Abstract:

Objective

To study the characteristics of periostin， tenascin-C （TNC）， and soluble human matrix metalloproteinase-2 （sST2） levels in asthmatic children infected with Mycoplasma pneumoniae and their impact on acute asthma exacerbations.

Methods

A total of 187 asthmatic children with mycoplasma pneumoniae infection who were hospitalized and treated in our hospital from May 2020 to October 2022 were selected， including 104 males and 83 females， with ages ranging from 10 to 14 years and a mean age of（12.07±1.25） years. The children were categorized into two groups： a remission group （n=134） and an acute exacerbation group （n=53）， based on the presence of acute asthma exacerbation. A comparison was made between the two groups in terms of general clinical characteristics， as well as serum levels of periostin， TNC，and sST2. Univariate and multivariate logistic regression analyses were conducted to ascertain whether serum periostin， TNC， and sST2 levels could independently predict the risk of acute exacerbations in children with asthma infected by Mycoplasma pneumoniae. Through the use of receiver operating characteristic （ROC）curves， cutoff values for serum periostin， TNC， and sST2 were identified. Based on the results of multivariate logistic regression analysis， a risk prediction nomogram model incorporating serum periostin， TNC， and sST2 was constructed. The model degree of fitting was evaluated using Hosmer-Lemeshow test and calibration curves， the predictive performance was assessed through ROC curve analysis， and the clinical application value was evaluated using decision curve analysis （DCA）.

Results

Compared to the remission group， the acute exacerbation group had a lower proportion of regular use of inhaled corticosteroids （ICS）， a lower forced expiratory volume in one second/forced vital capacity ratio （FEV1/FVC），and forced expiratory volume in 1 second as a percentage of predicted value （FEV₁/pred）， and higher levels of serum periostin， TNC， and sST2（P＜0.05）. ROC analysis indicated that the AUC values for serum periostin， TNC， and sST2 in predicting acute exacerbations in children with asthma infected by Mycoplasma pneumoniae were 0.673， 0.737， and 0.720， respectively. Multivariate logistic regression analysis indicated that high periostin ［OR （95%CI）=1.031 （1.014～1.049）］， high TNC ［OR （95%CI）=1.099 （1.055～1.144）］， and high sST2 ［OR （95%CI）=1.171（1.080～1.271）］ were all independent risk factors for acute exacerbations in children with asthma infected by Mycoplasma pneumoniae （P＜0.05）. The nomogram model constructed based on the aforementioned three indicators demonstrated favorable degree of fitting （Hosmer-Lemeshow test： χ²=7.356， df=8， P=0.499）. ROC analysis revealed that the AUC value of this nomogram model for predicting acute exacerbations in pediatric patients was 0.838 （95% CI： 0.779～0.898， P＜0.001）. DCA analysis indicated that this nomogram prediction model exhibited satisfactory clinical net benefit across a threshold probability range of 0～0.95.

Conclusion

The levels of serum periostin， TNC， and sST2 in children with asthma complicated by Mycoplasma pneumoniae infection are strongly correlated with the likelihood of experiencing acute asthma exacerbations.Utilizing a model that incorporates these serum biomarkers can greatly assist healthcare providers in assessing the risk of acute asthma exacerbations in this specific group of children， thereby demonstrating significant clinical utility.

Key words: Mycoplasma pneumoniae infection, Acute asthma exacerbation； Periostin, Tenascin-C, Soluble human matrix metalloproteinase 2