儿童病毒性肺炎血清肿瘤坏死因子超家族成员14、甲壳质酶蛋白40、可溶性白细胞介素2受体水平变化与短期预后的相关性  

Correlation between serum TNFSF14,YKL-40,sIL-2R levels and short-term prognosis in children with viral pneumonia

作　　者：梁银 田恬[2] 赵红 景芳丽 杜池龙 LIANG Yin;TIAN Tian;ZHAO Hong;JING Fangli;DU Chilong(Department of Pediatrics,Xi'an International Medical Center Hospital,Xi'an 710065,China)

机构地区：[1]西安国际医学中心医院儿内科,西安710065 [2]西安市中心医院儿科

出　　处：《中国感染与化疗杂志》2023年第5期574-579,共6页Chinese Journal of Infection and Chemotherapy

基　　金：陕西省重点研发计划(2017SF-098)。

摘　　要：目的探讨儿童病毒性肺炎血清肿瘤坏死因子超家族成员14(TNFSF14)、甲壳质酶蛋白40(YKL-40)、可溶性白细胞介素2受体(sIL-2R)水平变化与短期预后的关系。方法选取2019年1月—2020年6月在西安国际医学中心医院儿科接受治疗的病毒性肺炎患儿120例(观察组)。另选取这一时期在该院体检健康儿童80例(对照组)。采用酶联免疫吸附法检测血清TNFSF14、YKL-40、sIL-2R水平,并分析其与患者病情程度及预后的关系。采用受试者工作特征(ROC)曲线,分析TNFSF14、YKL-40、sIL-2R对病毒性肺炎患儿临床预后的诊断效能。结果观察组血清TNFSF14、YKL-40、sIL-2R水平分别均高于对照组,差异有统计学意义(P<0.05)。重度组血清TNFSF14、YKL-40、sIL-2R水平分别高于轻度组,差异有统计学意义(P<0.05)。预后不良组血清TNFSF14、YKL-40、sIL-2R水平分别高于预后良好组,差异有统计学意义(P<0.05)。Pearson相关性分析结果显示,血清TNFSF14、YKL-40、sIL-2R分别与急性生理学和慢性健康状况评价Ⅱ(APACHEⅡ)的评分呈正相关(P<0.05)。ROC曲线结果示:血清TNFSF14、YKL-40、sIL-2R联合检测预测患儿不良预后的AUC为0.921(95%CI:0.867~0.984,P<0.001),灵敏度和特异度分别为0.905和0.816。多因素logistic回归分析结果示:APACHEⅡ评分(95%CI:1.001~3.268,P=0.005)及血清CRP(95%CI:1.755~6.143,P=0.001)、TNFSF14(95%CI:1.427~5.619,P=0.001)、YKL-40(95%CI:1.109~3.525,P<0.001)、sIL-2R(95%CI:1.265~4.173,P=0.002)是病毒性肺炎患儿不良预后的独立危险因素。结论血清TNFSF14、YKL-40、sIL-2R水平变化与病毒性肺炎患儿的病情严重程度及临床预后密切相关,也是影响患儿不良预后的重要危险因素,且对评估患儿的临床结局有较高参考价值。Objective To investigate the correlation between the changes of serum tumor necrosis factor superfamily member 14(TNFSF14),chitinase protein-40(YKL-40)and soluble interleukin-2 receptor(sIL-2R)levels and short-term prognosis in children with viral pneumonia.Methods A total of 120 children with viral pneumonia who were treated in Department of Pediatrics,Xi'an International Medical Center Hospital from January 2019 to June 2020 were selected.Another 80 healthy children coming up for health checkup in our hospital during this period were selected as controls.Serum levels of TNFSF14,YKL-40 and sIL-2R were detected by enzyme-linked immunosorbent assay,and analyzed for their relationship with the disease severity and prognosis.Receiver operating characteristic(ROC)curve was used to analyze the diagnostic performance of TNFSF14,YKL-40 and sIL-2R for clinical prognosis of patients with viral pneumonia.Results The serum levels of TNFSF14,YKL-40 and sIL-2R in the patients were significantly different from those in the controls(P<0.05).Higher serum levels of TNFSF14,YKL-40,and sIL-2R were associated significantly with the severity of disease and poor prognosis(all P<0.05).Pearson correlation analysis showed that serum TNFSF14,YKL-40,sIL-2R levels were positively correlated with APACHE II score(P<0.05).ROC curve showed that the panel assay of serum TNFSF14,YKL-40 and sIL-2R had an AUC of 0.921(95%CI:0.867-0.984,P<0.001)in predicting the poor prognosis of children,with sensitivity and specificity of 0.905 and 0.816,respectively.Multivariate logistic regression analysis demonstrated that APACHE II score(95%CI:1.001-3.268,P=0.005),serum C-reactive protein(95%CI:1.755-6.143,P=0.001),TNFSF14(95%CI:1.427-5.619,P=0.001),YKL-40(95%CI:1.109-3.525,P<0.001),sIL-2R(95%CI:1.265-4.173,P=0.002)were independent risk factors for poor prognosis in children with viral pneumonia.Conclusions The changes of serum TNFSF14,YKL-40 and sIL-2R levels are closely related to the severity and clinical prognosis of children with viral pneumonia.It is als

关 键 词：病毒性肺炎 肿瘤坏死因子超家族成员14 甲壳质酶蛋白40 可溶性白细胞介素2受体 

分 类 号：R563.1[医药卫生—呼吸系统]