中性粒细胞弹性蛋白酶和纤维蛋白原联合肿瘤坏死因子-α在预测儿童重症肺炎预后中的应用价值  

Application value of neutrophil elastase and fibrinogen combined with tumor necrosis factor- a in the prognosis prediction of severe pneumonia in children

作　　者：沈逍雁[1] 斯明强 Shen Xiaoyan;Si Mingqiang(Department of Pediatrics, Yuhang District Maternal and Child Health Hospital, Hangzhou 311100, Zhejiang, China;Department of Pediatrics, First People's Hospital, Yuhang District of Hangzhou in Zhejiang Province, Hangzhou 311100,Zhejiang, China)

机构地区：[1]杭州市余杭区妇幼保健院儿科,浙江杭州311100 [2]浙江余杭区第一人民医院儿科,浙江杭州311100

出　　处：《中国中西医结合急救杂志》2019年第2期147-151,共5页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：浙江省杭州市卫生科技计划项目(2016BB44).

摘　　要：目的探讨中性粒细胞弹性蛋白酶(NE)、纤维蛋白原(Fib)联合肿瘤坏死因子-α(TNF-α)对儿童重症肺炎预后的预测价值。方法选择2016年7月至2018年9月在杭州市余杭区妇幼保健院接受诊治的82例重症肺炎患儿作为重症肺炎组,再按预后将重症肺炎患儿分为存活组(70例)和死亡组(12例);另选同期在本院接受诊治的90例普通肺炎患儿作为普通肺炎组;以同期于本院接受健康体检的85例健康儿童作为健康对照组。采用酶联免疫吸附试验(ELISα)检测3组受试者NE、Fib、TNF-α含量,统计重症肺炎组、普通肺炎组患儿肺炎严重指数(PSI);采用Speαrmαn相关性分析法分析重症肺炎患儿NE、Fib、TNF-α与PSI的相关性;绘制受试者工作特征曲线(ROC)评估NE、Fib、TNF-α预测重症肺症患儿预后的价值。结果重症肺炎组NE、Fib、TNF-α含量高于普通肺炎组及健康对照组〔NE(μg/L): 127.5± 12.3比75.1±6.6、24.3 ± 5.9, Fib (μg/L): 6.9 ± 1.2 比 5.1 ± 0.7、2.8 ± 0.8, TNF-α(μg/L ):98.3± 6.9 比 63.1 ± 6.8、30.2 ± 2.1,均 PV0.05〕。死亡组血清 NE、Fib、TNF-α含量均高于存活组〔NE(pg/L): 141.2± 14.9 比 80.3±7.4, Fib(gZL): 7.6± 1.5比 5.7±1.0, TNF-α(μg/L): 105.4±7.8 比 68.2±4.6,均 PV0.05〕。ROC 曲线分析显示:NE、Fib.TNF-α单独及联合检测对预测重症肺炎患儿的预后均有一定价值,ROC曲线下面积(αUC)分别为0.889. 0.809, 0.803、0.961, 95%可信区间(95%CZ)分别为 0.817 ~ 0.968、0.706 ?0.909、0.702 ~ 0.891、0.908 ~ 1.000,敏感度分别为71.2%、62.7%、64.9%、92.3%,特异度分别为 73.5%、68.3%、74.5%、90.9%,均 P=0.000o 重症肺炎组 PSI 明显高于普通肺炎组(97.4±12.1比76.4±9.6),死亡组BS1明显高于存活组(100.8±13」比87.3±10.5),差异均有统计学意义(均P<0.01)o Speαrmαn相关性分析显示,重症肺炎患儿NE. Fib. TNF-α与PSI均呈显著正相关(r=0.767. 0.734、0.673,均 PV0.05), NE 和 Fib(r=0.655, P=0.000)、NE 和 TNF-α G=0.530,Objective To study the application value of neutrophil elastase (NE), fibrinogen (Fib) combined with tumor necrosis factor- a (TNF- a) in the prognosis prediction of severe pneumonia in children. Methods Eighty-two children with severe pneumonia who were admitted into the Yuhang District Maternal and Child Health Hospital of Hangzhou in Zhejiang Province from July 2016 to September 2018 were treated as a severe group, and the children with severe pneumonia were subdivided into a survival group (70 cases) and a death group (12 cases) according to the prognosis;another 90 children with common pneumonia who were treated in our hospital at the same time were selected as a general group;and 85 normal children who received physical examinations at the same time as a healthy control group. The levels of serum NE, Fib and TNF- a in the three groups were measured by enzyme-linked immunosorbent assay (ELISA), and the pneumonia severity index (PSI) was calculated in the severe group and the general group;Spearman correlation analysis was used to analyze the correlation between NE, Fib, TNF- a and PSI;the NE, Fib and TNF- a levels were evaluated to predict the prognosis of children with severe pulmonary disease;the receive operating characteristic (ROC) curve was drawn to evaluate the prognostic value of NE, Fib, TNF- a in children with severe pulmonary disease. Results The expression levels of serum NE, Fib and TNF- a in the severe group were higher than those in the general group and the healthy control group [NE (pig/L): 127.5 ± 12.3 vs. 75.1 ±6.6, 24.3±5.9, Fib (g/L): 6.9±1.2 vs. 5.1 ±0.7, 2.8±0.& TNF-a (^g/L): 98.3±6.9 vs. 63.1 ±6.& 30.2±2.1, all P < 0.05]. Serum levels of NE, Fib and TNF- a in the death group were higher than those in the survival group [NE (pg/L): 141.2±14.9 vs. 80.3±7.4, Fib (g/L): 7.6±1.5 vs. 5.7± 1.0, TNF-a (pg/L): 105.4±7.8 vs. 68.2±4.6, all P < 0.05]. It was shown by ROC curve analysis that NE, Fib, TNF- a have some value in predicting the prognosis of children with severe pneumoni

关 键 词：中性粒细胞弹性蛋白酶 纤维蛋白原 肿瘤坏死因子 儿童重症肺炎 

分 类 号：R691.3[医药卫生—泌尿科学]