Abstract: Objective To investigate the predictive value of serum Toll-like receptor 4 (TLR4) for recurrence risk in children with severe asthma within one year after treatment, in order to provide new ideas for preventing the recurrence of asthma. Methods A total of 80 cases of severe asthma children underwent treatment in Chengde Central Hospital from September 2018 to September 2019 were selected into severe asthma group, meanwhile 100 healthy children who took physical examination during the same period were selected as control group. Serum TLR4 level was compared between severe asthma group and control group. The enrolled children were divided into relapse group (n=38) and non-relapse group (n=42) according to the recurrence of asthma within 1 year after treatment. The difference of serum TLR4 level in the early stage after admission was compared between the two groups. The predictive value of serum TLR4 level on the recurrence of asthma was analyzed using the Receiver Operating Characteristic (ROC) curve. Logistic multivariate regression model was used to analyze the risk factors of recurrence in children with severe asthma within 1 year after treatment. Results Serum TLR4 level of children with severe asthma at admission was significantly higher than that of normal control group (t=15.882, P＜0.01). ROC curve showed that critical value of serum TRL4 level in hospitalized children with severe asthma predicted recurrence within 1 year after treatment was 20.33 pg/mL, AUC was 0.860(95%CI:0.782-0.938), the corresponding sensitivity and specificity were 76.19% and 73.68%, respectively. There were statistically significant differences in the onset age, TLR4 level after one week treatment and allergic rhinitis between the relapse group and non-relapse group (t=4.825, 6.001,χ²=6.128, P＜0.05). Logistic regression analysis showed that onset age <6 years old(OR=1.711,95%CI:1.403-2.205), allergic rhinitis(OR=1.894, 95%CI: 1.654-2.420), serum TLR4 level >20.33 pg/mL after one week treatment(OR=2.401,95%CI:1.834-2.781) were independent risk factors for recurrence within 1 year after treatment of severe asthma(P＜0.05). Conclusions Abnormal increasing of serum TLR4 level in children with severe asthma at the early stage of admission is an independent risk factor for asthma recurrence within 1 year after treatment, which has early predictive value for recurrence.

Key words: severe asthma, Toll-like receptor 4, recurrence risk, prediction

摘要： 目的 探讨血清Toll样受体4(TLR4)对重症哮喘患儿治疗后1年内再发风险的预测价值,为预测哮喘再发提供新思路。 方法 2018年9月—2019年9月间在承德市中心医院接受治疗的重症哮喘患儿80例作为重症哮喘组,同期在本院进行体检的健康幼儿100例作为正常对照组,对比其血清Toll样受体4(TLR4)水平的差异。根据治疗后1年内哮喘再发情况将入组患儿分为复发组(n=38)、未复发组(n=42),对比其入院时血清TLR4水平的差异,采用受试者工作特征(ROC)曲线分析血清TLR4水平对哮喘再发的预测价值。采用Logistics多因素回归模型分析重症哮喘患儿治疗后1年内再发的危险因素。 结果 重症哮喘组患儿入院时血清TLR4的水平高于正常对照组,差异有统计学意义(t=15.882,P＜0.01)。ROC曲线显示,入院时血清TRL4水平预测重症哮喘患儿治疗后1年内再发的临界值为20.33 pg/mL,AUC为0.860(95%CI:0.782~0.938),对应的灵敏度、特异度分别为76.19%、73.68%。复发组、未复发组患儿发病年龄、治疗1周后TLR4水平、合并过敏性鼻炎的差异有统计学意义(t=4.825、6.001,χ²=6.128,P＜0.05)。Logistics回归分析发现:发病年龄＜6岁(OR=1.711,95%CI:1.403～2.205),合并过敏性鼻炎(OR=1.894,95%CI: 1.654～2.420)、治疗1周后血清TLR4水平＞20.33 pg/mL(OR=2.401,95%CI:1.834～2.781)是重症哮喘患儿治疗后1年内再发的独立危险因素(P＜0.05)。 结论 重症哮喘患儿入院早期血清TLR4水平异常增高,是治疗后1年内哮喘再发的独立危险因素,对再发事件具有早期预测价值。

关键词: 重症哮喘, Toll样受体4, 再发风险, 预测