Dynamic changes and clinical significance of serum chemokine CXCR3 in children with infectious mononucleosis during treatment
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摘要: 目的 观察儿童传染性单核细胞增多症(IM)治疗期间血清趋化因子受体3(CXCR3)动态变化及其临床意义。方法 采用病例对照研究方法，纳入2021年1月—2022年10月在医院进行对症治疗的80例IM患儿的病例资料，依据治疗效果分为无效组(n=22)及有效组(n=58)，收集2组临床资料及治疗前(T0)、治疗第3天(T1)及治疗第7天(T2)时血清CXCR3检测数据，计算IM患儿治疗期间血清CXCR3波动(ΔCXCR3)情况，分析IM患儿血清CXCR3动态变化对治疗结局的评估价值。结果 无效组EB病毒抗体滴度高于有效组，差异有统计学意义(P < 0.05)；无效组T2时点血清CXCR3水平高于有效组，ΔCXCR3值低于有效组，差异有统计学意义(P < 0.05)；多因素logistic回归分析结果显示，T2时点血清CXCR3水平高是IM患儿治疗无效的危险因素(OR>1，P < 0.05)；ΔCXCR3值高是IM患儿治疗无效的保护因素(OR < 1，P < 0.05)；绘制受试者工作特征曲线图，ΔCXCR3对IM患儿治疗无效评估的曲线下面积为0.712>0.7，评估价值较好，当取最佳阈值1.390 ng/mL时，可获取理想的敏感度0.909、特异度0.517。结论 IM患儿治疗期间血清CXCR3动态变化与治疗效果密切相关，IM治疗期间血清CXCR3波动较小的患儿治疗无效风险更大，可用于预测IM患儿抗病毒治疗效果。
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关键词:
- 儿童传染性单核细胞增多症 /
- 血清趋化因子CXCR3水平 /
- 治疗效果
Abstract: Objective To observe the dynamic changes and clinical significance of serum chemokine receptor 3(CXCR3) in children with infectious mononucleosis(IM) during treatment.Methods A case-control study was used to include the medical records of 80 children with IM who received symptomatic treatment in hospital from January 2021 to October 2022. According to the treatment effect, they were divided into ineffective group(n=22) and effective group(n=58). Clinical data and serum CXCR3 detection data of the two groups were collected at before treatment(T0), 3 days after treatment(T1) and 7 days after treatment(T2). The fluctuation of serum CXCR3(ΔCXCR3) in children with IM during treatment was calculated, and the evaluation value of dynamic changes of serum CXCR3 in children with IM on treatment outcome was analyzed.Results The titer of EB virus antibody in the ineffective group was higher than that in the effective group, with a statistical significant difference(P < 0.05). The serum CXCR3 level in the ineffective group was higher than that in the effective group at time point T2, and the ΔCXCR3 value was lower than that in the effective group, with a statistical significant difference(P < 0.05). Multivariate logistic regression analysis showed that the high level of CXCR3 in T2 serum was a risk factor for ineffective treatment in children with IM(OR>1, P < 0.05). High ΔCXCR3 value was a protective factor for ineffective treatment of IM children(OR < 1, P < 0.05). The receiver operating characteristic curve(ROC) was drawn. The area under the curve(AUC) of ΔCXCR3 for the evaluation of ineffective treatment in children with IM was 0.712>0.7, and the evaluation value was good. When the optimal threshold was 1.390 ng/mL, the ideal sensitivity was 0.909 and the specificity was 0.517.Conclusion The dynamic change of serum CXCR3 during treatment in children with IM was closely related to the treatment effect. Children with less fluctuation of serum CXCR3 during IM treatment might have a higher risk of ineffective treatment, which could be used to predict the effect of antiviral treatment in children with IM. -
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表 1 2组临床资料比较
项目 无效组(n=22) 有效组(n=58) 统计值 P 白细胞计数/(×109/L) 12.95±1.83 13.02±1.86 t=0.151 0.880 淋巴细胞绝对计数/(×109/L) 5.83±0.74 5.91±0.78 t=0.450 0.654 B淋巴细胞/% 55.82±4.23 56.07±4.34 t=0.233 0.817 CD3+/% 76.23±6.70 77.10±6.80 t=0.516 0.607 CD4+/% 28.91±2.11 29.02±2.19 t=0.199 0.843 CD8+/% 37.55±3.58 38.53±3.65 t=1.088 0.280 CD4+/CD8+ 0.77±0.18 0.75±0.15 t=0.642 0.523 ALT/(U/L) 25.71±2.74 24.58±2.69 t=1.682 0.097 AST/(U/L) 24.48±2.65 24.83±2.67 t=0.526 0.600 Scr/(μmol/L) 71.28±5.82 70.94±5.77 t=0.228 0.820 发热持续时间/d 5.50±0.74 5.17±0.70 t=1.832 0.071 咽痛持续时间/d 10.14±1.58 10.05±1.42 t=0.231 0.818 淋巴结肿大持续时间/d 14.73±1.83 14.67±1.79 t=0.122 0.904 EB病毒抗体滴度/例(%) Z=2.143 0.032 低滴度 5(22.73) 22(37.93) 中滴度 10(45.45) 31(53.45) 高滴度 7(31.82) 5(8.62) 
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表 2 2组不同时点血清CXCR3水平及ΔCXCR3值比较
ng/mL，X±S 项目 无效组 有效组 t P T0时点血清CXCR3水平 9.31±1.28 9.28±1.25 0.089 0.929 T1时点血清CXCR3水平 8.15±1.17 7.72±1.13 1.510 0.135 T2时点血清CXCR3水平 7.61±0.74 6.51±0.67 6.333 < 0.001 ΔCXCR3 1.28±0.28 1.53±0.34 3.220 0.002
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表 3 IM患儿抗病毒治疗无效的多因素logistic回归分析
多因素 β SE Wald P OR 95%CI 常量 -13.734 4.974 7.625 0.006 - - EB病毒抗体低滴度 - - 4.563 0.102 - - EB病毒抗体中滴度 -0.570 0.874 0.426 0.514 0.566 0.102~3.134 EB病毒抗体高滴度 1.804 1.124 2.578 0.108 6.073 0.672~54.926 T2时点血清CXCR3水平高 2.605 0.707 13.583 < 0.001 13.533 3.386~54.085 ΔCXCR3值高 -3.983 1.577 6.382 0.012 0.019 0.001~0.409
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