重症腺病毒肺炎患儿血清肝素...及其对疾病预后评估价值研究_刘晓燕.pdf

151现代检验医学杂志第 38 卷第 1 期2023 年 1 月J Mod Lab Med,Vol.38,No.1,Jan.2023重症腺病毒肺炎患儿血清肝素结合蛋白和肿瘤坏死因子-表达水平及其对疾病预后评估价值研究刘晓燕，张小佛，李嘉，余庆乐，刘麟（长沙市中心医院儿科，长沙 410004）摘要：目的分析血清肝素结合蛋白（heparin binding protein，HBP）、肿瘤坏死因子（tumor necrosis factor，TNF）-与儿童重症腺病毒肺炎的关系及其对预后的评估价值。方法收集长沙市中心医院儿童医学中心 2016 年 3月 2020 年 8 月住院治疗的 232 例腺病毒肺炎患儿，根据病情程度分为重症肺炎组（n=170）和非重症肺炎组（n=62）；根据预后情况将重症腺病毒肺炎患儿分为预后良好组（n=116）和预后不良组（n=54）。收集患儿病程、电解质紊乱、循环系统并发症等一般资料；采用酶联免疫吸附（ELISA）法检测患儿血清 HBP 和 TNF-水平，记录患者序贯器官功能衰竭评分（SOFA）和 Murray 肺损伤评分；绘制受试者工作特征（ROC）曲线对比分析血清 HBP 和 TNF-水平与 SOFA，Murray 肺损伤评分对重症腺病毒肺炎患儿预后的预测价值；采用多因素 Logistic 回归分析影响重症腺病毒肺炎患儿预后的因素。结果与非重症肺炎组相比，重症肺炎组血清 HBP（124.6732.84 ng/ml vs 40.796.54 ng/ml），TNF-（396.7453.71 pg/ml vs 263.9547.84 pg/ml）水平及 SOFA（5.321.36 分 vs 2.780.56 分），Murray 肺损伤评分（2.260.49 分 vs 1.520.29 分）升高，差异具有统计学意义（t=19.942，17.141，14.037，11.027，均 P 0.05）。与预后良好组相比，预后不良组血清 HBP（160.6145.82 ng/ml vs 107.9432.87 ng/ml），TNF-（432.4438.95 pg/ml vs 380.1235.41 pg/ml）水平及电解质紊乱（68.52%vs 33.62%）、循环系统并发症比例（57.41%vs 22.41%）、SOFA（7.041.95 分 vs 4.521.23 分）、Murray 肺损伤评分（2.760.48 分 vs 2.020.32 分）较高，差异具有统计学意义（t=8.539，8.686，2=18.153，20.245，t=10.232，11.888，均 P 0.05）。血清 HBP 和 TNF-，联合预测概率值及 SOFA，Murray 肺损伤评分预测重症腺病毒肺炎患儿预后的曲线下面积（AUC）分别为 0.778，0.816，0.939，0.828和 0.851，特异度分别为 81.6%，71.6%，98.3%，60.3%和 81.9%，敏感度分别为 63.5%，81.5%，76.4%，90.7%和74.1%。HBP 和 TNF-是重症腺病毒肺炎患儿预后不良的独立危险因素（P 0.05）。结论重症腺病毒肺炎患儿血清 HBP 和 TNF-水平相对较高，且二者高水平可能与不良预后有关。关键词：重症腺病毒肺炎；儿童；肝素结合蛋白；肿瘤坏死因子-中图分类号：R563.14；R392.11文献标识码：A文章编号:1671-7414（2023）01-151-06doi:10.3969/j.issn.1671-7414.2023.01.028 Study on the Expression Level of Serum Heparin Binding Protein and Tumor Necrosis Factor-and Its Prognostic Value in Children with Severe Adenovirus PneumoniaLIU Xiao-yan,ZHANG Xiao-fo,LI Jia,YU Qing-le,LIU Lin（Department of Pediatrics,Changsha Central Hospital,Changsha 410004，China）Abstract:ObjectiveTo analyze the relationship between serum heparin binding protein(HBP),tumor necrosis factor(TNF)-and severe Adenovirus pneumonia in children and their prognostic evaluation value.MethodsA total of 232 children with Adenovirus pneumonia who were hospitalized from March 2016 to August 2020 in the Childrens Medical Center of Changsha Central Hospital were collected.According to the severity of the disease,they were divided into 170 cases of severe pneumonia and 62 cases of non-severe pneumonia.According to the prognosis,children with severe Adenovirus pneumonia were divided into a good prognosis group of 116 cases and a poor prognosis group of 54 cases.The general data were collected,including childrens disease course,electrolyte disturbances,and circulatory system complications.Enzyme-linked immunosorbent assay(ELISA)was used to detect serum HBP and TNF-levels in children,the sequential organ failure score(SOFA)and Murray lung injury score were recorded.Draw the receiver operating characteristic(ROC)curve and compare and analyze the serum HBP and TNF-the value of serum level,SOFA and Murray lung injury score in predicting the prognosis of children with severe Adenovirus pneumonia.Multivariate Logistic regression was used to analyze the factors affecting the prognosis of 基金项目：长沙市科技计划项目（kq1907024）。作者简介：刘晓燕（1982-），女，硕士研究生，副主任医师，研究方向：儿童重症医学，E-mail：。152现代检验医学杂志第 38 卷第 1 期2023 年 1 月J Mod Lab Med,Vol.38,No.1,Jan.2023children with severe Adenovirus pneumonia.ResultsCompared with the non-severe pneumonia group,the severe pneumonia group had higher serum（124.6732.84 ng/ml vs 40.796.54 ng/ml），TNF-（396.7453.71 pg/ml vs 263.9547.84 pg/ml）levels and SOFA（5.321.36 score vs 2.780.56 score）and Murray lung injury score（2.260.49 score vs 1.520.29 score）,and the differences were statistically significant(t=19.942,17.141,14.037,11.027,all P 0.05).Compared with the good prognosis group,the poor prognosis group had higher serum HBP（160.6145.82 ng/ml vs 107.9432.87 ng/ml），TNF-（432.4438.95 pg/ml vs 380.1235.41 pg/ml）levels,proportions of electrolyte disturbances（68.52%vs 33.62%）,circulatory complications（57.41%vs 22.41%）and SOFA（7.041.95 score vs 4.521.23 score)and Murray lung injury score(2.760.48 score vs 2.020.32 score),and the differences were statistically significant(t=8.539,8.686,2=18.153,20.245,t=10.232,11.888,all P 0.05).The area under the curve(AUC)of serum HBP,TNF-,combined prediction probability value of the two and SOFA and Murray lung injury score for predicting the prognosis of children with severe Adenovirus pneumonia were 0.778,0.816,0.939,0.828 and 0.851 respectively,with specificity of 81.6%,71.6%,98.3%,60.3%and 81.9%,and the sensitivity of 63.5%,81.5%,76.4%,90.7%and 74.1%respectively.HBP and TNF-were independent risk factors for poor prognosis in children with severe Adenovirus pneumonia(P 0.05).ConclusionThe levels of serum HBP and TNF-in children with severe Adenovirus pneumonia were relatively high,and the high levels of the two may be related to poor prognosis.Keywords：severe Adenovirus pneumonia；children；heparin binding protein；tumor necrosis factor-腺病毒（Adenovirus）是引起儿童肺炎的重要病原，婴幼儿免疫系统发育尚不成熟，尤其是体液免疫功能不足，因此易发生重症腺病毒肺炎，可能会进一步发展为多器官功能衰竭1-3。寻找