高伟霞 秦小菀 张靖 朱永杰

[摘要] 目的 探討白细胞介素35（IL35）、高迁移率蛋白1（HMGB1）和CD5抗原样蛋白（CD5L）对儿童哮喘病情及预后的评估价值。方法 选取我院2016年5月—2018年4月收治的90例哮喘病儿作为观察对象，依据病情严重程度分为轻度组（n=29）、中度组（n=30）和重度组（n=31），另取30例同期健康体检者作为对照组，均行血清IL35、HMGB1和CD5L水平检测。比较观察组（轻度组、中度组、重度组）与对照组各血清指标水平，以及其与哮喘病情和预后相关性。结果 观察组IL35、CD5L水平低于对照组，血清HMGB1水平高于对照组（t=3.524～23.700，P<0.05）。各组间血清IL35、HMGB1和CD5L水平比较，差异有显著性（F=8.416～200.766，P<0.05）;且重度组、中度组及轻度组血清IL35、CD5L水平低于对照组，血清HMGB1水平高于对照组（P<0.05）;重度组及中度组血清IL35、CD5L水平低于轻度组，血清HMGB1水平高于轻度组（P<0.05）;重度组血清IL35、CD5L水平低于中度组，血清HMGB1水平高于中度组（P<0.05）。血清IL35、CD5L水平与哮喘病情呈负相关（r=-0.719、-0.706，P<0.05）;血清HMGB1水平与哮喘病情呈正相关（r=0.699，P<0.05）。经Logistic回归分析，血清HMGB1、CD5L及IL35均为病儿预后影响因素（OR=0.546～1.867，95%CI=0.371～2.841，P<0.05）。结论 相比于健康小儿，哮喘病儿血清HMGB1水平较高、血清IL35与CD5L水平较低，经对症治疗后其水平有相应改变，可用来评估病儿病情及预后。

[关键词] 哮喘;儿童;白细胞介素-35;HMGB1蛋白质;CD5抗原

[中图分类号] R562.25  [文献标志码] A  [文章编号] 2096-5532（2020）02-0233-04

doi：10.11712/jms.2096-5532.2020.56.039 [开放科学（资源服务）标识码（OSID）]

[网络出版] http：//kns.cnki.net/kcms/detail/37.1517.R.20200320.1506.002.html;2020-03-23 11：59：13

[ABSTRACT] Objective To investigate the value of interleukin-35 （IL-35）， high-mobility group box 1 （HMGB1）， and CD5 antigen-like protein （CD5L） in evaluating the condition and prognosis of children with asthma.  Methods A total of 90 children with asthma who were admitted to our hospital from May 2016 to April 2018 were enrolled as subjects， and according to di-sease severity， they were divided into mild group with 29 children， moderate group with 30 children， and severe group with 31 children. A total of 30 children who underwent physical examination were enrolled as control group. Serum levels of IL-35， HMGB1， and CD5L were measured for both groups. Serum indices were compared between the observation group （the mild group， the mo-derate group， and the severe group） and the control group， and their correlation with the condition and prognosis of asthma was analyzed.  Results Compared with the control group， the observation group had significantly lower levels of IL-35 and CD5L and a significantly higher level of HMGB1 （t=3.524-23.700，P<0.05）. There were significant differences in the serum levels of IL-35， HMGB1， and CD5L between groups （F=8.416-200.766，P<0.05）， and compared with the control group， the severe， mode-rate， and mild groups had significantly lower levels of IL-35 and CD5L and a significantly higher level of HMGB1 （P<0.05）; compared with the mild group， the severe and moderate groups had significantly lower levels of IL-35 and CD5L and a significantly higher level of HMGB1 （P<0.05）; the severe group had significantly lower levels of IL-35 and CD5L and a significantly higher le-vel of HMGB1 than the moderate group （P<0.05）. The serum levels of IL-35 and CD5L were negatively correlated with the condition of asthma （r=-0.719，-0.706;P<0.05）， and the serum level of HMGB1 was positively correlated with the condition of asthma （r=0.699，P<0.05）. The logistic regression analysis showed that serum HMGB1， CD5L， and IL-35 were influencing factors for the prognosis of children with asthma （OR=0.546-1.867，95%CI：0.371-2.841，P<0.05）.  Conclusion Compared with healthy children， children with asthma have a higher serum level of HMGB1 and lower serum levels of IL35 and CD5L， which tend to change after symptomatic treatment and can thus be used to assess the condition and prognosis of children with asthma.

[KEY WORDS] asthma; child; interleukin-35; HMGB1 protein; CD5 antigen

哮喘为小儿常见多发慢性呼吸系统疾患，相关报道显示全球范围内哮喘病人高达3億人之多，预测至2025年将升至4亿人，且每年约有25万人因哮喘而死亡，约有1 500万人因哮喘致伤残[1-5]。生物学标志物CD5抗原样蛋白（CD5L）是一种反映机体所处生物学进程的、可供客观评价及测定的血清标志物，有学者指出其水平与哮喘等呼吸道疾病病人的病情严重程度呈负相关，为评估病情进展的有效指标[6-7]。此外，有学者指出哮喘发作时白细胞介素35（IL35）、高迁移率蛋白1（HMGB1）等细胞因子调节失衡，亦在一定程度上促进了病情进展[8-11]。基于此本研究选取我院90例哮喘病儿及30例健康小儿，首次探讨了血清HMGB1、CD5L及IL35水平变化对儿童哮喘病情及预后的评估价值。

1 对象与方法

1.1 研究对象

选取我院2016年5月—2018年4月收治的90例哮喘病儿作为观察对象（观察组），依据朱碧君等[12]报道的病情严重程度分为3个亚组。……