粒細(xì)胞E%分別為(3.10±2.54)%和(1.31±1.15)%,復(fù)發(fā)組顯著高于對(duì)照組,且差異有統(tǒng)計(jì)學(xué)意義(t=5.68,P0.05)。8.以EDN為參考,診斷首次喘息發(fā)作患兒出現(xiàn)再次喘息的敏感度為72.69%、特異度為66.13%。ROC曲線下面積(AUC)=0.79,診斷的截?cái)嘀禐?9.95 ng/m L。9.以嗜酸性粒細(xì)胞E%為參考,診斷首次喘息發(fā)作患兒出現(xiàn)再次喘息的敏感度為90.36%、特異度為51.61%。ROC的AUC=0.75,診斷的截?cái)嘀禐?.50%。10.復(fù)發(fā)組患兒血清EDN水平與嗜酸性粒細(xì)胞E%不存在統(tǒng)計(jì)學(xué)相關(guān)性(r=-0.02,P0.05)。11.可以用濕疹史、RSV感染、EDN和嗜酸粒細(xì)胞幾個(gè)指標(biāo)聯(lián)合,計(jì)算其敏感度和特異度,評(píng)價(jià)其預(yù)測(cè)價(jià)值結(jié)論:1.RSV感染陽性率在復(fù)發(fā)組較高,RSV感染可能是喘息復(fù)發(fā)的危險(xiǎn)因素。2.復(fù)發(fā)組患兒嗜酸性粒細(xì)胞百分比水平較高,提示其可能參與了小兒喘息復(fù)發(fā)的病生理過程.3.EDN在復(fù)發(fā)組患兒血清中水平較高,以其為預(yù)測(cè)小兒喘息復(fù)發(fā)的血清學(xué)標(biāo)志物敏感度和特異度均較高。
[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.

【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R725.6

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