Objective To investigate the predictive value of serum Toll-like receptor 4 (TLR4) for recurrence risk in children with severe asthma within one year after treatment, in order to provide new ideas for preventing the recurrence of asthma. Methods A total of 80 cases of severe asthma children underwent treatment in Chengde Central Hospital from September 2018 to September 2019 were selected into severe asthma group, meanwhile 100 healthy children who took physical examination during the same period were selected as control group. Serum TLR4 level was compared between severe asthma group and control group. The enrolled children were divided into relapse group (n=38) and non-relapse group (n=42) according to the recurrence of asthma within 1 year after treatment. The difference of serum TLR4 level in the early stage after admission was compared between the two groups. The predictive value of serum TLR4 level on the recurrence of asthma was analyzed using the Receiver Operating Characteristic (ROC) curve. Logistic multivariate regression model was used to analyze the risk factors of recurrence in children with severe asthma within 1 year after treatment. Results Serum TLR4 level of children with severe asthma at admission was significantly higher than that of normal control group (t=15.882, P＜0.01). ROC curve showed that critical value of serum TRL4 level in hospitalized children with severe asthma predicted recurrence within 1 year after treatment was 20.33 pg/mL, AUC was 0.860(95%CI:0.782-0.938), the corresponding sensitivity and specificity were 76.19% and 73.68%, respectively. There were statistically significant differences in the onset age, TLR4 level after one week treatment and allergic rhinitis between the relapse group and non-relapse group (t=4.825, 6.001,χ2=6.128, P＜0.05). Logistic regression analysis showed that onset age <6 years old(OR=1.711,95%CI:1.403-2.205), allergic rhinitis(OR=1.894, 95%CI: 1.654-2.420), serum TLR4 level >20.33 pg/mL after one week treatment(OR=2.401,95%CI:1.834-2.781) were independent risk factors for recurrence within 1 year after treatment of severe asthma(P＜0.05). Conclusions Abnormal increasing of serum TLR4 level in children with severe asthma at the early stage of admission is an independent risk factor for asthma recurrence within 1 year after treatment, which has early predictive value for recurrence.
Key words
severe asthma /
Toll-like receptor 4 /
recurrence risk /
prediction
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
References
[1] Roukas C, Quayyum Z, Patel A, et al.Developing core economic parameter sets for asthma studies:a realist review and an analytical framework[J].BMJ Open, 2020, 10(10):e037889.
[2] Sanchez-Solis M, Parra-Carrillo MS,Mondejar-Lopez P, et al. Preschool asthma symptoms in children born preterm: The relevance of lung function in infancy[J].J Clin Med, 2020, 9(10):e3345.
[3] Chen S, Deng Y, He Q, et al.Toll-like receptor 4 deficiency aggravates airway hyperresponsiveness and inflammation by impairing neutrophil apoptosis in a toluene eiisocyanate-induced murine asthma model[J].Allergy Asthma Immunol Res, 2020, 12(4):608-625.
[4] Chen J,Jayachandran M, Zhang W, et al.Dietarysupplementation with sea bass (lateolabrax maculatus) ameliorates ulcerative colitis and inflammation in macrophages through inhibiting Toll-like receptor 4-linked pathways[J].Int J Mol Sci, 2019, 20(12):2907.
[5] 韩雨薇,王晨辰,李晓明,等. 齐墩果酸调节HMGB1/TLR4/NF-κB介导的炎症通路减轻蛛网膜下腔出血后的早期脑损伤[J]. 实用药物与临床,2020,23(1):5-9.
[6] 张华,马学宽,王思静,等. 芳香新塔花对动脉粥样硬化模型小鼠Toll样受体-4/核因子-κB信号通路的影响[J]. 中国循环杂志,2020,35(4):395-400.
[7] 中华医学会呼吸病学分会哮喘学组. 重症哮喘诊断与处理中国专家共识[J]. 中华结核和呼吸杂志,2017,40(11):813-829.
[8] 中华医学会儿科学分会呼吸学组. 儿童支气管哮喘诊断与防治指南(2016年版)[J].中华儿科杂志,2016,54(3):167-181.
[9] DePriest K, Butz A, Curriero FC, et al.Associations among neighborhood greenspace, neighborhood violence, and children's asthma control in an urban city[J].Ann Allergy Asthma Immunol, 2019, 123(6):608-610.
[10] Islamovic F, Silver EJ, ReznikM.Do urban minority parents and children agree on asthma symptoms with exercise, worries, and confidence in disease management?[J]. Acad Pediatr, 2019, 19(6):624-630.
[11] 王亚洲,何鹏,王丹虹. 孟鲁司特钠通过抑制TLR4/NF-κB信号通路影响哮喘大鼠气道平滑肌细胞增殖和凋亡[J]. 吉林大学学报(医学版),2020,46(2):274-279.
[12] 赵宏芳,刘娟. 支气管哮喘患儿外周血单核细胞培养上清液中肿瘤坏死因子-α、白细胞介素-17和免疫球蛋白E水平与Toll样受体4表达的相关性[J]. 新乡医学院学报,2020,37(7):687-690.
[13] Schurman SH, Bravo MA, Innes CL, et al.Toll-like receptor 4 pathway polymorphisms interact with pollution to influence asthma diagnosis and severity[J].Sci Rep, 2018, 8(1):12713.
[14] Francisco-Garcia AS,Garrido-Martín EM, Rupani H, et al.Small RNA species and microRNA profiles are altered in severe asthma nanovesicles from broncho alveolar lavageand associate with impaired lung function and inflammation[J].Noncoding RNA, 2019, 5(4):51.
[15] Tatler AL.MAP(kinase)-ing a link between obesity and inflammation in severe asthma[J].Am J Respir Cell Mol Biol, 2019, 60(5):497-498.
[16] 范丽,邓芸. 住院儿童不同年龄支气管哮喘临床特点[J]. 贵州医药,2019,43(3):401-402.
[17] 靳丹丹,周卫芳,李嫣,等. 儿童腺病毒肺炎的混合感染特点和重症病例的危险因素分析[J]. 临床肺科杂志,2019,24(10):1747-1750.
[18] 李妍,程哲,李鹏飞,等. 支气管哮喘合并过敏性鼻炎患者的肺功能和气道炎症特征[J]. 河南医学研究,2020,29(14):2532-2535.
PDF(659 KB)
