大叶性肺炎患儿血清免疫球蛋白及维生素D水平检测及其临床意义  

Detection and clinical significance of serum immunoglobulins and vitamin D in children with lobar pneumonia.

作　　者：梁宽[1] 彭林强[1] 薛满 马春利[1] 刘亚辉 朱云芳 LIANG Kuan;PENG Lin-qiang;XUE Man;MA Chun-li;LIU Ya-hui;ZHU Yun-fang(Department of Pediatrics,Baoji People's Hospital,Baoji 721000,Shaanxi,CHINA)

机构地区：[1]宝鸡市人民医院儿科,陕西宝鸡721000

出　　处：《海南医学》2022年第18期2366-2369,共4页Hainan Medical Journal

基　　金：陕西省科学技术研究发展计划项目(编号:S2018SKZ1804591)。

摘　　要：目的检测大叶性肺炎患儿血清免疫球蛋白及25羟维生素D[25-(OH)D]的表达水平,并探讨其临床意义。方法选取2018年1月至2021年1月宝鸡市人民医院儿科收治的94例大叶性肺炎患儿作为研究组,并选取在我院体检的52例健康儿童作为对照组。根据临床肺部感染评分(CPIS)将研究组患儿分为重度组(≥6分,31例)和轻度组(<6分,63例),比较重度组、轻度组及对照组受检者的血清免疫球蛋白[免疫球蛋白A(IgA)、免疫球蛋白G(IgG)、免疫球蛋白M(IgM)、免疫球蛋白E(IgE)]及25-(OH)D水平,采用接受者操作特征曲线(ROC)分析其对大叶性肺炎病情进展的评估价值;采用Spearman检验分析血清免疫球蛋白及25-(OH)D水平与大叶性肺炎严重程度的相关性;对研究组患者给予针对性治疗,根据临床疗效分为有效组(69例)和无效组(25例),采用ROC分析血清免疫球蛋白及25-(OH)D水平对临床疗效的评估价值。结果IgA、IgG、25-(OH)D水平随大叶性肺炎严重程度的加重而降低,IgE水平随病情严重程度的加重而升高,差异均有统计学意义(P<0.05),但重度组、轻度组和对照组受检者的IgM水平比较差异无统计学意义(P>0.05);血清免疫球蛋白及25-(OH)D水平联合检测评估大叶性肺炎严重程度的ROC曲线下面积(AUC)大于IgG、IgM等指标单独检测,差异均有统计学意义(P<0.05);经Spearman检验分析结果显示,IgA、IgG、25-(OH)D水平与大叶性肺炎严重程度呈负相关(r=-0.507、-0.221、-0.380,P<0.05),IgE与病情严重程度呈正相关(r=0.418,P<0.05);治疗后无效组患者的IgA、IgG、25-(OH)D水平明显低于有效组,IgE水平明显高于有效组,差异均有统计学意义(P<0.05),而两组患者的IgM水平比较差异无统计学意义(P>0.05);血清免疫球蛋白及25-(OH)D水平联合检测评估临床疗效的AUC大于IgA、IgG、IgM等指标单独检测,差异均有统计学意义(P<0.05)。结论大叶性肺炎患儿存在血清免疫球蛋白及25-(OH)DObjective To detect the expression levels of serum immunoglobulins and 25-hydroxyvitamin D[25-(OH)D]in children with lobar pneumonia,and explore their clinical significance.Methods A total of 94 children with lobar pneumonia admitted to Department of Pediatrics,Baoji People’s Hospital were enrolled as study group between January 2018 and January 2021,while 52 healthy children undergoing physical examination in the hospital were enrolled as control group.According to Clinical Pulmonary Infection Score(CPIS),patients in the study group were divided into severe group(≥6 points,31 cases)and mild group(<6 points,63 cases).The levels of serum immunoglobulins[immunoglobulin A(IgA),immunoglobulin G(IgG),immunoglobulin M(IgM),immunoglobulin E(IgE)]and 25-(OH)Dwere compared among severe group,mild group and control group.Their evaluation value for the progression of lobar pneumonia was analyzed by receiver operating characteristic(ROC)curves.The correlation between serum immunoglobulins,25-(OH)Dlevels and the severity of lobar pneumonia was analyzed by Spearman test.The patients in study group were given targeted treatment,and then were divided into effective group(69 cases)and ineffective group(25 cases)according to clinical curative effect.The evaluation value of serum immunoglobulins and 25-(OH)Dfor clinical curative effect was analyzed by ROC curves.Results With the aggravation of lobar pneumonia,levels of IgA,IgG,and 25-(OH)Dwere decreased,while Ig E level was increased(P<0.05).There was no significant difference in Ig M level among severe group,mild group,and control group(P>0.05).The area under the ROC curve(AUC)of serum immunoglobulins combined with 25-(OH)Dfor assessing the severity of lobar pneumonia was greater than that of IgG and Ig M alone(P<0.05).Spearman analysis showed that levels of Ig A,Ig G and 25-(OH)Dwere negatively correlated with the severity of lobar pneumonia(r=-0.507;-0.221;-0.380,P<0.05),while IgE was positively correlated with it(r=0.418,P<0.05).After treatment,levels of Ig A,IgG,and 25-(OH

关 键 词：大叶性肺炎 免疫球蛋白 维生素D 血清水平 严重程度 临床价值 

分 类 号：R563.1[医药卫生—呼吸系统]