肠道黏液层中MUC2、sIgA在婴儿食物过敏中的动态变化及应用价值

doi:10.12372/jcp.2024.23e0852

摘要/Abstract

摘要：

目的动态监测分析食物过敏婴儿临床治疗过程中粪便黏蛋白2(MUC2)及分泌型免疫球蛋白A(sIgA)的变化情况，探究其与食物过敏的关系及应用价值。方法选择2022年7月至2023年6月门诊就诊的食物过敏婴儿52例为食物过敏组，同期选取非过敏性疾病婴儿52例作为对照组，比较两组患儿粪便MUC2、sIgA水平的差异。结果食物过敏组男23例、女29例，对照组男女各26例，两组患儿在年龄、分娩方式、喂养方式、辅食添加、过敏性疾病家族史的差异均无统计学意义。食物过敏组中粪便MUC2及sIgA水平均高于对照组[37.81±14.91 μg/mL比25.33±14.29 μg/mL；182.4(150.2~202.7) μg/mL比147.7(131.4~157.9) μg/mL]，差异具有统计学意义(P<0.001)。在随访第2、4周时，食物过敏组患儿的粪便MUC2水平逐渐下降，但组间比较显示差异无统计学意义(P>0.05)；而粪便sIgA水平逐渐升高，组间比较提示差异有统计学意义(P<0.05)。对粪便MUC2、sIgA进行二元logistic回归分析及ROC曲线分析，粪便MUC2及sIgA的ROC曲线下面积均在0.7以上(P<0.001)，两者联合诊断可提高诊断的特异度。结论粪便MUC2及sIgA水平在两组患儿之间均存在差异，随着食物过敏患儿临床症状的好转，粪便MUC2水平有下降趋势、sIgA水平逐渐升高，两者可能作为诊断食物过敏的潜在生物标志物。

关键词: 食物过敏, 肠道黏液层, 黏蛋白2, 分泌型免疫球蛋白A, 生物标志物

Abstract:

Objective To dynamically monitor and analyze the changes of fecal mucin 2 (MUC2) and secretory immunoglobulin A (sIgA) levels during the clinical treatment process of infants with food allergy, and to investigate the usefulness of food allergy’s interaction with sIgA and MUC2. Methods Fifty-two infants diagnosed with food allergy who received outpatient treatment from July 2022 to June 2023 were selected as the food allergy group. Simultaneously, 52 non-allergic diseases infants were chosen as the control group. The levels of fecal MUC2 and sIgA were compared between the two groups. Results There were 23 boys and 29 girls in the food allergy group and 26 boys and 26 girls in the control group. There were no statistically significant differences in age, delivery mode, feeding method, introduction of complementary foods and family history of allergic diseases between the two groups (P>0.05). The levels of fecal MUC2 and sIgA in the food allergy group were higher than those in the control group [(37.81±14.91) μg/mL vs. (25.33±14.29) μg/mL; 182.4(150.2-202.7) μg/mL vs. 147.7(131.4-157.9) μg/mL], and the differences were statistically significant (P<0.001). At the 2nd and 4th week of follow-up, fecal MUC2 level of children with food allergy group gradually decreased, but there was no statistical significance between groups (P>0.05). The level of fecal sIgA increased gradually, and the difference between groups was statistically significant (P<0.05). Binary logistic regression and ROC curve analysis showed that fecal MUC2 and sIgA both had area under the ROC curves above 0.7 (P<0.001), and the combination of the two could increase the diagnosis specificity. Conclusions There were differences in fecal MUC2 and sIgA levels between the two groups. With the improvement of clinical symptoms of children with food allergy, fecal MUC2 levels showed a downward trend and sIgA levels gradually increased, which may serve as potential biomarkers for the diagnosis of food allergy. The two groups' fecal MUC2 and sIgA levels varied from one another. With the improvement of clinical symptoms of children with food allergy, fecal MUC2 level had a downward trend and sIgA level gradually increased, suggesting that these markers could be useful for food allergy diagnosis.

Key words: food allergy, intestinal mucus layer, mucin 2, secreted immunoglobulin A, biomarker

代妮妮, 高亚娟, 孙晋波, 张娟, 李在玲. 肠道黏液层中MUC2、sIgA在婴儿食物过敏中的动态变化及应用价值[J]. 临床儿科杂志, 2024, 42(4): 297-304.

DAI Nini, GAO Yajuan, SUN Jinbo, ZHANG Juan, LI Zailing. The dynamic changes and application value of MUC2 and sIgA in intestinal mucus layer of infants with food allergy[J]. Journal of Clinical Pediatrics, 2024, 42(4): 297-304.

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项目	总体（n=104）	过敏组（n=52）	对照组（n=52）	统计值	P
入组年龄[M(P₂₅~P₇₅)/月]	4.10(3.00~5.93)	3.90(2.83~5.33)	4.30(4.00~6.00)	Z=1.56	0.119
性别[n(%)]				χ²=0.35	0.556
男	49（47.12%）	23（44.23%）	26（50.00%）
女	55（52.88%）	29（55.77%）	26（50.00%）
出生方式[n(%)]				χ²=0.04	0.842
剖宫产	43（41.35%）	22（42.31%）	21（40.38%）
经阴分娩	61（58.65%）	30（57.69%）	31（59.62%）
喂养方式[n(%)]				-	0.486¹⁾
纯母乳喂养	48（46.15%）	27（51.92%）	21（40.38%）
人工喂养	3（2.89%）	1（1.92%）	2（3.85%）
混合喂养	53（50.96%）	24（46.16%）	29（55.77%）
入组时辅食添加情况				χ²=3.47	0.063
已添加	24（23.08%）	8（15.38%）	16（30.77%）
未添加	80（76.92%）	44（84.62%）	36（69.23%）
一级亲属过敏性疾病家族史[n(%)]				χ²=3.21	0.073
无	43（41.35%）	17（32.69%）	26（50.00%）
有	61（58.65%）	35（67.31%）	26（50.00%）

临床表现	入组时	治疗2周	治疗4周
皮疹SCORAD评分[M(P₂₅~P₇₅)]	7.30(0.00~21.30)	0.00(0.00~0.00)	0.00(0.00~0.00)
腹泻/%	94.23%	36.67%	7.69%
便血/%	88.46%	26.67%	11.54%
黏液便/%	94.23%	30.00%	7.69%

目标标志物	AUC(95%CI)	P值	灵敏度	特异度	Cut-off值/μg·mL^-1
粪便MUC2	0.728(0.632~0.825)	<0.001	0.635	0.731	34.16
粪便sIgA	0.769(0.676~0.862)	<0.001	0.731	0.788	158.80
联合预测因子	0.794(0.709~0.879)	<0.001	0.577	0.885	0.37

自变量	B	Wald χ²值	P值	OR值(95% CI)
粪便MUC2	0.04	4.70	0.030	1.037(1.003~1.071)
粪便sIgA	0.03	10.05	0.002	1.028(1.011~1.046)