2026 年第 1 期 第 21 卷

血清肝配蛋白A型受体2和转录激活因子3水平在肺炎支原体肺炎合并哮喘患儿中的表达及临床意义

Expression and clinical significance of serum ephrin type A receptor 2 and activating transcription factor 3 levels in children with Mycoplasma pneumoniae pneumonia complicated with asthma

作者：李莉郝晓燕祁洁田慧弓芳艳贾芳

英文作者：Li Li Hao Xiaoyan Qi Jie Tian Hui Gong Fangyan Jia Fang

单位：山西省儿童医院山西省妇幼保健院特需病区，太原030000

英文单位：Special Needs Ward Shanxi Children′s Hospital Shanxi Women and Children Hospital Taiyuan 030000 China

关键词：肺炎支原体肺炎；哮喘；肺功能；气道炎症；气道重塑

英文关键词：Mycoplasmapneumoniaepneumonia;Asthma;Pulmonaryfunction;Airwayinflammation;Airwayremodeling

• 摘要：

• 目的 探讨血清肝配蛋白A型受体2（EphA2）、转录激活因子3（ATF3）水平在肺炎支原体肺炎（MMP）合并哮喘患儿中的表达及临床意义。方法 选取2022年1月至2025年2月山西省儿童医院收治的MPP合并哮喘患儿（MPP合并哮喘组）、单纯MPP患儿（MPP组）和同期体检健康儿童（对照组）各120例，MPP合并哮喘患儿根据病情分为轻度组（30例）、中度组（42例）、重度组（48例）。检测血清EphA2、ATF3水平、肺功能指标［峰值呼气流速（PEF）、第1秒用力呼气容积（FEV1）/用力肺活量（FVC）、FEV1占预计值百分比（FEV1%）］、气道炎症指标［嗜酸粒细胞（EOS）计数、呼出气一氧化氮（FeNO）、总免疫球蛋白E（IgE）］、气道重塑指标［转化生长因子β1（TGF-β1）、基质金属蛋白酶2（MMP-2）、MMP-9］。分析MPP合并哮喘患儿血清EphA2、ATF3水平与临床指标的相关性；分析血清EphA2、ATF3水平与MPP合并哮喘患儿病情的关系；受试者工作特征曲线分析血清EphA2、ATF3水平对MPP合并哮喘患儿病情的评估价值。结果 单纯MPP组、MPP合并哮喘组PEF、FEV1/FVC、FEV1%均低于对照组，且MPP合并哮喘组均低于单纯MPP组，单纯MPP组、MPP合并哮喘组EOS计数、总IgE、FeNO、TGF-β1、MMP-2、MMP-9、EphA2、ATF3水平均高于对照组，且MPP合并哮喘组均高于单纯MPP组（均P＜0.05）。中度组、重度组PEF、FEV1/FVC比值、FEV1%均低于对照组，且重度组均低于中度组，中度组、重度组EOS计数、总IgE、FeNO、TGF-β1、MMP-2、MMP-9、EphA2、ATF3水平均高于对照组，且重度组均高于中度组（均P＜0.05）。MPP合并哮喘患儿血清EphA2、ATF3水平与严重程度、EOS计数、总IgE、FeNO、TGF-β1、MMP-2、MMP-9水平均呈正相关，与PEF、FEV1/FVC比值、FEV1%均呈负相关（均P＜0.05）。有序多分类Logistic回归分析结果表明，EphA2（比值比＝1.022,95%置信区间：1.006~1.039）、ATF3（比值比＝1.489,95%置信区间：1.292~1.716）均为MPP合并哮喘患儿病情加重的独立危险因素（均P＜0.001）。血清EphA2、ATF3水平及二者联合评估MPP合并中重度哮喘的曲线下面积为0.830、0.817、0.895，二者联合优于各自单独评估价值。结论 MPP合并哮喘患儿血清EphA2、ATF3水平升高，与病情、气道炎症、气道重塑加重和肺功能降低相关，可能成为评估MPP合并哮喘患儿病情程度的标志物。

• Objective To explore the expression and clinical significance of serum ephrin type A receptor 2 (EphA2) and activating transcription factor 3 (ATF3) levels in children with Mycoplasma pneumoniae pneumonia (MPP) complicated with asthma. Methods A total of 120 children with MPP complicated with asthma (MPP+asthma group), 120 children with simple MPP (MPP group), and 120 healthy children who underwent physical examination during the same period (control group) admitted to Shanxi Children′s Hospital from January 2022 to February 2025 were selected. Children in the MPP+asthma group were divided into mild group (30 cases), moderate group (42 cases), and severe group (48 cases) according to the disease severity. Serum EphA2 and ATF3 levels, pulmonary function indices ［peak expiratory flow (PEF), forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC), FEV1 as a percentage of predicted value (FEV1%)］, airway inflammation indices ［eosinophil (EOS) count, fractional exhaled nitric oxide (FeNO), total immunoglobulin E (IgE)］, and airway remodeling indices ［transforming growth factor β1 (TGF-β1), matrix metalloproteinase 2 (MMP-2), MMP-9］ were detected. The correlations between serum EphA2 and ATF3 levels and clinical indicators in children with MPP complicated with asthma were analyzed; the relationship between serum EphA2 and ATF3 levels and the disease severity of these children was explored; and the value of serum EphA2 and ATF3 levels in assessing the disease severity was evaluated using receiver operating characteristic curve analysis. Results The PEF, FEV1/FVC ratio, and FEV1% in the simple MPP group and MPP+asthma group were significantly lower than those in the control group, with the MPP+asthma group showing even lower values than the simple MPP group. The EOS count, total IgE, FeNO, TGF-β1, MMP-2, MMP-9, EphA2, and ATF3 levels in the simple MPP group and MPP+asthma group were significantly higher than those in the control group, and the MPP+asthma group had higher levels than the simple MPP group (all P<0.05). The PEF, FEV1/FVC ratio, and FEV1% in the moderate and severe subgroups were significantly lower than those in the control group, with the severe subgroup having lower values than the moderate subgroup. The EOS count, total IgE, FeNO, TGF-β1, MMP-2, MMP-9, EphA2, and ATF3 levels in the moderate and severe subgroups were significantly higher than those in the control group, and the severe subgroup had higher levels than the moderate subgroup (all P<0.05). In children with MPP complicated with asthma, serum EphA2 and ATF3 levels were positively correlated with disease severity, EOS count, total IgE, FeNO, TGF-β1, MMP-2, and MMP-9 levels, while negatively correlated with PEF, FEV1/FVC ratio, and FEV1% (all P<0.05). Results  of ordinal multinomial Logistic regression analysis showed that EphA2 (odds ratio=1.022, 95% confidence interval: 1.006-1.039) and ATF3 (odds ratio=1.489, 95% confidence interval: 1.292-1.716) were independent risk factors for disease progression in children with MPP complicated with asthma (all P<0.001). The areas under the curve of serum EphA2, ATF3 levels, and their combination for evaluating moderate-to-severe MPP complicated with asthma were 0.830, 0.817, and 0.895, respectively, with the combined evaluation being superior to either single indicator. Conclusion  Serum EphA2 and ATF3 levels are elevated in children with MPP complicated with asthma, which are associated with disease severity, aggravated airway inflammation, enhanced airway remodeling, and decreased pulmonary function. These two indicators may serve as biomarkers for assessing the disease severity in such children.