关键词: 髓系分化初级反应蛋白88, 肿瘤坏死因子受体相关因子6, C反应蛋白, 急性呼吸道感染, 儿童

Abstract:

Objective To investigate the roles of serum myeloid differentiation primary response protein 88（MyD88）and tumor necrosis factor receptor-associated factor 6（TRAF-6）combined determination in the diagnosis and prognosis of severe acute respiratory tract infection in children. Method Totally，80 children with acute respiratory tract infection（acute respiratory tract infection group）in Nanyang Central Hospital from January 2020 to June 2022 were enrolled. According to the results of etiological diagnosis，they were classified into non-bacterial infection group（42 cases）and bacterial infection group（38 cases）. According to the severity of patients' condition，they were classified into mild group（28 cases），moderate group（20 cases）and severe group（32 cases）. According to the prognosis of children，they were classified into good prognosis group（58 cases）and poor prognosis group（22 cases）. Totally，80 healthy children were enrolled as controls. Multivariate Logistic regression analysis was used to evaluate the prognostic factors of acute respiratory tract infection in children. Receiver operating characteristic（ROC）curve was used to analyze the diagnostic roles of serum MyD88 and TRAF-6 levels for severe acute respiratory tract infection in children. Results Serum levels of MyD88 and TRAF-6 in acute respiratory tract infection group were higher than those in control group（P<0.001）. Serum levels of MyD88 and TRAF-6 in bacterial infection group were higher than those in non-bacterial infection group（P<0.001）. Serum levels of MyD88 and TRAF-6 in mild，moderate and severe groups were increased in turn（P<0.001）. The areas under curves（AUC）of serum MyD88 and TRAF-6 single and combined determinations for the diagnosis of severe acute respiratory tract infection were 0.762，0.734 and 0.876，respectively. The proportion of bacterial infection，infection site in lower respiratory tract，the proportion of severe disease and the levels of white blood cell（WBC）count，C-reactive protein（CRP），MyD88 and TRAF-6 in poor prognosis group were higher than those in good prognosis group（P<0.05）. The severity of disease，elevated CRP，MyD88 and TRAF-6 were all risk factors for poor prognosis of children with acute respiratory tract infection [odds ratios（OR）were 1.693，1.864，3.218 and 2.869，95% confidence intervals（CI）were 1.142-2.510，1.228-2.830，1.561-6.633 and 1.511-5.446，P<0.05]. The AUC of serum MyD88，TRAF-6 and CRP for the prognosis of children with acute respiratory tract infection were 0.848，0.900，0.817 and 0.951，respectively. Conclusions Serum levels of MyD88 and TRAF-6 in children with acute respiratory tract infection are elevated，and the combined determination has good evaluation value in the diagnosis and prognosis of severe acute respiratory tract infection in children.

Key words: Myeloid differentiation primary response protein 88, Tumor necrosis factor receptor-associated factor 6, C-reactive protein, Acute respiratory tract infection, Children