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

Li Li; Hao Xiaoyan; Qi Jie; Tian Hui; Gong Fangyan; Jia Fang

doi:10.3760/j.issn.1673-4777.2026.01.006

Abstract：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 β,(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.