儿童难治性支原体肺炎血清载脂蛋白C1和YKL-40水平变化及临床意义  

Changes and clinical significances of serum apolipoprotein C1 and YKL-40 levels in children with refractory mycoplasma pneumoniae pneumonia

作　　者：孙慧[1] 李君娥[1] 郭艳梅[1] 徐梅先[1] SUN Hui;LI Jun'e;GUO Yanmei;XU Meixian(Department of ICU,Hebei Children's Hospital,Shijiazhuang 050000,China)

机构地区：[1]河北省儿童医院重症监护科,石家庄050000

出　　处：《中华实用诊断与治疗杂志》2020年第6期592-595,共4页Journal of Chinese Practical Diagnosis and Therapy

基　　金：河北省医学科学研究重点课题计划(20170386)。

摘　　要：目的探讨血清载脂蛋白C1(apolipoprotein C1,APOC1)、YKL-40在儿童难治性肺炎支原体肺炎(mycoplasma pneumoniae pneumonia,MPP)中的表达水平及临床意义。方法89例MPP患儿依据病情分为普通性MPP组53例和难治性MPP组36例,体检健康儿童40例为对照组。采用ELISA法检测血清APOC1、YKL-40水平,采用肺功能仪测定用力肺活量占预计值百分比(forced vital capacity of the predicted value,FVC%pred)、第1秒用力呼气容积占预计值百分比(forced expiratory volume in one second of the predicted value,FEV1%pred)、第1秒用力呼气容积/用力肺活量(forced expiratory volume in one second/forced vital capacity,FEV1/FVC);采用Pearson积矩相关分析普通性MPP、难治性MPP患儿血清APOC1、YKL40与肺功能指标的相关性;绘制ROC曲线,评估APOC1、YKL-40单独及二者联合检测预测MPP患儿发生难治性MPP的效能。结果难治性MPP组血清APOC1[(16.31±1.22)mg/L]和YKL-40[(38.02±2.37)mmol/L]水平高于普通性MPP组[(9.86±1.63)mg/L、(23.17±1.85)mmol/L]和对照组[(5.24±1.35)mg/L、(12.68±2.09)mmol/L],普通性MPP组高于对照组(P<0.05);难治性MPP组FVC% pred[(69.14±7.49)%]、FEV1% pred[(56.22±6.90)%]、FEV1/FVC(0.75±0.06)水平低于普通性MPP组[(78.95±7.24)%、(67.61±6.78)%、0.82±0.09]和对照组[(90.47±8.16)%、(89.08±6.24)%、0.93±0.07],普通性MPP组低于对照组(P<0.05)。普通性MPP、难治性MPP患儿血清APOC1、YKL40水平与肺功能指标FVC% pred、FEV1% pred、FEV1/FVC均呈不同程度负相关(P<0.05)。APOC1、YKL-40单独检测预测MPP患儿难治性MPP的AUC为0.892、0.900,灵敏度为79.25%、83.02%,特异度为83.33%、86.11%,准确率为80.90%、84.27%;APOC1联合YKL-40检测预测MPP患儿发生难治性MPP的AUC为0.948,灵敏度为92.45%,特异度为94.44%,准确率为93.26%。结论血清APOC1、YKL-40异常升高参与了难治性MPP的发病过程,且与肺功能密切相关,早期二者联合检测可作为预测MPP患儿发生难治性MPP的重要指标�Objective To investigate the expressions of serum apolipoprotein C1(APOC1)and YKL-40 in children with refractory mycoplasma pneumoniae pneumonia(MPP)and its clinical significances.Methods Eighty-nine children with MPP were divided into general MPP group(n=53)and refractory MPP group(n=36),and another 40 healthy volunteers were as controls(control group).The levels of serum APOC1 and YKL-40 were detected by ELISA.The pulmonary function indexes were measured by pulmonary function instrument,including forced vital capacity of the predicted value(FVC%pred),forced expiratory volume in one second of the predicted valuce(FEV1%pred),and forced expiratory volume in one second/forced vital capacity(FEV1/FVC).The correlations of serum APOC1 and YKL-40 with pulmonary function indexes were analyzed by Pearson’s moment correlation in general and refractory MPP groups.The ROC curve was drawn to evaluate the value of APOC1 and/or YKL-40 detection to predicting refractory MPP in MPP children.Results The levels of APOC1 and YKL-40 were the highest in refractory MPP group((16.31±1.22)mg/L,(38.02±2.37)mmol/L),followed by general MPP group((9.86±1.63)mg/L,(23.17±1.85)mmol/L)and control group((5.24±1.35)mg/L,(12.68±2.09)mmol/L)in turn(P<0.05).The levels of FVC% pred,FEV1% pred and FEV1/FVC were the lowest in refractory MPP group((69.14±7.49)%,(56.22±6.90)%,0.75±0.06),followed by general MPP group((78.95±7.24)%,(67.61±6.78)%,0.82±0.09)and control group((90.47±8.16)%,(89.08±6.24)%,0.93±0.07)in turn(P<0.05).The serum APOC1 and YKL-40 levels were negatively correlated with FVC% pred,FEV1% pred and FEV1/FVC in general and refractory MPP groups(P<0.05).The AUCs of APOC1 and YKL-40 for predicting the risk for refractory MPP were 0.892 and 0.900,with the sensitivities of 79.25% and 83.33%,specificities of 83.33% and 86.11%,and accuracies of 80.90% and 84.27%.The AUCof joint detection of APOC1 and YKL-40 for predicting the risk for refractory MPP was 0.948,with a sensitivity of 92.45%,specificity of 94.44%,and accuracy of 93.2

关 键 词：难治性支原体肺炎 儿童 载脂蛋白C1 YKL-40 

分 类 号：R725.6[医药卫生—儿科]