外周血可溶性Fas蛋白及其配体、髓过氧化物酶水平对重症肺炎患儿预后不良的预测价值  

Predictive value of peripheral blood levels of soluble Fas protein,soluble Fas protein ligand and myeloperoxidase on poor prognosis in children with severe pneumonia

作　　者：沈杨 余海波 曾强英 Shen Yang;Yu Haibo;Zeng Qiangying(Department of Pediatrics,Mianyang Wanjiang Eye Hospital,Mianyang 621000,China;Emergency Department,Sichuan Mianyang 404 Hospital,Mianyang 621000,China;Department of Pediatrics,Mianyang Fulin Hospital,Sichuan College of Traditional Chinese Medicine,Mianyang 621000,China)

机构地区：[1]绵阳万江眼科医院儿科,绵阳市621000 [2]四川绵阳四〇四医院急诊科,绵阳市621000 [3]四川中医药高等专科学校绵阳富临医院儿科,绵阳市621000

出　　处：《中华实验和临床感染病杂志（电子版）》2022年第4期268-274,共7页Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition)

基　　金：2018年四川省卫生和计划生育委员会科研课题(No.18PJ037)。

摘　　要：目的观察重症肺炎患儿外周血可溶性Fas蛋白(sFas)、可溶性Fas蛋白配体(sFasL)和髓过氧化物酶(MPO)水平变化,并探讨三者对重症肺炎预后不良的预测价值。方法选取四川中医药高等专科学校绵阳富临医院2016年2月至2020年5月收治的182例重症肺炎、196例轻症肺炎患儿和178例健康儿童,分别为重症组、轻症组和对照组;重症组患儿再根据预后分为预后不良组(29例)和预后良好组(153例)。采用单因素方差分析比较重症组、轻症组治疗前和对照组外周血sFas、sFasL和MPO水平;采用单因素和多因素Logistic回归分析重症组患儿预后不良的影响因素,采用受试者工作特征(ROC)曲线评价外周血sFas、sFasL和MPO水平以及联合指标预测重症组患儿预后不良的价值。结果三组研究对象的性别、年龄和体重,重症组与轻症组患儿病原微生物分布、肺炎分期差异均无统计学意义(P均>0.05)。重症组患儿治疗前外周血sFas、sFasL和MPO水平分别为(104.63±19.75)ng/L、(1062.36±179.85)ng/L和(1020.26±59.71)U/L,轻症组患儿分别为(80.52±13.66)ng/L、(703.57±127.66)ng/L和(796.75±43.02)U/L,对照组儿童分别为(58.78±10.16)ng/L、(577.83±121.22)ng/L和(632.59±38.71)U/L;重症组和轻症组患儿以上3个指标水平均高于对照组(sFas:重症组vs.对照组:t=27.605、P<0.001;轻症组vs.对照组:t=17.322、P<0.001;sFasL:重症组vs.对照组:t=29.908、P<0.001,轻症组vs.对照组:t=9.744、P<0.001;MPO:重症组vs.对照组:t=71.920、P<0.001;轻症组vs.对照组:t=38.647、P<0.001),重症组患儿以上3个指标水平均显著高于轻症组(t=13.885、22.488、41.973,P均<0.001)。重症组患儿预后不良发生率为15.93%(29/182)。预后不良组患儿双重/多重感染占比(χ^(2)=12.081、P=0.001)、多肺叶感染占比(χ^(2)=32.378、P<0.001)和外周血白细胞计数(WBC)(t=6.432、P<0.001)、中性粒细胞百分比(N%)(t=3.658、P=0.001)、C-反应蛋白(CRP)(t=19.415、P<0.001)、降Objective To investigate the changes of soluble Fas protein(sFas),soluble Fas protein ligand(sFasL)and myeloperoxidase(MPO)in peripheral blood of children with severe pneumonia,and to explore the predictive value on poor prognosis.Methods Total of 182 cases of severe pneumonia,196 cases of mild pneumonia and 178 healthy children in Mianyang Fulin hospital,Sichuan College of traditional Chinese Medicine were enrolled as severe group,mild group and control group,respectively;Children in severe group were then divided into poor prognosis group(29 cases)and good prognosis group(153 cases).The levels of sFas,sFasL and MPO in peripheral blood were compared among cases of severe group and mild group before treatment with those of control group by one way ANOVA.The risk factors for poor prognosis in severe group were determined by univariate and multivariate Logistic regression analysis,and the value of peripheral blood sFasL,sFasL,MPO levels and the combination of the three indexes on predicting poor prognosis in severe group were explored by receiver operating characteristic curve(ROC).Results There was no significant difference in gender,age and weight among cases in the three groups;distribution of pathogenic microorganisms and stages of pneumonia between cases in severe group and mild group were also without significant difference(all P>0.05).The levels of sFas,sFasL and MPO in peripheral blood of cases in severe group were(104.63±19.75)ng/L,(1062.36±179.85)ng/L,(1020.26±59.71)U/L,which were(80.52±13.66)ng/L,(703.57±127.66)ng/L and(796.75±43.02)U/L in cases of mild group,while(58.78±10.16)ng/L,(577.83±121.22)ng/L and(632.59±38.71)U/L in cases of control group,respectively;and the levels of the above indexes of cases in severe group and mild group before treatment were significantly higher than those of the control group(sFas:severe group vs.control group:t=27.605,P<0.001;mild group vs.control group:t=17.322,P<0.001.sFasL:severe group vs.control group:t=29.908、P<0.001;mild group vs.control group:t=9.744,P<

关 键 词：重症肺炎 可溶性Fas蛋白 可溶性Fas蛋白配体 髓过氧化物酶 

分 类 号：R725.6[医药卫生—儿科]