摘要
目的分析血清热休克蛋白60(HSP60)、热休克蛋白70(HSP70)与原发性免疫性血小板减少症(ITP)患儿辅助性T细胞17/调节性T细胞(Th17/Treg)和预后的关系。方法选取2020年6月—2022年6月保山市人民医院儿科诊治的ITP患儿128例作为病例组,另选同期体检健康儿童60例作为健康对照组。检测并比较2组血清HSP60、HSP70与Th17/Treg细胞水平。Pearson法分析血清HSP60、HSP70与Th17/Treg细胞的相关性。ITP患儿出院后随访1年,根据不同预后情况分为预后良好亚组(107例)和预后不良亚组(21例)。收集ITP患儿的临床资料,采用单因素、多因素Logistic回归模型分析ITP患儿预后的影响因素,并构建风险预测列线图模型。建立受试者工作特征(ROC)曲线分析血清HSP60、HSP70与Th17/Treg细胞对ITP患儿预后的预测价值。结果病例组血清HSP60、HSP70水平及Th17/Treg细胞显著高于健康对照组(t/Z/P=20.445/<0.001、17.467/<0.001、5.823/<0.001)。Pearson相关分析显示,血清HSP60、HSP70与Th17/Treg细胞呈正相关(r/P=0.417/<0.001、0.348/<0.001)。多因素Logistic回归分析显示,HSP60高、HSP70高、Th17/Treg高为ITP患儿预后不良的独立危险因素[OR(95%CI)=1.177(1.041~1.331),1.181(1.038~1.343),9.895(2.171~68.177)],初诊时PLT计数偏高则为保护因素[OR(95%CI)=0.848(0.726~0.990)]。ROC曲线分析结果显示,初诊时PLT、HSP60、HSP70、Th17/Treg水平及列线图模型的曲线AUC分别为0.793、0.730、0.787、0.840、0.975;Bootstrap法(B=1000)对列线图模型进行内部验证显示,Bias-corrected预测曲线与Ideal线基本重合,该模型预测能力较好。决策曲线显示,该模型的阈值概率范围为0.01~0.98,其净收益率>0,高于两条无效线。结论IPT患儿血清HSP60、HSP70、Th17/Treg水平均明显升高,血清HSP60、HSP70与Th17/Treg呈显著正相关。初诊时PLT、HSP60、HSP70、Th17/Treg水平是ITP患儿预后不良的影响因素,且基于HSP60、HSP70等独立危险因素构建的列线图模型对ITP患儿预后不良具有较好的预测价值。
Objective To analyzed the relationship between serum heat shock protein 60(HSP60),heat shock protein 70(HSP70)and helper T cell 17/regulatory T cell(Th17/Treg)cells and prognosis in children with primary immune thrombocytopenia(ITP).Methods One hundred and twenty-eight ITP children diagnosed and treated in the Department of Pediatrics,Baoshan People's Hospital from June 2020 to June 2022 were selected as observation group,and 60 healthy children in the same period were selected as control group.The levels of serum HSP60,HSP70 and Th17/Treg cells were detected and compared between two groups.The correlation between serum HSP60,HSP70 and Th17/Treg cells was analyzed by Pearson method.ITP children were followed up for 1 year after discharge,and were divided into good prognosis subgroup and poor prognosis subgroup according to different prognosis.The clinical data of ITP children were collected,the influencing factors of prognosis in ITP children were analyzed by univariate and multivariate Logistic regression models,and the risk prediction nomogram model was constructed.The predictive value of serum HSP60,HSP70 and Th17/Treg cells on the prognosis of ITP children was analyzed by established receiver operating characteristic(ROC)curve.Results The levels of serum HSP60,HSP70 and Th17/Treg cells in observation group were significantly higher than those in control group(t/Z/P=20.445/<0.001,17.467/<0.001,5.823/<0.001).Pearson analysis showed that,serum HSP60 and HSP70 were positively correlated with Th17/Treg cells(r/P=0.417/<0.001,0.348/<0.001).Multivariate Logistic regression analysis showed that,high HSP60,high HSP70,and high Th17/Treg levels were independent risk factors[OR(95%CI)=1.177(1.041-1.331),1.181(1.038-1.343),9.895(2.171-68.177)]for poor prognosis in ITP children,and high PLT count at initial diagnosis was a protective factor[OR(95%CI)=0.848(0.726-0.990)].The results of ROC curve analysis showed that,the AUC of PLT count,HSP60,HSP70,Th17/Treg level and nomogram model at the initial diagnosis were 0.793,0.730,0.787,0.840 and 0.975 respectively.The Bootstrap method(B=1000)was used to verify the nomogram model internally,the Bias-corrected prediction curve was basically coincident with the Ideal line,and the prediction ability of the model was better.The decision curve shows that,the threshold probability range of the model was 0.01-0.98,and its net return rate was>0,which was higher than the two invalid lines.Conclusion The levels of serum HSP60,HSP70 and Th17/Treg in IPT children are significantly increase,and serum HSP60 and HSP70 are positively correlated with Th17/Treg.PLT count,HSP60,HSP70 and Th17/Treg levels at initial diagnosis are the influencing factors of poor prognosis in ITP children,and the nomogram model based on independent risk factors such as HSP60 and HSP70 has a good predictive value for poor prognosis in ITP children.
作者
陈信发
万佳倩
王春文
常明春
李林
Chen Xinfa;Wan Jiaqian;Wang Chunwen;Chang Mingchun;Li Lin(Department of Pediatrics,Baoshan People's Hospital,Yunnan Province,Baoshan 678000,China)
出处
《疑难病杂志》
CAS
2024年第8期981-986,共6页
Chinese Journal of Difficult and Complicated Cases
基金
2021年度云南省基础研究计划青年项目(Q20210213000143)。
