Changes of Serum Levels of 6-Keto-PGF1α，TGF-α and TXB2 during the Treatment of Peptic Ulcer in Children and Their Influence on Prognosis
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摘要:
目的 探讨小儿消化性溃疡治疗期间血清6-酮前列腺素（6-Keto-PGF1α）、转化生长因子α（TGF-α）、血栓素B2（TXB2）水平变化，并分析其对预后的预测价值。 方法 选取2019年1月至2022年6月消化性溃疡患儿108例为研究对象，根据奥美拉唑三联疗法治疗效果分为预后良好组（86例）与预后不良组（22例）。比较2组临床资料、治疗期间血清6-Keto-PGF1α、TGF-α、TXB2水平。分析各血清指标对治疗预后的影响及预测预后价值。 结果 预后不良组治疗6周后血清6-Keto-PGF1α、TGF-α水平高于预后良好组，TXB2水平低于预后良好组，治疗前后各血清指标变化差值小于预后良好组（P < 0.05）；血清6-Keto-PGF1α、TGF-α、TXB2变化差值与预后独立相关，且各血清指标变化差值阳性者发生预后不良风险分别为阴性者的5.804、4.014、3.241倍（P < 0.05）；各血清指标变化差值联合预测预后的AUC大于单项指标预测（P < 0.05）。 结论 小儿消化性溃疡治疗期间血清6-Keto-PGF1α、TGF-α水平升高，而TXB2水平降低，治疗前后各血清指标水平变化与预后不良密切相关，联合检测其水平变化对预后不良具有一定预测价值。 Abstract:Objective To investigate the changes of serum levels of 6-Keto-PGF1α, transforming growth factor α （TGF-α） and thromboxane B2 （TXB2） during the treatment of peptic ulcer in children, and to analyze their prognostic value. Methods 108 children with peptic ulcer from January 2019 to June 2022 were selected as the study subjects. According to the therapeutic effect of omeprazole triple therapy, they were divided into the good prognosis group （86 cases） and the poor prognosis group （22 cases）. The clinical data and serum levels of 6-Keto-PGF1α, TGF-α and TXB2 during the treatment were compared between the two groups to analyze the influence and prognostic value of each serum index on the treatment and prognosis. Results After 6 weeks of the treatment, the serum levels of 6-Keto-PGF1α and TGF-α in the poor prognosis group were higher than those in the good prognosis group, and the level of TXB2 was lower than that in the good prognosis group, and the difference of serum indexes before and after the treatment was smaller than that in the good prognosis group （P < 0.05）. The difference of serum 6-Keto-PGF1α, TGF-α and TXB2 were independently correlated with the prognosis, and the risk of adverse prognosis in positive patients was 5.804, 4.014 and 3.241 times that of negative patients respectively （P < 0.05）. The combined prediction AUC of the difference of serum indexes was greater than that of the single indexes （P < 0.05）. Conclusion The serum levels of 6-Keto-PGF1α and TGF-α increased during the treatment of peptic ulcer in children, while the levels of TXB2 decreased. The changes of serum indexes before and after treatment are closely related to poor prognosis, and the combined detection of their changes has certain predictive value for poor prognosis. -
Key words:
- Peptic ulcer in children /
- 6-keto prostaglandin /
- Transforming growth factor α /
- Thromboxane B2 /
- Prognosis /
- Forecast
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图 1 血清6-Keto-PGF1α、TGF-α、TXB2变化差值预测预后价值
Figure 1. Prognostic value of the difference of serum 6-Keto-PGF1α，TGF-α and TXB2
表 1 2组临床资料比较[n（%）/（
$\bar x \pm s $ ）]Table 1. Comparison of clinical data between the two groups [n（%）/（
$\bar x \pm s $ ）]资料 预后不良组（n = 22） 预后良好组（n = 86） t/χ2 P 性别 0.163 0.686 男 12（54.55） 51（59.30） 女 10（45.45） 35（40.70） 年龄（岁） 8.14 ± 1.71 8.23 ± 1.55 0.238 0.812 病程（月） 6.07 ± 1.23 5.89 ± 1.14 0.650 0.517 溃疡直径（cm） 2.16 ± 0.52 1.75 ± 0.39 4.096 0.000* 疾病类型 0.183 0.913 十二指肠溃疡 7（31.82） 29（33.72） 胃溃疡 12（54.55） 48（55.81） 复合型溃疡 3（13.64） 9（10.47） Hp阳性 12.806 0.000* 否 5（22.73） 56（65.12） 是 17（77.27） 30（34.88） 溃疡分期 7.120 0.008* 非活动期 8（36.36） 58（67.44） 活动期 14（63.64） 28（32.56） *P < 0.05。 
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表 2 2组治疗期间血清6-Keto-PGF1α、TGF-α、TXB2水平及变化差值比较（
$\bar x \pm s $ ）Table 2. Comparison of serum levels of 6-Keto-PGF1α，TGF-α and TXB2 and their differences between the two groups during treatment （
$\bar x \pm s $ ）指标 预后不良组（n = 22） 预后良好组（n = 86） t P 治疗前 6-Keto-PGF1α（pg/mL） 30.06 ± 6.48 29.73 ± 5.81 0.232 0.817 TGF-α（μg/L） 11.38 ± 3.04 11.09 ± 1.87 0.564 0.574 TXB2（pg/mL） 86.92 ± 18.27 88.14 ± 20.03 0.259 0.796 治疗6周后 6-Keto-PGF1α（pg/mL） 25.67 ± 4.22 18.46 ± 3.36 8.508 0.000* TGF-α（μg/L） 9.22 ± 2.17 6.28 ± 1.23 8.400 0.000* TXB2（pg/mL） 113.58 ± 17.60 136.21 ± 22.57 4.370 0.000* 治疗前与治疗6周后差值 6-Keto-PGF1α（pg/mL） 4.38 ± 1.15 11.27 ± 2.89 10.932 0.000* TGF-α（μg/L） 2.16 ± 0.70 4.81 ± 1.26 9.476 0.000* TXB2（pg/mL） 26.66 ± 8.23 48.07 ± 12.75 7.473 0.000* *P < 0.05。
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表 3 血清6-Keto-PGF1α、TGF-α、TXB2变化差值与预后的关系
Table 3. Relationship between the difference of serum 6-Keto-PGF1α，TGF-α and TXB2 and prognosis
自变量 校正前 校正后 OR 95%CI P OR 95%CI P 6-Keto-PGF1α差值 0.510 0.424～0.613 < 0.001* 0.331 0.239～0.458 < 0.001* TGF-α差值 0.499 0.315～0.791 < 0.001* 0.439 0.301～0.639 < 0.001* TXB2差值 0.617 0.437～0.870 < 0.001* 0.395 0.280～0.557 < 0.001* *P < 0.05。
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表 4 血清6-Keto-PGF1α、TGF-α、TXB2变化差值预测预后价值
Table 4. Prognostic value of serum difference of 6-Keto-PGF1α，TGF-α and TXB2
指标 AUC 95%CI 截断值 敏感度（%） 特异度（%） P 6-Keto-PGF1α差值 0.786 0.696～0.859 6.57 pg/mL 72.73 79.07 < 0.001* TGF-α差值 0.834 0.750～0.898 2.84 μg/L 90.91 62.79 < 0.001* TXB2差值 0.742 0.649～0.821 30.30 pg/mL 68.18 73.26 < 0.001* *P < 0.05。
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表 5 以最佳截断值为界分析血清6-Keto-PGF1α、TGF-α、TXB2对预后的影响
Table 5. The effects of serum 6-Keto-PGF1α，TGF-α and TXB2 on prognosis were analyzed with the optimal cut-off value as the boundary
指标 预后不良组（n = 22） 预后良好组（n = 86） RR（95%CI） U P 6-Keto-PGF1α差值 阳性 16 18 5.804（2.491～13.523） 4.165 < 0.001* 阴性 6 68 TGF-α差值 阳性 20 32 10.769（2.646～43.833） 4.014 < 0.001* 阴性 2 54 TXB2差值 阳性 15 23 3.947（1.764～8.834） 3.241 0.001* 阴性 7 63 *P < 0.05。
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