血清骨膜蛋白水平对咳嗽变异性哮喘患儿治疗反应性的预测分析

doi:10.3877/cma.j.issn.1674-6902.2025.04.025

目的

分析血清骨膜蛋白水平对咳嗽变异性哮喘(cough variant asthma, CVA)患儿治疗反应性的早期预测。

方法

选取2021年6月至2024年11月我院收治的59例CVA患儿为对象，患儿接受吸入性糖皮质激素联合长效β2受体激动剂(inhalation corticosteroids combined with long-acting β₂ agonists, ICS/LABA)治疗28 d，治疗反应性良好48例为对照组，治疗反应性不良11例为观察组。对比两组临床资料，采用多因素Logistic回归筛选影响因素，绘制受试者工作特征(receiver operating characteristic, ROC)曲线分析血清骨膜蛋白水平对CVA患儿治疗反应性不良的预测。

结果

观察组病程(2.48±0.41)个月、呼吸道反复感染史9例(81.82%)、血清骨膜蛋白水平(82.29±2.22)ng/ml、呼出气一氧化氮(fractional exhaled nitric oxide, FeNO)(21.28±3.74)ppb高于对照组病程(2.06±0.32)个月、呼吸道反复感染史18例(37.50%)、血清骨膜蛋白水平(78.33±4.42)ng/ml、FeNO(18.33±1.80)ppb(P<0.05)；多因素Logistic回归分析显示，血清骨膜蛋白水平(OR＝1.346，95%CI：1.028~1.761)、FeNO(OR＝1.670，95%CI：1.068~2.611)是CVA患儿治疗反应性不良的危险因素(P<0.05)；ROC曲线分析显示，血清骨膜蛋白水平、FeNO预测CVA患儿治疗反应性不良的曲线下面积(area under curve, AUC)分别为0.807、0.769、0.837。

结论

血清骨膜蛋白水平可预测CVA患儿治疗反应性，具有临床意义。

关键词: 咳嗽变异性哮喘, 血清骨膜蛋白, 治疗反应性, 预测价值

Objective

To analyze the predictive value of serum periostin levels for early treatment responsiveness in children with cough variant asthma (CVA).

Methods

Fifty-nine children with CVA admitted to our hospital from June 2021 to November 2024 were enrolled. All children received inhaled corticosteroids combined with long-acting β₂ agonists (ICS/LABA) for 28 days. Forty-eight children with good treatment responsiveness were assigned to the control group, and 11 children with poor treatment responsiveness were assigned to the observation group. Clinical data were compared between the two groups. Multivariate logistic regression was used to identify influencing factors, and receiver operating characteristic (ROC) curve analysis was performed to evaluate the predictive value of serum periostin levels for poor treatment responsiveness in CVA children.

Results

The observation group showed significantly higher values than the control group in: disease duration (2.48±0.41 months vs. 2.06±0.32 months), proportion with a history of recurrent respiratory infections 9 cases (81.82%) vs. 18 cases(37.50%), serum periostin levels (82.29±2.22 ng/ml vs. 78.33±4.42 ng/ml), and fractional exhaled nitric oxide (FeNO) (21.28±3.74 ppb vs. 18.33±1.80 ppb) (P<0.05). Multivariate logistic regression analysis revealed that serum periostin level (OR=1.346, 95%CI: 1.028~1.761) and FeNO(OR=1.670, 95%CI: 1.068~2.611) were independent risk factors for poor treatment responsiveness in CVA children (P<0.05). ROC curve analysis showed that the area under the curve (AUC) for predicting poor treatment responsiveness was 0.807 for serum periostin, 0.769 for FeNO, and 0.837 for the combination.

Conclusion

The level of serum periostin can predict the treatment responsiveness of children with CVA, which is of clinical significance.

Key words: Cough variant asthma, Serum periostin, Therapeutic reactivity, Predictive value

表1 两组CVA患儿临床资料对比

临床资料	观察组(n＝11)	对照组(n＝48)	t/χ²值	P值
病程[月，(±s)]	2.48±0.41	2.06±0.32	2.510	0.019
湿疹史[n(%)]	5(45.45)	30(62.50)	1.078	0.299
过敏史[n(%)]	7(63.64)	20(41.67)	1.740	0.187
咳嗽特征[n(%)]			3.463	0.063
夜间显著	3(27.27)	28(58.33)
白天显著	8(72.73)	20(41.67)
呼吸道反复感染史[n(%)]	9(81.82)	18(37.50)	7.082	0.008
血清生化指标
白细胞计数[×10⁹，(±s)]	6.25±1.11	6.37±1.08	0.325	0.750
C反应蛋白[mg/L，(±s)]	3.32±0.29	3.27±0.41	0.474	0.641
中性粒细胞[%，(±s)]	58.25±10.25	57.99±7.64	0.079	0.938
嗜酸性粒细胞[%，(±s)]	4.75±1.17	4.69±1.31	0.150	0.883
血清骨膜蛋白水平[ng/ml, (±s)]	82.29±2.22	78.33±4.42	2.877	0.006
气道功能指标
FEV[%，(±s)]	88.01±12.35	87.31±10.64	0.174	0.865
FVC[%，(±s)]	92.93±13.01	91.44±12.54	0.345	0.735
FeNO[ppb，(±s)]	21.28±3.74	18.33±1.80	3.911	0.000

表1 两组CVA患儿临床资料对比

临床资料	观察组(n＝11)	对照组(n＝48)	t/χ²值	P值
病程[月，(±s)]	2.48±0.41	2.06±0.32	2.510	0.019
湿疹史[n(%)]	5(45.45)	30(62.50)	1.078	0.299
过敏史[n(%)]	7(63.64)	20(41.67)	1.740	0.187
咳嗽特征[n(%)]			3.463	0.063
夜间显著	3(27.27)	28(58.33)
白天显著	8(72.73)	20(41.67)
呼吸道反复感染史[n(%)]	9(81.82)	18(37.50)	7.082	0.008
血清生化指标
白细胞计数[×10⁹，(±s)]	6.25±1.11	6.37±1.08	0.325	0.750
C反应蛋白[mg/L，(±s)]	3.32±0.29	3.27±0.41	0.474	0.641
中性粒细胞[%，(±s)]	58.25±10.25	57.99±7.64	0.079	0.938
嗜酸性粒细胞[%，(±s)]	4.75±1.17	4.69±1.31	0.150	0.883
血清骨膜蛋白水平[ng/ml, (±s)]	82.29±2.22	78.33±4.42	2.877	0.006
气道功能指标
FEV[%，(±s)]	88.01±12.35	87.31±10.64	0.174	0.865
FVC[%，(±s)]	92.93±13.01	91.44±12.54	0.345	0.735
FeNO[ppb，(±s)]	21.28±3.74	18.33±1.80	3.911	0.000

表2 CVA患儿治疗反应性不良的Logistic回归分析

自变量	β	标准误	Wald	P值	OR	95%CI
自变量	β	标准误	Wald	P值	OR	下限	上限
血清骨膜蛋白水平	0.297	0.137	4.683	0.030	1.346	1.028	1.761
FeNO	0.513	0.228	5.05	0.025	1.670	1.068	2.611
呼吸道反复感染史	1.320	1.077	1.503	0.220	3.743	0.454	30.878
病程	2.325	1.187	3.839	0.050	10.228	0.999	104.676

表2 CVA患儿治疗反应性不良的Logistic回归分析

自变量	β	标准误	Wald	P值	OR	95%CI
自变量	β	标准误	Wald	P值	OR	下限	上限
血清骨膜蛋白水平	0.297	0.137	4.683	0.030	1.346	1.028	1.761
FeNO	0.513	0.228	5.05	0.025	1.670	1.068	2.611
呼吸道反复感染史	1.320	1.077	1.503	0.220	3.743	0.454	30.878
病程	2.325	1.187	3.839	0.050	10.228	0.999	104.676

表3 CVA患儿治疗反应性不良预测ROC曲线分析

变量	AUC	SE	95%CI	特异度(%)	灵敏度(%)
血清骨膜蛋白水平	0.807	0.066	0.683~0.898	79.20	90.90
FeNO	0.769	0.103	0.641~0.869	87.50	72.70
联合	0.837	0.078	0.718~0.920	91.70	72.70

表3 CVA患儿治疗反应性不良预测ROC曲线分析

变量	AUC	SE	95%CI	特异度(%)	灵敏度(%)
血清骨膜蛋白水平	0.807	0.066	0.683~0.898	79.20	90.90
FeNO	0.769	0.103	0.641~0.869	87.50	72.70
联合	0.837	0.078	0.718~0.920	91.70	72.70

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Predictive analysis of serum periostin levels on the treatment responsiveness in children with cough variant asthma

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Predictive analysis of serum periostin levels on the treatment responsiveness in children with cough variant asthma