Zhang Haisheng,Men Nan,Li Xuequn.Preoperative serum levels of IL-1β,I-FABP and PRDX1 in children with Hirschsprung‘s disease and their predictive values for postoperative enterocolitis[J].Journal of Clinical Pediatric Surgery,2025,(08):764-770.[doi:10.3760/cma.j.cn101785-202404039-011]
先天性巨结肠患儿术前血清IL-1β、I-FABP和PRDX1水平对于术后小肠结肠炎的预测价值研究
- Title:
- Preoperative serum levels of IL-1β,I-FABP and PRDX1 in children with Hirschsprung‘s disease and their predictive values for postoperative enterocolitis
- Keywords:
- Hirschsprung Disease; Enterocolitis; Interleukin-1; Fatty Acid-Binding Proteins; Intestine; Small; Oxidoreductases; Peroxidases; Correlation of Data; Forecasting
- 摘要:
- 目的 探究先天性巨结肠(Hirschsprung‘s disease,HD)患儿血清白细胞介素-1β(interleukin-1β,IL-1β)、小肠脂肪酸结合蛋白(intestinal fatty acid binding protein,I-FABP)及过氧化物氧化还原酶-1(peroxiredoxin-1,PRDX1)水平对于术后小肠结肠炎(Hirschsprung associated enterocolitis,HAEC)的预测价值。方法 本研究为回顾性研究。选择2021年6月至2023年6月在唐山市妇幼保健院接受诊治的178例HD患儿作为研究对象,根据术后是否发生HAEC分为HAEC组(52例)和非HAEC组(126例)。另外选择150例同期在本院体检的健康儿童作为对照组。采取酶联免疫吸附试验检测C反应蛋白(C-reactive protein,CRP)、肿瘤坏死因子-α(tumor necrosis factor-alpha,TNF-α)、IL-1β、I-FABP、PRDX1水平;采用Pearson和Spearman相关性分析IL-1β、I-FABP及PRDX1水平与病变痉挛段长度、肠炎史、术后伤口感染、术后肠梗阻以及CRP、TNF-α水平的相关性;采用ROC曲线分析IL-1β、I-FABP、PRDX1水平对于HD患儿术后HAEC的诊断价值,采用Z检验比较曲线下面积(area under curve,AUC)的差异。结果 与对照组相比,HD组IL-1β［（13.97±4.15）pg/mL比（8.74±2.73）pg/mL］、IFABP［（98.27±31.96）pg/mL比（56.24±18.12）pg/mL］、PRDX1［（24.07±7.65）μg/L比（16.53±5.24）μg/L］水平较高（P<0.05）；与非HAEC组相比，HAEC组病变痉挛段长度（42.31%比24.60%），肠炎史（48.08%比30.16%）、术后伤口感染（9.62%比1.59%）及术后肠梗阻（11.54%比1.59%）占比，血清CRP［（25.67±7.25）pg/mL比（18.34±5.64）pg/mL］、TNFα［（21.87±6.73）pg/mL比（15.28±4.67）pg/mL］、L1β［（17.57±5.62）pg/mL比（12.48±3.84）pg/mL］、IFABP［（124.72±36.57）pg/mL比（87.35±28.63）pg/mL］、PRDX1［（30.38±9.65）μg/L比（21.47±6.73）μg/L］水平均较高(P<0.05);HAEC组IL-1β、I-FABP、PRDX1水平与患儿病变痉挛段长度(r=0.421、0.423、0.408)、肠炎史(r=0.417、0.426、0.415)、术后伤口感染(r=0.402、0.425、0.414)、术后肠梗阻(r=0.432、0.428、0.434)、CRP(r=0.411、0.416、0.415)以及TNF-α(r=0.409、0.403、0.407)水平呈正相关(P<0.05);血清IL-1β、I-FABP、PRDX1单独诊断HD患儿术后HAEC的AUC分别为0.811(95%CI:0.746~0.866)、0.803(95%CI:0.737~0.859)、0.816(95%CI:0.752~0.870),联合诊断的AUC为0.946(95%CI:0.902~0.974),优于各自单独诊断(Z三者联合-IL-1β=4.170、Z三者联合-I-FABP=4.602、Z三者联合-PRDX1=3.487,P<0.05)。结论 与健康儿童相比,HD患儿血清IL-1β、I-FABP、PRDX1水平升高。HD患儿术前血清IL-1β、I-FABP、PRDX1水平越高,预示其术后发生HAEC的风险越大。与单独诊断相比,IL-1β、I-FABP、PRDX1联合诊断HD患儿术后HAEC具有较高的临床指导意义。
- Abstract:
- Objective To explore the serum levels of interleukin-1β (IL-1β),intestinal fatty acid binding protein (I-FABP) and peroxiredoxin-1 (PRDX1) in children with Hirschsprung‘s disease (HD) and examine their predictive values for postoperative Hirschsprung associated enterocolitis (HAEC). Methods From June 2021 to June 2023,178 HD children were recruited and another 150 healthy children undergoing physical examinations were regarded as control group.According to the presence or absence of postoperative HAEC,they were assigned into two groups of HAEC (n=52) and non-HAEC (n=126).Enzyme-linked immunosorbent assay (ELISA) was utilized for detecting the levels of C-reactive protein (CRP),tumor necrosis factor-alph (TNF-α),IL-1β,I-FABP and PRDX1.Pearson/Spearman‘s correlation analysis revealed that the levels of IL-1β,I-FABP and PRDX1 were correlated with length of spastic segment,history of enteritis,postoperative wound infection,postoperative intestinal obstruction and level of CRP/TNF-α.Receiver operating characteristic (ROC) curve was applied for analyzing the diagnostic value of IL-1β,I-FABP and PRDX1 levels for HAEC in HD children.Z-test was employed for comparing the differences in area under curve (AUC). Results Compared with the control group,the HD group had higher levels of IL-1β［(13.97±4.15)pg/mL vs.(8.74±2.73)pg/mL］,IFABP［(98.27±31.96)pg/mL vs.(56.24±18.12）pg/mL］,and PRDX1［(24.07±7.65）μg/L vs.(16.53±5.24）μg/L］(P<0.05).Compared with the non HAEC group,the HAEC group had higher proportions of spastic segment length of lesion (42.31% vs.24.60%),history of enteritis (48.08% vs.30.16%),postoperative wound infection (9.62% vs.1.59%),postoperative intestinal obstruction (11.54% vs.1.59%),and higher levels of serum CRP［(25.67±7.25）pg/mL vs.(18.34±5.64）pg/mL］,TNFα［(21.87±6.73)pg/mL vs.(15.28±4.67)pg/mL］,IL1β［(17.57±5.62)pg/mL vs.(12.48±3.84)pg/mL］,IFABP［(124.72±36.57)pg/mL vs.(87.35±28.63)pg/mL］,and PRDX1［(30.38±9.65)μg/L vs.(21.47±6.73)μg/L］,and a lower proportion of dietary control (P<0.05).The levels of IL-1β,I-FABP,and PRDX1 in the HAEC group were positively correlated with Spastic segment length of lesion (r=0.421、0.423、0.408),history of enteritis (r=0.417、0.426、0.415),postoperative wound infection (r=0.402、0.425、0.414),postoperative intestinal obstruction (r=0.432、0.428、0.434),CRP (r=0.411、0.416、0.415),TNF-α (r=0.409、0.403、0.407) levels,and negatively correlated with dietary control (P<0.05).The AUC for postoperative HAEC in HD patients diagnosed with serum IL-1β,I-FABP,and PRDX1 alone was 0.811 (95%CI:0.746-0.866)、0.803 (95%CI:0.737-0.859)、0.816 (95%CI:0.752-0.870),while the AUC for combined diagnosis was 0.946 (95%CI:0.902-0.974),which was better than their respective individual diagnoses (Ztriple combination - IL-1β=4.170,Ztriple combination- I-FABP=4.602,Ztriple combination-PRDX1=3.487,P<0.05). Conclusions As compared with healthy controls,serum levels of IL-1β,I-FABP and PRDX1 are higher in HD children.Further analysis indicates that the higher preoperative serum levels of IL-1β,I-FABP and PRDX1,the greater postoperative risk of HAEC in HD children.As compared with individual diagnosis,a combined diagnosis has higher clinical guidance significance.
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备注/Memo
收稿日期:2024-4-16。
基金项目:河北省医学科学研究重点课题计划项目(20240471)
通讯作者:张海生,Email:knownowg@163.com