Correlation between umbilical cord blood Gal-9, IL-33 levels and early infant eczema: A prospective study
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摘要:
背景 湿疹是婴儿时期最早出现、最常见的一种过敏性疾病，受环境、遗传、免疫等多种因素的影响，且发病机制尚未全面阐释。有半乳凝素-9(galectin-9，Gal-9)、白细胞介素-33(interleukin-10，IL-33)与支气管哮喘、过敏性鼻炎、特应性皮炎等多种过敏性疾病密切相关的报道。 目的 分析脐血Gal-9、IL-33水平与42 d婴儿湿疹发生的相关性。 方法 收集2020年9月 - 2021年5月在空军特色医学中心产科出生的新生儿114例，新生儿出生时立即采集脐血，检测脐血Gal-9、IL-33水平。在生后42 d进行门诊随访，调查婴儿湿疹发生情况及母亲相关情况。根据是否发生湿疹分为湿疹组和无湿疹组，分别比较两组脐血Gal-9、IL-33水平与42 d婴儿湿疹发生的相关性；进行logistic逐步回归分析婴儿湿疹发生的相关危险因素；制作脐血IL-33的ROC曲线。 结果 湿疹组68例，无湿疹组46例，婴儿湿疹患病率为59.6%。两组在性别、胎龄、身长、出生体质量、分娩方式、喂养方式、家族过敏史、母亲年龄及母亲孕期是否患病方面差异均无统计学意义(P＞0.05)，在母亲哺乳期间是否进食易致敏食物有统计学差异(P＜0.05)。两组脐血Gal-9水平差异无统计学意义(P＞0.05)，脐血IL-33中位水平湿疹组高于无湿疹组[31.03(15.42，44.80) pg/mL vs 22.42(12.25，32.53) pg/mL，P＜0.05]，logistic逐步回归分析提示脐血IL-33高水平表达与母亲哺乳期间致敏饮食与42 d婴儿湿疹发生独立关联(P＜0.05)。脐血IL-33的ROC曲线结果显示AUC为0.619(95% CI：0.516 ~ 0.722)，特异度为82.6%，敏感度为41.2%。 结论 脐血Gal-9水平与42 d婴儿湿疹的相关性较差，脐血IL-33水平则与婴儿湿疹的发生存在相关性，且IL-33高水平表达是湿疹发生的相关危险因素，但对早期婴儿湿疹的预测价值较低。 Abstract:Background Eczema is one of the earliest and most common allergic diseases in infants. It is affected by many factors such as environment, heredity and immunity, and its pathogenesis has not been fully explained. Gal-9 and IL-33 have been reported to be closely related to bronchial asthma, allergic rhinitis, atopic dermatitis and other allergic diseases. Objective To analyze the correlation between the levels of galectin-9 (Gal-9) and IL-33 in umbilical cord blood and the occurrence of eczema in 42d infants. Methods A total of 114 newborns born in the Department of Obstetrics, Air Force Special Medical Center, from September 2020 to May 2021 were collected. Umbilical cord blood was collected immediately after birth to detect the levels of Gal-9 and IL-33. Outpatient follow-up was conducted 42d postnatal to investigate the incidence of infant eczema and maternal related information. According to the occurrence of eczema, subjects were divided into eczema group and non-eczema group. The correlation between the levels of cord blood Gal-9 and IL-33 and the occurrence of eczema in 42d infants was compared between the two groups. Logistic stepwise regression analysis was performed to analyze the risk factors of infant eczema. ROC curve of cord blood IL-33 was made. Results There were 68 cases in the eczema group and 46 cases in the non-eczema group, and the prevalence rate of infant eczema was 59.6%. There was no significant difference between the two groups in terms of gender, gestational age, body length, birth weight, mode of delivery, feeding mode, family history of allergy, mother's age and maternal illness during pregnancy (P＞0.05). There was significant difference in whether the mother ate allergenic food during breastfeeding (P＜0.05). There was no significant difference in cord blood Gal-9 level between the two groups (P＞0.05), and the level of cord blood IL-33 in the eczema group was higher than that in the eczema group (31.03 [15.42, 44.80] vs 22.42 [12.25, 32.53], P＜0.05). Logistic stepwise regression analysis showed that high level of IL-33 in umbilical cord blood and sensitized diet of mothers during lactation were related risk factors affecting the occurrence of eczema in 42d infants (P＜0.05). ROC curve results of cord blood IL-33 showed that the AUC was 0.619 (95%CI: 0.516-0.722), with specificity of 82.6% and sensitivity of 41.2%. Conclusion The correlation between umbilical cord blood Gal-9 level and 42d infant eczema is poor. The level of IL-33 in umbilical cord blood is correlated with the occurrence of infant eczema, and high level of IL-33 expression is a related risk factor for the occurrence of eczema, but its predictive value for early infant eczema is low. -
Key words:
- cord blood /
- early infant eczema /
- Gal-9 /
- IL-33 /
- allergic disease
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表 1 两组婴儿一般情况比较
Table 1. Comparison of general conditions between the two groups
指标 湿疹组(n=68) 无湿疹组(n=46) χ2/t值 P值 性别/(例，%) 0.142 0.706 男 36(52.9) 26(56.5) 女 32(47.1) 20(43.5) 胎龄/d 276.24 ± 6.27 275.20 ± 5.80 -0.894 0.373 身长/cm 50.81 ± 2.08 50.09 ± 1.90 -1.882 0.062 出生体质量/g 3330.88 ± 359.21 3243.48 ± 337.25 -1.306 0.194 分娩方式/(例，%) 1.721 0.190 自然分娩 52(76.5) 30(65.2) 人工分娩 16(23.5) 16(34.8) 母亲年龄/岁 32.43 ± 3.85 31.76 ± 3.69 -0.921 0.359 母亲孕期体
检/(例，%)0.022 0.883 正常 32(47.1) 21(45.7) 不正常 36(52.9) 25(54.3) 喂养方式/(例，%) 3.647 0.056 母乳喂养 32(47.1) 30(65.2) 混合喂养 36(52.9) 16(34.8) 乳母易致敏
饮食/(例，%)6.237 0.013 否 5(7.4) 11(23.9) 是 63(92.6) 35(76.1) 家族过敏史/
(例，%)0.409 0.522 无 17(25.0) 14(30.4) 有 51(75.0) 32(69.6) 
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表 2 两组婴儿脐血Gal-9、IL-33水平的比较[Md(IQR)]
Table 2. Comparison of the levels of Gal-9 and IL-33 in umbilical cord blood between the two groups (Md[IQR])
指标 湿疹组 无湿疹组 U值 P值 Gal-9/(ng·mL-1) 7.25(5.41，9.44) 6.92(5.34，8.31) 1433.50 0.451 IL-33/(pg·mL-1) 31.03(15.42，44.80) 22.42(12.25，32.53) 1192.00 0.032
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表 3 42 d婴儿湿疹相关危险因素的logistic回归分析
Table 3. Logistic regression analysis of factors associated with eczema in 42 d infants
指标 β $S \bar x $ Wald OR 95% CI P值 常熟项 家族过敏史 0.167 0.483 0.119 1.181 0.459 ~ 3.043 0.730 乳母易致敏饮食 1.422 0.652 4.758 4.144 1.155 ~ 14.869 0.029 喂养方式 0.717 0.432 2.750 2.048 0.878 ~ 4.781 0.097 Gal-9 0.035 0.026 1.853 1.036 0.985 ~ 1.090 0.173 IL-33 0.031 0.012 6.235 1.031 1.007 ~ 1.056 0.013
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表 4 脐血IL-33水平的ROC曲线分析
Table 4. ROC curve analysis of cord blood IL-33 level
指标 AUC $S \bar x $ 特异度/% 敏感度/% 95% CI IL-33 0.619 0.053 82.6 41.2 0.516 ~ 0.722
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