血清TRAIL、CXCL16、FABP7水平与自身免疫性脑炎患儿认知障碍发生及预后的相关性研究-东南大学学报医学版

血清TRAIL、CXCL16、FABP7水平与自身免疫性脑炎患儿认知障碍发生及预后的相关性研究

单位：1. 邯郸市第一医院儿一科, 河北邯郸 056002;
2. 邯郸市第一医院检验科, 河北邯郸 056002

关键词：自身免疫性脑炎认知障碍肿瘤坏死因子相关凋亡诱导配体 CXC趋化因子配体16 脂肪酸结合蛋白7 预后

分类号：R742

出版年·卷·期（页码）：2026·45·第二期（274-281）

摘要：

目的:探讨血清肿瘤坏死因子相关凋亡诱导配体(TRAIL)、CXC趋化因子配体16(CXCL16)、脂肪酸结合蛋白7(FABP7)水平与自身免疫性脑炎(AE)患儿认知障碍(CI)发生及预后的相关性。方法:将邯郸市第一医院2021年8月至2024年1月收治的132例AE患儿设为AE组,另将109名健康体检儿童设为对照组。根据CI发生情况将AE患儿分为CI组(n=54)和非CI组(n=78),另根据6个月预后将AE患儿分为预后不良组(n=37)和预后良好组(n=95)。TRAIL、CXCL16、FABP7水平均采用ELISA检测;相关性分析采用Pearson法;血清TRAIL、CXCL16、FABP7对AE患儿预后的预测价值采用ROC曲线分析,并绘制校准曲线进行内部验证;不同血清TRAIL、CXCL16、FABP7表达水平的AE患儿发生预后不良的风险采用相对危险度分析。结果:与对照组比较,AE组血清TRAIL、CXCL16、FABP7水平升高(P＜0.05)。与非CI组相比,CI组血清TRAIL、CXCL16、FABP7水平升高(P＜0.05)。相比预后良好组,预后不良组血清TRAIL、CXCL16、FABP7水平升高(P＜0.05),且出现癫痫和运动障碍的占比也升高(P＜0.05)。相关性分析显示,AE患儿血清TRAIL、CXCL16、FABP7水平与韦氏儿童智力量表第Ⅳ版(WISC-Ⅳ)评分呈负相关(r=-0.465、-0.439、-0.481,P＜0.05),与改良Rankin量表评分呈正相关(r=0.503、0.476、0.432,P＜0.05)。ROC曲线分析显示,血清TRAIL、CXCL16、FABP7联合预测AE患儿预后不良的敏感度和特异度分别为83.78%、87.37%,且AUC(0.927)高于TRAIL(Z=3.289,P=0.001)、CXCL16(Z=3.088,P=0.002)、FABP7(Z=3.287,P=0.001)单独预测。相对危险度分析显示,血清TRAIL、CXCL16、FABP7高水平的AE患儿预后不良的风险分别是TRAIL、CXCL16、FABP7低水平患儿的4.464倍、5.436倍、4.246倍(P＜0.05)。结论:血清TRAIL、CXCL16、FABP7水平与AE患儿CI及预后不良的发生密切相关。

Objective: To explore the correlation between levels of serum tumor necrosis factor related apoptosis inducing ligand(TRAIL), CXC chemokine ligand 16(CXCL16), fatty acid binding protein 7(FABP7) and the occurrence of cognitive impairment(CI) and prognosis in children with autoimmune encephalitis(AE). Methods: From August 2021 to January 2024, 132 AE pediatric patients admitted to Handan First Hospital were labeled as the AE group. Additionally, 109 children who underwent health check ups were designated as the control group. According to the occurrence of CI, AE pediatric patients were separated into CI group(n=54) and non CI group(n=78).According to the 6-month prognosis, AE pediatric patients were separated into the poor prognosis group(n=37) and the good prognosis group(n=95). The levels of TRAIL, CXCL16, and FABP7 were all measured by ELISA. The correlation analysis was conducted using Pearson method. The predictive value of serum TRAIL, CXCL16, and FABP7 for the prognosis of AE patients was analyzed using ROC curve, and calibration curves were plotted for internal validation. Moreover, the risk of poor prognosis in AE pediatric patients with different levels of serum TRAIL, CXCL16, and FABP7 expression was analyzed using relative risk analysis. Results: Compared with the control group, the AE group had higher levels of serum TRAIL, CXCL16, and FABP7(P<0.05). Compared with the non CI group, the CI group had higher levels of serum TRAIL, CXCL16, and FABP7(P<0.05). Compared with the good prognosis group, the poor prognosis group had higher levels of serum TRAIL, CXCL16, and FABP7(P<0.05), and higher proportions of epilepsy and motor disorders(P<0.05). Correlation analysis showed that the levels of TRAIL, CXCL16 and FABP7 in the serum of AE patients were negatively correlated with the scores of the Wechsler Intelligence Scale for Children-Fourth Edition(WISC-Ⅳ)(r =-0.465, -0.439, -0.481, P<0.05), and positively correlated with the scores of the Modified Rankin Scale(r=0.503, 0.476, 0.432, P<0.05). ROC curve analysis showed that the sensitivity and specificity of the combination of serum TRAIL, CXCL16, and FABP7 in predicting poor prognosis in AE patients were 83.78% and 87.37%, respectively, and the AUC(0.927) was higher than that of the single prediction of TRAIL(Z=3.289, P=0.001), CXCL16(Z=3.088, P=0.002), and FABP7(Z=3.287, P=0.001). Relative risk analysis showed that the risk of poor prognosis in AE pediatric patients with high levels of serum TRAIL, CXCL16, and FABP7 was 4.464 times, 5.436 times, and 4.246 times higher than that in patients with low levels of TRAIL, CXCL16, and FABP7, respectively(P<0.05). Conclusion: Serum TRAIL, CXCL16, and FABP7 are closely related to the occurrences of CI and poor prognosis in AE patients.

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