血清ANXA1、CLDN18水平与支气管哮喘患儿临床分期、急性期病情严重程度及气道炎症的关系OA

Objective To analyze the relationship between serum annexin A1(ANXA1)and claudin 18(CLDN18)with the clinical stage,severity in the acute stage and airway inflammation in children patients with bronchial asthma(BA).Methods A total of 240 children patients with acute stage of BA(acute stage group)and 80 children patients with remission stage of BA(remission stage group)admitted and treated in this hospital from January 2023 to December 2024 were selected as the research subjects.The children patients with acute phase of BA were divided into the mild acute BA group(96 cases),moderate acute BA group(84 cases)and severe acute BA group(60 cases)based on the disease severity.The other 80 healthy children who underwent physical examinations in this hospital during the same period were selected as the control group.The serum ANXA1 and CLDN18 levels,eosinophil count in peripheral blood,lung function indicators[peak expiratory flow(PEF)and forced expiratory volume in one second as a percentage of predicted value(FEV1%pred)],and fractional exhaled nitric oxide(FeNO)levels were compared among the groups.Pearson or Spearman correlation analysis was used to conduct the correlation analysis.The multivariate Logistic regres-sion was used to analyze the associated factors of BA stages,and the ordered multinomial Logistic regression was used to analyze the associated factors of the severity in the children patients with acute BA.The receiver operating characteristic(ROC)curves were drawn to analyze the value of serum ANXA1 and CLDN18 in jud-ging the acute stage and severe acute stage of BA.Results The serum ANXA1 and CLDN18 levels in the a-cute phase group were higher than those in the control group and remission phase group(P<0.017),and the serum ANXA1 and CLDN18 levels in the remission phase group were higher than those in the control group(P<0.017).The PEF and FEV1%pred in the acute phase group were lower than those in the control group and remission phase group(P<0.017),and the eosinophil count and FeNO level were higher than those in the control group and remission phase group(P<0.017);the PEF and FEV1%pred in the remission phase group were lower than those in the control group(P<0.017),and the eosinophil count and FeNO level were higher than those in the control group(P<0.017).The PEF and FEV1%pred in the severe acute stage BA group were lower than those in the mild acute stage BA group and the moderate acute stage BA group(P<0.017),and the eosinophil count,FeNO levels and serum ANXA1 and CLDN18 levels were higher than those in the mild acute stage BA group and moderate acute stage BA group(P<0.017);the PEF and FEV1%pred in the moderate acute stage BA group were lower than those in the mild acute stage BA group(P<0.017),and the eosinophil count,FeNO levels,and serum ANXA1 and CLDN18 levels were higher than those in the mild acute stage BA group(P<0.017).The serum ANXA1 level in children patients with acute stage BA was positively correlated with the severity degree of the disease,eosinophil count and FeNO level(rs/r=0.774,0.513,0.651;all P<0.001),and negatively correlated with PEF and FEV1%pred(r=-0.570,-0.724;both P<0.001);the serum CLDN18 level was positively correlated with the severity degree of the disease,eosino-phil count and FeNO level(rs/r=0.784,0.456,0.582;all P<0.001),and negatively correlated with PEF and FEV1%pred(r=-0.567,-0.696;both P<0.001).The severity degree of the disease was negatively corre-lated with PEF and FEV1%pred(rs=-0.708,-0.757;both P<0.001),and positively correlated with EOS count and FeNO level(rs=0.668,0.737;both P<0.001).The increased PEF and increased FEV1%pred were both correlated with reduced likelihood of BA being in the acute stage(P<0.05),while the increased EOS count,increased FeNO level,increased serum ANXA1 level and increased serum CLDN18 level were all correlated with reduced likelihood of BA being in the acute stage(P<0.05).The increased PEF and increased FEV1%pred were both correlated with reduced likelihood of disease aggravation in children patients with a-cute stage of BA(P<0.05),while the increased EOS count,increased FeNO level,increased serum ANXA1 level and increased serum CLDN18 level were all correlated with increased likelihood of disease aggravation in children patients with acute stage of BA(P<0.05).The areas under the curves(AUCs)of serum ANXA1,CLDN18 alone and their combination for judging the acute stage in BA were 0.798,0.813 and 0.887,respec-tively.The AUC of the 2-item combination judgment was greater than that of serum ANXA1 and CLDN18 a-lone(Z=3.817,3.718;both P<0.001).The AUCs of serum ANXA1,CLDN18 alone and their combination judgment for the acute stage in severe BA were 0.783,0.796,and 0.897,respectively.The AUC of the 2-item combination judgment was greater than that of serum ANXA1 and CLDN18 alone(Z=4.541,3.824;both P<0.001).Conclusion The serum ANXA1 and CLDN18 levels are increased in children patients with acute stage of BA.These two indicators are related to the severity degree of the disease,aggravation of airway in-flammation and lung function reduction in children patients with acute stage of BA.Moreover,the value of the 2-item combination for judging BA in the acute stage and the acute stage of severe BA is relatively high.