PICU重症肺炎患儿纤维支气管镜肺泡灌洗液中PI3K、MMP-9表达及其临床意义.pdf

实用医学杂志 2023年第39卷第15期 The Journal of Practical Medicine 2023 Vol.39 No.15PICU重症肺炎患儿纤维支气管镜肺泡灌洗液中PI3K、MMP-9表达及其临床意义姜家利 陈婷 童文佳 丁洁 徐卫华安徽省儿童医院儿科（合肥 230001）【摘要】目的探讨儿科重症监护病房（PICU）重症肺炎患儿纤维支气管镜肺泡灌洗液中磷脂酰肌醇-3-激酶（PI3K）、基质金属蛋白酶-9（MMP-9）表达及其临床意义。方法选取2021年1月到2022年6月医院PICU收治的103例行纤维支气管镜肺泡灌洗术的重症肺炎患儿，采用实时荧光定量聚合酶链反应测定PI3K表达情况，采用酶联免疫吸附法测定肺泡灌洗液中MMP-9表达情况。患儿入院后随访21 d统计其预后情况。Logistic回归分析影响PICU重症肺炎患儿预后的因素，采用Pearson相关性分析泡灌洗液中PI3K、MMP-9表达水平与PICU重症肺炎患儿儿童危重病例评分（PCIS）、儿童器官功能障碍2（PELOD-2）评分的相关性，采用受试者工作曲线（ROC）分析肺泡灌洗液中PI3K、MMP-9表达水平预测PICU重症肺炎患儿预后的价值。结果103例PICU重症肺炎患儿中，预后不良29例，预后良好74例。Logistic多因素回归分析结果显示：合并休克（OR=4.104，95%CI：1.689 9.974）、PELOD-2 评分（OR=4.764，95%CI：1.960 11.577）、PCIS 评分（OR=5.068，95%CI：2.085 12.318）、PI3K（OR=3.924，95%CI：1.614 9.536）、MMP-9（OR=3.873，95%CI：1.594 9.412）是影响PICU重症肺炎患儿预后的因素（P 0.05）。Pearson相关性分析显示：肺泡灌洗液中PI3K、MMP-9表达水平与患儿PCIS评分均呈负相关（r=-0.598，P=0.000；r=-0.537，P=0.000），肺泡灌洗液中 PI3K、MMP-9 表达水平与患儿 PELOD-2 评分均呈正相关（r=0.546，P=0.000；r=0.571，P=0.000）。ROC曲线结果显示，PI3K、MMP-9及二者联合预测PICU重症肺炎患儿预后的灵敏度分别为75.86%（95%CI：56.08%88.98%）、72.41%（95%CI：52.51%86.55%）、82.76%（95%CI：63.51%93.47%），特异度分别为 75.68%（95%CI：64.07%84.58%）、79.73%（95%CI：68.47%87.85%）、89.19%（95%CI：79.28%94.88%），AUC 分别为0.762（95%CI：0.666 0.859）、0.767（95%CI：0.670 0.873）、0.909（95%CI：0.848 0.971）。结论纤维支气管镜肺泡灌洗液中 PI3K、MMP-9 表达与 PICU 重症肺炎患儿预后有关，二者联合预测患儿预后效能良好，将其作为预测PICU重症肺炎患儿预后的敏感指标具有一定临床价值。【关键词】儿科重症监护病房；儿童重症肺炎；纤维支气管镜肺泡灌洗；磷脂酰肌醇-3-激酶；基质金属蛋白酶-9；预后【中图分类号】R725.6Expression and clinical significance of PI3K and MMP9 in bronchoscopic alveolar lavage fluid of children with severe pneumonia in PICU JIANG Jiali，CHEN Ting，TONG Wenjia，DING Jie，XU Weihua.Department of Pediatrics，Anhui Childrens Hospital，Hefei 230001，ChinaCorresponding author：XU Weihua Email： 【Abstract】Objective To investigate the expression and clinical significance of phosphatidylinoinosidine3kinase（PI3K）and matrix metalloproteinase 9（MMP9）in bronchoscopic alveolar lavage fluid of children with severe pneumonia in pediatric intensive care unit（PICU）.Methods A total of 103 children with severe pneumonia admitted to PICU of the hospital from January 2021 to June 2022 were enrolled.All patients underwent fiberbronchoscopic alveolar lavage.Realtime fluorescence quantitative polymerase chain reaction was used to determine the expression of PI3K，and enzymelinked immunosorption was used to determine the expression of MMP9 in alveolar lavage fluid.The patients were followed up for 21 days after admission to evaluate the prognosis.Logistic regression analysis was used to analyze the factors affecting the prognosis.Pearson correlation was used to analyze the correlation between the expression levels of PI3K and MMP9 in the bubble lavage solution and the child Critical Case Score 临 床 研 究doi：10.3969/j.issn.1006-5725.2023.15.014基金项目：安徽省自然科学基金面上项目（编号：1808085MH230）通信作者：徐卫华 E-mail：1939实用医学杂志 2023年第39卷第15期 The Journal of Practical Medicine 2023 Vol.39 No.15（PCIS）and child Organ Dysfunction 2（PELOD2）Scores.The values of PI3K and MMP9 expression levels in alveolar lavage fluid to predict the prognosis were analyzed by receiver operating curve（ROC）.Results Among the 103 children，29 cases had poor prognosis vs 74 cases had good prognosis.Logistic multivariate regression analysis showed that combined shock（OR=4.104，95%CI：1.689 9.974），PELOD2 score（OR=4.764，95%CI：1.960 11.577），PCIS score（OR=5.068，95%CI：2.085 12.318），PI3K（OR=3.924，95%CI：1.614 9.536）and MMP9（OR=3.873，95%CI：1.594 9.412）were the prognostic factors of PICU children with severe pneumonia（P 0.05）.Pearson correlation analysis showed that the expression levels of PI3K and MMP9 in alveolar lavage fluid were negatively correlated with PCIS scores（r=-0.598，P=0.000；r=-0.537，P=0.000），PI3K and MMP9 expression levels in alveolar lavage fluid were positively correlated with PELOD2 scores（r=0.546，P=0.000；r=0.571，P=0.000）.ROC curve results showed that the sensitivity of PI3K，MMP9 and their combination to predict the prognosis of PICU children with severe pneumonia was 75.86%（95%CI：56.08%88.98%），72.41%（95%CI：52.51%86.55%）and 82.76%（95%CI：63.51%93.47%），the specificity was 75.68%（95%CI：64.07%84.58%），79.73%（95%CI：68.47%87.85%），89.19%（95%CI：79.28%94.88%），and the AUC was 0.762（95%CI：0.666 0.859），0.767（95%CI：0.670 0.873），0.909（95%CI：0.848 0.971）.Conclusion The expression of PI3K and MMP9 in bronchoscopic alveolar lavage fluid was related to the prognosis of children with severe pneumonia in PICU，and the combination in predicting the prognosis was effective，so it has certain clinical value to use them as a sensitive indicator to predict the prognosis of children with severe pneumonia in PICU.【Key words】pediatric intensive care unit；childrens severe pneumonia；fibrous bronchoscope alveolar lavage；phosphatidylinositol3kinase；matrix metalloproteinase 9；prognosis儿 科 重 症 监 护 病 房（pediatric intensive care unit，PICU）重症肺炎具有发病率高、病变进展快的特点12。重症肺炎不仅可进展为肺不张、坏死性肺炎等严重疾病，还可诱发肺外并发症，造成多组织器官功能障碍3-4。纤维支气管镜肺泡灌洗术是临床治疗 PICU 重症肺炎患儿常用的方法，可清除患儿肺部痰液，阻止肺内分泌物堆积，有效控制肺部感染，但不同 PICU 重症肺炎患儿治疗疗效具有明显差异5。早期评估 PICU 重症肺炎患儿纤维支气管镜肺泡灌洗术后治疗转归情况，可指导临床早期及时调整医疗方案，改善