PICU重症肺炎患儿纤维支气管镜肺泡灌洗液中PI3K、MMP-9表达及其临床意义  

Expression and clinical significance of PI3K and MMP-9 in bronchoscopic alveolar lavage fluid of children with severe pneumonia in PICU

作　　者：姜家利 陈婷 童文佳 丁洁 徐卫华 JIANG Jiali;CHEN Ting;TONG Wenjia;DING Jie;XU Weihua(Department of Pediatrics,Anhui Children′s Hospital,Hefei 230001,China)

机构地区：[1]安徽省儿童医院儿科,合肥230001

出　　处：《实用医学杂志》2023年第15期1939-1944,共6页The Journal of Practical Medicine

基　　金：安徽省自然科学基金面上项目(编号:1808085MH230)。

摘　　要：目的 探讨儿科重症监护病房(PICU)重症肺炎患儿纤维支气管镜肺泡灌洗液中磷脂酰肌醇-3-激酶(PI3K)、基质金属蛋白酶-9(MMP-9)表达及其临床意义。方法 选取2021年1月到2022年6月医院PICU收治的103例行纤维支气管镜肺泡灌洗术的重症肺炎患儿,采用实时荧光定量聚合酶链反应测定PI3K表达情况,采用酶联免疫吸附法测定肺泡灌洗液中MMP-9表达情况。患儿入院后随访21 d统计其预后情况。Logistic回归分析影响PICU重症肺炎患儿预后的因素,采用Pearson相关性分析泡灌洗液中PI3K、MMP-9表达水平与PICU重症肺炎患儿儿童危重病例评分(PCIS)、儿童器官功能障碍2(PELOD-2)评分的相关性,采用受试者工作曲线(ROC)分析肺泡灌洗液中PI3K、MMP-9表达水平预测PICU重症肺炎患儿预后的价值。结果 103例PICU重症肺炎患儿中,预后不良29例,预后良好74例。Logistic多因素回归分析结果显示:合并休克(OR=4.104,95%CI:1.689~9.974)、PELOD-2评分(OR=4.764,95%CI:1.960~11.577)、PCIS评分(OR=5.068,95%CI:2.085~12.318)、PI3K(OR=3.924,95%CI:1.614~9.536)、MMP-9(OR=3.873,95%CI:1.594~9.412)是影响PICU重症肺炎患儿预后的因素(P <0.05)。Pearson相关性分析显示:肺泡灌洗液中PI3K、MMP-9表达水平与患儿PCIS评分均呈负相关(r=-0.598,P=0.000;r=-0.537,P=0.000),肺泡灌洗液中PI3K、MMP-9表达水平与患儿PELOD-2评分均呈正相关(r=0.546,P=0.000;r=0.571,P=0.000)。ROC曲线结果显示,PI3K、MMP-9及二者联合预测PICU重症肺炎患儿预后的灵敏度分别为75.86%(95%CI:56.08%~88.98%)、72.41%(95%CI:52.51%~86.55%)、82.76%(95%CI:63.51%~93.47%),特异度分别为75.68%(95%CI:64.07%~84.58%)、79.73%(95%CI:68.47%~87.85%)、89.19%(95%CI:79.28%~94.88%),AUC分别为0.762(95%CI:0.666~0.859)、0.767(95%CI:0.670~0.873)、0.909(95%CI:0.848~0.971)。结论 纤维支气管镜肺泡灌洗液中PI3K、MMP-9表达与PICU重症肺炎患儿预后有关,二者联合预测患儿预后效能良好,将其作为预测PICU�Objective To investigate the expression and clinical significance of phosphatidylinoinosidine-3-kinase(PI3K)and matrix metalloproteinase 9(MMP-9)in bronchoscopic alveolar lavage fluid of children with severe pneumonia in pediatric intensive care unit(PICU).Methods A total of 103 children with severe pneumonia admitted to PICU of the hospital from January 2021 to June 2022 were enrolled.All patients underwent fiberbronchoscopic alveolar lavage.Real-time fluorescence quantitative polymerase chain reaction was used to determine the expression of PI3K,and enzyme-linked immunosorption was used to determine the expression of MMP-9 in alveolar lavage fluid.The patients were followed up for 21 days after admission to evaluate the prognosis.Logistic regression analysis was used to analyze the factors affecting the prognosis.Pearson correlation was used to analyze the correlation between the expression levels of PI3K and MMP-9 in the bubble lavage solution and the child Critical Case Score(PCIS)and child Organ Dysfunction 2(PELOD-2)Scores.The values of PI3K and MMP-9 expression levels in alveolar lavage fluid to predict the prognosis were analyzed by receiver operating curve(ROC).Results Among the 103children,29 cases had poor prognosis vs 74 cases had good prognosis.Logistic multivariate regression analysis showed that combined shock(OR=4.104,95%CI:1.689~9.974),PELOD-2 score(OR=4.764,95%CI:1.960~11.577),PCIS score(OR=5.068,95%CI:2.085~12.318),PI3K(OR=3.924,95%CI:1.614~9.536)and MMP-9(OR=3.873,95%CI:1.594~9.412)were the prognostic factors of PICU children with severe pneumonia(P<0.05).Pearson correlation analysis showed that the expression levels of PI3K and MMP-9 in alveolar lavage fluid were negatively correlated with PCIS scores(r=-0.598,P=0.000;r=-0.537,P=0.000),PI3K and MMP-9 expression levels in alveolar lavage fluid were positively correlated with PELOD-2 scores(r=0.546,P=0.000;r=0.571,P=0.000).ROC curve results showed that the sensitivity of PI3K,MMP-9 and their combination to predict the prognosis of PICU children

关 键 词：儿科重症监护病房 儿童重症肺炎 纤维支气管镜肺泡灌洗 磷脂酰肌醇-3-激酶 基质金属蛋白酶-9 预后 

分 类 号：R725.6[医药卫生—儿科]