肺炎支原体感染患儿NQO-1相对表达量、HBD-3水平与胸部CT影像特征及预后的相关性研究

陈燕; 王昶; 李庚武

doi:10.3760/cma.j.cn121381-202410003-00547

肺炎支原体感染患儿NQO-1相对表达量、HBD-3水平与胸部CT影像特征及预后的相关性研究

Correlation study of the relative expression of NQO-1, the level of HBD-3 and the characteristics of chest CT images and prognosis in children with Mycoplasma pneumoniae infection

摘要

摘要:
目的探讨醌氧化还原酶1（NQO-1）相对表达量、人类β-防御素3（HBD-3）水平与肺炎支原体（MP）感染患儿胸部CT影像特征、预后的关系。
方法选取2022年1月至2024年1月于中国科学技术大学附属第一医院治疗的78例MP感染患儿（研究组）男患儿43例、女患儿35例，年龄（5.6±0.6）岁和50名健康儿童（对照组）男性健康儿童27名、女性健康儿童23名，年龄（5.7±0.6）岁进行回顾性病例−对照研究。参照儿童肺炎支原体肺炎诊疗指南（2023年版）将患儿分为轻症组和重症组。观察患儿和健康儿童的胸部CT影像特征，检测NQO-1相对表达量、HBD-3水平。根据治疗后情况将患儿分为预后良好组和预后不良组。计量资料的2组间比较采用配对t检验，多组间比较采用方差分析；计数资料的组间比较采用χ²检验。胸部CT影像特征与NQO-1相对表达量、HBD-3水平的相关性分析采用Spearman相关系数模型；采用单因素分析、多因素Logistic回归分析MP感染患儿预后的危险因素。
结果与轻症组（45例）相比，重症组（33例）磨玻璃影、结节影、实变影的发生率较高24.44%（11/45）对48.48%（16/33）、11.11%（5/45）对57.58%（19/33）、17.78%（8/45）对39.39%（13/33），χ²=2.195、19.296、4.256，均P<0.05。与对照组相比，轻症组、重症组NQO-1的相对表达量较低（1.23±0.24对0.98±0.10对0.48±0.05），而HBD-3的水平较高（33.52±4.36） pg/ml对（51.25±6.23） pg/ml对（65.43±7.68） pg/ml（F=210.365、289.732，均P=0.001）。NQO-1相对表达量与胸部CT影像特征（磨玻璃影、结节影、实变影）呈负相关（r=−0.556、−0.612、−0.445，均P<0.05），HBD-3水平与胸部CT影像学特征呈正相关（r=0.714、0.563、0.648，均P<0.05）。与预后良好组（57例）相比，预后不良组（21例）心肌损伤35.09%（20/57）对71.43%（15/21）、磨玻璃影36.84%（21/57）对66.67%（14/21）、结节影29.82%（17/57）对85.71%（18/21）、实变影33.33%（19/57）对76.19%（16/21）的占比高，中性粒细胞与淋巴细胞计数比值（NLR）（2.03±0.31 对 2.88±0.39）、降钙素原（PCT）（0.41±0.26） ng/ml 对（0.57±0.21） ng/ml、C反应蛋白（CRP）（9.33±1.25） mg/L 对（13.58±2.45） mg/L、HBD-3（50.12±7.57） pg/ml对（80.65±9.11） pg/ml水平较高（χ²=8.193、8.193、19.378、11.395，t=10.002、2.491、10.075、14.943，均P<0.05）。血小板计数（PLT）（224.25±31.47）×10⁹/L 对（187.25±27.69）×10⁹/L、用力肺活量（FVC）相对于正常预测值的百分比（87.41±9.68）% 对（71.35±8.22）%、第一秒用力呼气容积（FEV1）相对于正常预测值的百分比（77.25±8.66）%对（61.49±7.17）%、用力呼气容量（FEF）相对于正常预测值的百分比（75.33±8.02）% 对（60.36±7.08）%水平、NQO-1相对表达量（0.93±0.17 对 0.38±0.11）较低（t=4.749~13.115，均P<0.001）。多因素Logistics回归分析结果显示，心肌损伤、PLT、NLR、FVC相对于正常预测值的百分比、FEV1相对于正常预测值的百分比、FEF相对于正常预测值的百分比、PCT、CRP、NQO-1、HBD-3、磨玻璃影、结节影、实变影为影响MP感染患儿预后的独立危险因素（OR：1.263~14.118，均P<0.05）。
结论 NQO-1相对表达量、HBD-3水平与胸部CT影像特征相关，检测二者的相对表达量和水平，可用于MP感染患儿预后的判断。

Abstract:
Objective To investigate the relationship between the relative expression of quinone oxidoreductase-1 (NQO-1) and levels of human β-defensin-3 (HBD-3) and the chest CT imaging features and prognosis of children infected with Mycoplasma pneumoniae (MP).

Methods A retrospective case-control study was conducted on 78 children with MP infection (study group) (43 males and 35 females, with an age of (5.6±0.6) years) who were treated at the First Affiliated Hospital of University of Science and Technology of China from January 2022 to January 2024 and 50 healthy children (control group) (27 healthy males and 23 healthy females, with an age of (5.7±0.6) years).The children were divided into mild and severe groups according to the Guidelines for thediagnosis and treatment of Mycoplasma pneumoniae pneumonia in children (2023 Edition).The chest CT imaging features of patients and healthy children were observed, and the relative expression of NQO-1 and levels of HBD-3 were detected. The children were then divided into good and poor prognosis groups according to their conditions after treatment. The paired t-test (homogeneous variance) was used for comparison between groups of measured data, and ANOVA was used for comparison among multiple groups. The intergroup comparison of counting data was conducted using the χ² test. The correlation analysis between the characteristics of chest CT images and the relative expression of NQO-1 and levels of HBD-3 was conducted using the Spearman correlation coefficient model. Univariate and multivariate Logistic regression analyses were used to identify risk factors for poor prognosis in children with MP infection.

Results The incidences of ground-glass opacity, nodular opacity, and consolidation opacity were higher in the severe group (33 cases) than in the mild group (45 cases) (24.44% (11/45) vs. 48.48% (16/33); 11.11% (5/45) vs. 57.58% (19/33); 17.78% (8/45) vs. 39.39% (13/33); χ²=2.195, 19.296, 4.256; all P<0.05). The relative expression of NQO-1 in the mild and severe groups were lower than that in the control group (1.23±0.24 vs. 0.98±0.10 vs. 0.48±0.05), whereas the levels of HBD-3 were higher than that in the control group ((33.52±4.36) pg/ml vs. (51.25±6.23) pg/ml vs. (65.43±7.68) pg/ml; F=210.365, 289.732; both P=0.001). The relative expression of NQO-1 was negatively correlated with the chest CT image features (ground-glass opacity, nodular opacity, consolidation opacity; r=–0.556, –0.612, –0.445; all P<0.05). The level of HBD-3 was positively correlated with the imaging characteristics of chest CT (r=0.714, 0.563, 0.648; all P<0.05). Compared with the good prognosis group(n=57), the proportion of cases of myocardial injury (35.09%(20/57) vs. 71.43%(15/21)), ground-glass opacity (36.84%(21/57) vs. 66.67%(14/21)), nodular opacity (29.82%(17/57) vs. 85.71%(18/21)), and consolidation opacity (33.33%(19/57) vs. 76.19% (16/21)) was higher in the poor prognosis group (n=21). Moreover, neutrophil-to-lymphocyteratio (NLR) (2.03±0.31 vs. 2.88±0.39), procalcitonin (PCT) ((0.41±0.26) ng/ml vs. (0.57±0.21) ng/ml), C reactive protein (CRP) ((9.33±1.25) mg/L vs. (13.58±2.45) mg/L) and HBD-3 level ((50.12±7.57) pg/ml vs. (80.65±9.11) pg/ml) were relatively high in the poor prognosis group (χ²=8.193, 8.193, 19.378, 11.395; t=10.002, 2.491, 10.075, 14.943; all P< 0.05). By contrast, platelet count (PLT) ((224.25±31.47)×10⁹/L vs. (187.25±27.69)×10⁹/L), forced vital capacity (FVC) percentage relative to the normal predicted value ((87.41±9.68)% vs. (71.35±8.22)%), forced expiratory volume in one second (FEV1) percentage relative to the normal predicted value ((77.25±8.66)% vs. (61.49±7.17)%), forced expiratory flow (FEF) percentage relative to the normal predicted value ((75.33±8.02)% vs. (60.36±7.08)%), and NQO-1 relative expression (0.93±0.17 vs. 0.38±0.11) were relatively low (t=4.749−13.115; all P<0.001). The multivariate Logistic regression analysis showed that myocardial injury, PLT, NLR, FVC percentage relative to the normal predicted value, FEV1 percentage relative to the normal predicted value, FEF percentage relative to the normal predicted value, PCT, CRP, NQO-1, HBD-3, ground-glass opacity, nodular opacity, and consolidation opacity were independent risk factors affecting the prognosis of childrenwith MP infection (OR: 1.263−14.118, all P<0.05).

Conclusions The relative expression of NQO-1 and level of HBD-3 are related to the characteristics of chest CT images. As such, detecting their levels can be used to determine prognosis of children infected with MP.

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