传染病信息

目的 分析反复呼吸道感染(recurrent respiratory tract infections, RRTI)患儿血清沉默信息调节因子2相关酶1(silence information regulator 2 related enzyme 1, SIRT1)和高迁移率族蛋白B1(high mobility group box 1, HMGB1)水平与免疫功能之间的关系。方法 选取2019年1月至2021年1月核工业四一六医院收治的80例RRTI患儿作为研究组，选取同期收治的非RRTI患儿75例作为非RRTI组，另选择同期健康体检儿童75例作为对照组。ELISA检测血清SIRT1和HMGB1水平；免疫球蛋白水平采用单向免疫扩散法测定；CD3⁺T细胞、CD4⁺T细胞、CD8⁺T细胞水平采用流式细胞术测定；采用Pearson法分析血清SIRT1和HMGB1与免疫功能指标的相关性；采用Logistic回归分析RRTI的影响因素；受试者工作特征(receiver operating characteristic, ROC)曲线分析血清SIRT1和HMGB1水平对RRTI的诊断价值。结果 对照组、非RRTI组和研究组的SIRT1、免疫球蛋白(immunoglobulin, Ig)A、Ig M、Ig G、CD3⁺T细胞、CD4⁺T细胞及CD8⁺T细胞水平依次降低(P均<0.05)，血清HMGB1水平依次升高(P <0.05)；研究组CD4⁺/CD8⁺高于对照组(P <0.05)。根据Pearson相关性分析得知，血清SIRT1和HMGB1水平呈负相关(r=-0.561, P=0.000)；血清SIRT1与Ig A、Ig M、Ig G、CD3⁺T细胞、CD4⁺T细胞、CD8⁺T细胞和CD4⁺/CD8⁺均呈正相有关(r=0.489、0.521、0.495、0.568、0.687、0.589、0.642,P均<0.05)；血清HMGB1与Ig A、Ig M、Ig G、CD3⁺T细胞、CD4⁺T细胞、CD8⁺T细胞和CD4⁺/CD8⁺均呈负相关(r=-0.548、-0.436、-0.526、-0.635、-0.598、-0.587、-0.530,P均<0.05)。根据Logistic回归分析得知SIRT1、HMGB1是影响RRTI发生的危险因素(P均<0.05),Ig A、Ig M、Ig G、CD3⁺T细胞、CD4⁺T细胞、CD8⁺T细胞和CD4⁺/CD8⁺是保护因素(P均<0.05)。血清SIRT1、HMGB1诊断RRTI的曲线下面积(area under the curve, AUC)为0.838、0.834,2者联合诊断RRTI的AUC为0.902,2者联合优于各自单独诊断(z=3.154、z=4.398,P均<0.05)。结论 RRTI患儿血清中SIRT1低表达、HMGB1高表达，2者表达水平与免疫功能有关，2者联合对RRTI具有一定的诊断价值。

Objective Analyze the relationship between serum levels of silence information regulator 2 related enzyme 1(SIRT1) and high mobility group box 1(HMGB1) and immune function in children with recurrent respiratory tract infections(RRTI).Methods Eighty children with RRTI admitted to the Fourteen Sixth Hospital of Nuclear Industry from January 2019 to January 2021 were selected as the study group, 75 non-RRTI children admitted during the same period served as the non-RRTI group,and 75 healthy children undergoing physical examinations in the same period were chosen as the control group. serum SIRT1 and HMGB1 levels were detected by ELISA, immunoglobulin levels were determined using one-way immunodiffusion assay; CD3⁺T cell, CD4⁺ T cell and CD8⁺ T cell were quantified by flow cytometry, the correlation between serum SIRT1 and HMGB1 levels and immune function parameters were analysed by Pearson's method, factors associated with RRTI were assessed by logistic regression analysis, the diagnostic value of serum SIRT1 and HMGB1 levels for RRTI was evaluated using receiver operating characteristic(ROC) curve analysis. Results Level of SIRT1, immunoglobulin(Ig) A, IgM, IgG, CD3⁺ T cells, CD4⁺ T cells, CD8⁺T cells progressively decreased from the control group to the non-RRTI group and then to the study group(P <0.05), while serum HMGB1 level was progressively increased in that order(P <0.05). CD4⁺/CD8⁺ ratio in the study group was higher than that in the control group(P <0.05). Pearson correlation analysis showed a significant inverse correlation between serum SIRT1 and HMGB1levels(r=-0.561, P=0.000). Both serum SIRT1 and HMGB were associated with IgA, IgM, IgG, CD3⁺ T cells, CD4⁺ T cells, CD8⁺T cells and CD4⁺/CD8⁺(P <0.05). Logistic regression analysis identified SIRT1 and HMGB1 as risk factors for RRTI occurrence(P <0.05), while IgA, IgM, IgG, CD3⁺ T cells, CD4⁺ T cells, CD8⁺ T cells and CD4⁺/CD8⁺ served as protective factors(P <0.05).The AUC for diagnosing RRTI was 0.838 for serum SIRT1 and 0.834 for serum HMGB1. The combined diagnostic AUC of both biomarkers reached 0.902, demonstrating superior diagnostic performance compared to either biomarker alone.(z=3.154, z=4.398,P <0.05). Conclusion Children with RRTI exhibit significantly reduced serum SIRT1 expression and elevated HMGB1 expressio.Furthermore, both biomarkers demonstrate significant associations with immune competence, and their combination demonstrates potential diagnostic utility for RRTI.