血清ATX、HO-1联合SNAPPE-Ⅱ评分对新生儿急性呼吸窘迫综合征病情和预后的评估价值  

Evaluation value of serum ATX,HO-1 combined with SNAPPE-Ⅱscore for the condition and prognosis of neonatal acute respiratory distress syndrome

作　　者：王梦莹 贺红岩 李美娇 常晓丹[1] WANG Mengying;HE Hongyan;LI Meijiao;CHANG Xiaodan(Department of Neonatology,the Second Central Hospital of Baoding,Baoding,Hebei 072750,China)

机构地区：[1]保定市第二中心医院新生儿科,河北保定072750

出　　处：《临床肺科杂志》2024年第6期872-877,共6页Journal of Clinical Pulmonary Medicine

基　　金：河北省医学科学研究重点课题计划(No.20181498)。

摘　　要：目的 探讨血清自分泌运动因子(ATX)、血红素加氧酶-1(HO-1)联合新生儿急性生理学评分围产期补充Ⅱ(SNAPPE-Ⅱ)评分对新生儿急性呼吸窘迫综合征(NARDS)病情和预后的评估价值。方法 选择2018年6月至2021年6月保定市第二中心医院新生儿科收治的90例NARDS患儿(NARDS组),根据氧合指数(OI)将NARDS患儿分为轻度组(4mmHg≤OI<8mmHg, 25例)、中度组(8mmHg≤OI<16mmHg, 44例)和重度组(OI≥16mmHg, 21例),另选择60例健康新生儿为对照组。入组当日检测NARDS患儿血清ATX、HO-1水平,入院12h内完成SNAPPE-Ⅱ评分,统计患儿入住新生儿重症监护室(NICU)出院时的生存情况,将NARDS患儿分为生存组(n=71)和死亡组(n=19)。采用单因素和多因素Logistic回归分析影响NARDS患儿预后的因素,受试者工作特征(ROC)曲线分析ATX、HO-1联合SNAPPE-Ⅱ评分预测NARDS患儿预后的价值。结果 NARDS组血清ATX水平,SNAPPE-Ⅱ评分高于对照组,HO-1水平低于对照组(P<0.05)。重度组血清ATX水平,SNAPPE-Ⅱ评分高于中度组和轻度组,HO-1水平低于中度组和轻度组(P<0.05)。多因素Logistic回归分析结果显示,伴脓毒症、高ATX、高SNAPPE-Ⅱ评分是NARDS患儿死亡的危险因素(P<0.05),大胎龄、高出生5min Apgar评分和高HO-1水平是其保护因素(P<0.05)。ATX、HO-1、SNAPPE-Ⅱ评分预测NARDS患儿死亡的曲线下面积为0.699、0.688、0.766,灵敏度为73.68%、68.42%、78.95%,特异度为70.42%、71.83%、74.65%;联合ATX、HO-1和SNAPPE-Ⅱ评分预测NARDS患儿死亡的曲线下面积为0.903,灵敏度为94.74%,特异度为69.01%。结论 NARDS患儿血清ATX水平和SNAPPE-Ⅱ评分显著升高,HO-1水平下降,且与病情加重以及预后不良有关,血清ATX、HO-1联合SNAPPE-Ⅱ评分有助于评估NARDS患儿预后不良风险。Objective To explore the evaluation value of serum autocrine kinesin(ATX),heme oxygenase-1(HO-1),combined with neonatal acute physiology score perinatal supplement II(SNAPPE-Ⅱ)score for the condition and prognosis of neonatal acute respiratory distress syndrome(NARDS).Methods 90 children with NARDS who were admitted to the Department of Neonatology at Baoding Second Central Hospital from June 2018 to June 2021(the NARDS group)were selected.According to the oxygenation index(OI),they were divided into the mild group(4mmHg≤OI<8mmHg,25 cases),the moderate group(8mmHg≤OI<16mmHg,44 cases),and the severe group(OI≥16mmHg,21 cases).Another 60 healthy newborns were selected as the control group.On the day of enrollment,the serum ATX and HO-1 levels of NARDS patients were tested.SNAPPE-Ⅱscores were completed within 12 hours of admission,and the survival status of the children upon admission to the neonatal intensive care unit(NICU)and discharge was counted.NARDS patients were divided into the survival group(71 cases)and the death group(19 cases).The factors affecting the prognosis of children with NARDS was analyzed by univariate and multivariate logistic regression.The value of ATX,HO-1 combined with SNAPPE-Ⅱscore in predicting the prognosis of children with NARDS was analyzed by subjects′job characteristics(ROC)curve.Results The serum ATX levels,SNAPPE-Ⅱscores,and HO-1 levels in the NARDS group were higher than those in the control group(P<0.05).The serum ATX level and SNAPPE-Ⅱscore in the severe group were higher than those in the moderate and mild groups,while the HO-1 level was lower than that in the moderate and mild groups(P<0.05).The results of multivariate logistic regression analysis showed that sepsis,high ATX,and high SNAPPE-Ⅱscore were risk factors for mortality in children with NARDS(P<0.05),while older gestational age,high 5-minute Apgar score,and high HO-1 level were protective factors(P<0.05).The area under the curve of ATX,HO-1,and SNAPPE-Ⅱscore for predicting mortality in children w

关 键 词：新生儿急性呼吸窘迫综合征 自分泌运动因子 血红素加氧酶-1 新生儿急性生理学评分围产期补充Ⅱ 病情分级 预后 

分 类 号：R722.1[医药卫生—儿科]