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| 呼出气冷凝液IL-33 sST2动态监测对极低出生体重儿支气管肺发育不良的预测价值 |
| Predictive value of dynamic monitoring of exhaled breath condensate IL-33 and sST2 for BPD in very low birth weight infants |
| 投稿时间：2025-09-05 |
| DOI：10.3969/j.issn.1000-0399.2026.05.005 |
| 中文关键词: 极低出生体重儿 呼出气冷凝液 白介素-33 可溶性生长刺激表达基因2蛋白 支气管肺发育不良 |
| 英文关键词: Very low birth weight infants Exhaled breath condensate Interleukin-33 Soluble growth stimulating gene 2 protein Bronchopulmonary dysplasia |
| 基金项目:2023年陕西省科技计划项目(编号:2023-JC-YB-669) |
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| 中文摘要: |
| 目的 探讨呼出气冷凝液中白介素-33（IL-33）和可溶性生长刺激表达基因2蛋白（sST2）动态监测对极低出生体重儿（VLBW）支气管肺发育不良（BPD）的预测价值。方法 选取2020年1月至2024年10月西安国际医院中心医院收治的150例VLBW，根据是否诊断BPD分为BPD组（n=54）和非BPD组（n=96）,BPD组根据其严重程度分为轻度BPD亚组（n=19）、中度BPD亚组（n=22）和重度BPD亚组（n=13）。比较不同严重程度BPD呼出气冷凝液中IL-33、sST2表达水平，分析其与BPD严重程度的相关性，比较BPD组、非BPD组不同时间呼出气冷凝液中IL-33、sST2表达水平，并分析呼出气冷凝液中IL-33、sST2动态变化对BPD的预测效能。结果 轻度BPD亚组出生后第24小时呼出气冷凝液中IL-33、sST2表达水平低于中度BPD亚组、重度BPD亚组，且中度BPD亚组低于重度BPD亚组（P<0.05）；出生后第24小时呼出气冷凝液中IL-33、sST2与BPD严重程度呈正相关（r1=0.781、r2=0.733,P<0.05）；对IL-33、sST2进行Mauchly’s球形检验，结果显示，均不满足球形假设（IL-33:W=0.836,P<0.001;sST2:W=0.912,P=0.001），故采用Greenhouse-Geisser法进行校正。重复测量方差分析显示，BPD组、非BPD组不同时间呼出气冷凝液中IL-33、sST2水平差异有统计学意义，存在时间效应和交互效应（P<0.05）；出生后第7天、第14天呼出气冷凝液中IL-33、sST2联合预测BPD的AUC分别为0.869（95%CI:0.804～0.919）,0.922（95%CI:0.867～0.960），均大于两指标单独预测（Z1=2.175、2.698,Z2=2.497、2.204,P<0.05）;BPD组出生后第7天至出生后第14天IL-33、sST2变化率高于非BPD组（P<0.05）；ΔIL-33、ΔsST2联合预测BPD的AUC为0.938（95%CI:0.887～0.971），大于出生后第7天IL-33、sST2联合的AUC（Z=2.129,P<0.05）。结论 VLBW呼出气冷凝液中IL-33、sST2表达与BPD的发生及严重程度有关，动态监测出生后第7天、第14天的IL-33、sST2水平有利于提高BPD预测效能，为临床早期干预提供参考依据。 |
| 英文摘要: |
| Objective To investigate the predictive value of dynamic monitoring of interleukin-33（IL-33） and soluble growth stimulating gene 2 protein（sST2） in exhaled breath condensate for bronchopulmonary dysplasia（BPD） in very low birth weight infants（VLBW）. Methods A total of 150 VLBW patients admitted to Xi'an International Hospital Central Hospital from January 2020 to October 2024 were selected and divided into BPD group（n=54） and non-BPD group（n=96） according to whether BPD was diagnosed. The BPD group was divided into mild BPD subgroup（n=19）, moderate BPD subgroup（n=22） and severe BPD subgroup（n=13） according to its severity. The expression levels of IL-33 and sST2 in exhaled breath condensate of BPD with different severity were compared, and their correlation with the severity of BPD was analyzed. The expression levels of IL-33 and sST2 in exhaled breath condensate of BPD group and non-BPD group at different time were compared, and the predictive efficacy of dynamic changes of IL-33 and sST2 in exhaled breath condensate on BPD was analyzed. Results The expression levels of IL-33 and sST2 in exhaled breath condensate at 24 h after birth in mild BPD subgroup were lower than those in moderate BPD subgroup and severe BPD subgroup, and those in moderate BPD subgroup were lower than those in severe BPD subgroup（P<0.05）. The levels of IL-33 and sST2 in exhaled breath condensate at 24 h after birth were positively correlated with the severity of BPD（r1=0.781, r2=0.733, P<0.05）. Mauchly's sphericity test was performed on IL-33 and sST2, and the results showed that they did not meet the sphericity hypothesis（IL-33: W=0.836, P<0.001; sST2: W=0.912, P=0.001）, so Greenhouse-Geisser method was used for correction. Repeated measures analysis of variance showed that there were significant differences in the levels of IL-33 and sST2 in exhaled breath condensate between BPD group and non-BPD group at different time points, with time effect and interaction effect（P< 0.05）. The AUC of IL-33 and sST2 in the exhaled breath condensate on the 7 th and 14 th day after birth to predict BPD were 0.869（95%CI: 0.804～0.919） and 0.922（95%CI: 0.867～0.960）, respectively, which were greater than those predicted by the two indicators alone（Z1=2.175, 2.698; Z2=2.497, 2.204; P<0.05）. The change rate of IL-33 and sST2 in BPD group was higher than that in non-BPD group from 7 days to 14 days after birth（P<0.05）. The AUC of combined IL-33 and sST2 in predicting BPD was 0.938（95%CI: 0.887～0.971）, which was greater than that of combined 1（Z=2.129, P<0.05）. Conclusion The expression of IL-33 and sST2 in exhaled breath condensate of VLBW is related to the occurrence and severity of BPD. Dynamic monitoring of IL-33 and sST2 levels on day 7 and day 14 after birth is beneficial to improve the predictive efficiency of BPD and provide reference for early clinical intervention. |
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