PDF(1418 KB)
PDF(1418 KB)
PDF(1418 KB)
反复肺炎患儿血清YKL-40与体液免疫功能的变化及意义
Changes in serum YKL-40 level and humoral immune function and their significance in children with recurrent pneumonia
目的 研究反复肺炎患儿血清YKL-40与体液免疫功能的变化及意义。方法 收集30例反复肺炎患儿（反复肺炎组）、30例急性肺炎患儿（急性肺炎组）、30例健康体检儿童（对照组）的血标本，采用酶联免疫吸附法检测各组血清YKL-40浓度。并进行血清YKL-40与体液免疫相关实验室指标的相关性分析。利用受试者工作特征（ROC）曲线分析血清YKL-40对反复肺炎的诊断价值。结果 反复肺炎组血清YKL-40浓度高于急性肺炎组及对照组（P < 0.05），急性肺炎组血清YKL-40浓度高于对照组（P < 0.05）。反复肺炎组血清IgG和补体C4水平均低于急性肺炎组（P < 0.05）。血清YKL-40浓度与IgG水平呈负相关（rs=-0.309，P=0.047），与补体C4水平亦呈负相关（r=-0.324，P=0.039）。血清YKL-40诊断反复肺炎的ROC曲线下面积为0.958（95% CI：0.921~0.994）。结论 反复肺炎患儿体液免疫功能降低；血清YKL-40可能参与了反复肺炎的发生，并可作为反复肺炎诊断的参考指标。
Objective To investigate the changes in serum YKL-40 level and humoral immune function and their significance in children with recurrent pneumonia. Methods Blood samples were collected from 30 children with recurrent pneumonia (recurrent pneumonia group), 30 children with acute pneumonia (acute pneumonia group), and 30 healthy children (control group). Serum YKL-40 levels were measured by enzyme-linked immunosorbent assay. The correlation between serum YKL-40 level and laboratory indices related to humoral immune function was analyzed. The receiver operating characteristic (ROC) curve was used to analyze the diagnostic value of serum YKL-40 level for recurrent pneumonia. Results The recurrent pneumonia group had a significantly higher serum YKL-40 level than the acute pneumonia and control groups (P < 0.05). The acute pneumonia group had a significantly higher serum YKL-40 level than the control group (P < 0.05). Serum levels of IgG and complement 4 in the recurrent pneumonia group were significantly lower than in the acute pneumonia group (P < 0.05). Serum YKL-40 level was negatively correlated with serum IgG level (rs=-0.309, P=0.047) and serum complement 4 level (r=-0.324, P=0.039). The area under the ROC curve of serum YKL-40 level for diagnosing recurrent pneumonia was 0.958 (95%CI:0.921-0.994). Conclusions Humoral immune function is low in children with recurrent pneumonia. Serum YKL-40 may be involved in the occurrence of recurrent pneumonia and can be used as a reference index for diagnosing recurrent pneumonia.
Recurrent pneumonia / YKL-40 / Humoral immune function / Child
[1] Saad K, Mohamed SA, Metwallety KA. Recurrent/Persistent pneumonia among children in Upper Egypt[J]. Mediterr J Hematol Infect Dis, 2013, 5(1):e2013028.
[2] 中华医学会儿科学分会呼吸学组,《中华儿科杂志》编辑委员会. 反复呼吸道感染的临床概念和处理原则[J]. 中华儿科杂志, 2008, 46(2):108-110.
[3] 李惠民, 江载芳, 江沁波, 等. 小儿反复肺炎的基础疾病和诊断分析[J]. 中国实用儿科杂志, 2004, 19(3):153-155.
[4] 张立梅. 儿童反复肺炎与机体免疫功能和炎性相关因子的关系研究[J]. 河北医药, 2016, 38(9):1333-1335.
[5] Owayed AF, Campbell DM, Wang EE. Underlying causes of recurrent pneumonia in children[J]. Arch Pediatr Adolesc Med, 2000, 154(2):190-194.
[6] Johansen JS, Williamson MK, Rice JS, et al. Identification of proteins secreted by human osteoblastic cells in culture[J]. J Bone Miner Res, 1992, 7(5):501-512.
[7] Libreros S, Iragavarapu-Charyulu V. YKL-40/CHI3L1 drives inflammation on the road of tumor progression[J]. J Leukoc Biol, 2015, 98(6):931-936.
[8] Roslind A, Johansen JS. YKL-40:a novel marker shared by chronic inflammation and oncogenic transformation[J]. Methods Mol Biol, 2009, 511(7):159-184.
[9] Wang HL, Hsiao PC, Tsai HT, et al. Usefulness of plasma YKL-40 in management of community-acquired pneumonia severity in patients[J]. Int J Mol Sci, 2013, 14(11):22817-22825.
[10] Liu L, Oza S, Hogan D, et al. Global, regional, and national causes of child mortality in 2000-13, with projections to inform post-2015 priorities:an updated systematic analysis[J]. Lancet, 2015, 385(9966):430-440.
[11] Patria F, Longhi B, Tagliabue C, et al. Clinical profile of recurrent community-acquired pneumonia in children[J]. BMC Pulm Med, 2013, 13:60.
[12] 王萍, 周戎, 何永涛, 等. 反复呼吸道感染患儿血清免疫指标的观察分析[J]. 中国医院感染学杂志, 2016, 26(15):3554-3556.
[13] Volck B, Price PA, Johansen JS, et al. YKL-40, a mammalian member of the chitinase family, is a matrix protein of specific granules in human neutrophils[J]. Proc Assoc Am Physicians, 1998, 110(4):351-360.
[14] Hakala BE, White C, Recklies AD. Human cartilage gp-39, a major secretory product of articular chondrocytes and synovial cells, is a mammalian member of a chitinase protein family[J]. J Biol Chem, 1993, 268(34):25803-25810.
[15] Malinda KM, Ponce L, Kleinman HK, et al. Gp38k, a protein synthesized by vascular smooth muscle cells, stimulates directional migration of human umbilical vein endothelial cells[J]. Exp Cell Res, 1999, 250(1):168-173.
[16] Salvatore V, Focaroli S, Teti G, et al. Changes in the gene expression of co-cultured human fibroblast cells and osteosarcoma cells:the role of microenvironment[J]. Oncotarget, 2015, 6(30):28988-28998.
[17] Senetta R, Duregon E, Sonetto C, et al. YKL-40/c-Met expression in rectal cancer biopsies predicts tumor regression following neoadjuvant chemoradiotherapy:a multi-institutional study[J]. PLoS One, 2015, 10(4):e0123759.
[18] 孙海斌, 王晓雷, 李征瀛, 等. ROC曲线评价血清人软骨糖蛋白39在儿童社区获得性肺炎诊断和预测并发症中的应用[J]. 东南大学学报(医学版), 2014, 33(6):768-771.
[19] Lee CG, Hartl D, Lee GR, et al. Role of breast regression protein 39(BRP-39)/chitinase 3-like-1 in Th2 and IL-13-induced tissue responses and apoptosis[J]. J Exp Med, 2009, 206(5):1149-1166.
[20] Letuve S, Kozhich A, Arouche N, et al. YKL-40 is elevated in patients with chronic obstructive pulmonary disease and activates alveolar macrophages[J]. J Immunol, 2008, 181(7):5167-5173.
[21] Ober C, Tan Z, Sun Y, et a1. Effect of variation in CHI3L1 on serum YKL-40 level, risk of asthma, and lung function[J]. N Engl J Med, 2008, 358(16):1682-1691.
[22] Tang H, Sun Y, Shi Z, et al. YKL-40 induces IL-8 expression from bronchial epithelium via MAPK (JNK and ERK) and NF-κB pathways, causing bronchial smooth muscle proliferation and migration[J]. J Immunol, 2013, 190(1):438-446.
