血清PGRN、IL-21、4-HNE水平与重症肺炎患儿病情程度、预后的相关性及对患儿预后不良的预测价值  

Correlation of serum levels of PGRN,IL-21 and 4-HNE with the severity and prognosis of severe pneumonia and the predictive value of poor prognosis in children

作　　者：刘鹤 赵静维 李晓娟[1] 刘莹[1] 崔慧贤[1] LIU He;ZHAO Jingwei;LI Xiaojuan;LIU Ying;CUI Huixian(Department of Pediatric Respiratory Critical Care,Tangshan Maternal and Child Health Hospital,Tangshan,Heibei 063000,China)

机构地区：[1]河北省唐山市妇幼保健院小儿呼吸重症科,河北唐山063000

出　　处：《检验医学与临床》2024年第13期1939-1944,共6页Laboratory Medicine and Clinic

摘　　要：目的探讨血清颗粒蛋白前体(PGRN)、白细胞介素(IL)-21、4-羟基壬烯醛(4-HNE)水平与重症肺炎(SP)患儿病情程度、预后的相关性及对患儿预后不良的预测价值。方法选取2022年1月至2023年1月该院收治的110例SP患儿作为SP组,另随机选取该院同期收治的55例轻症肺炎患儿作为轻症组、55例健康儿童作为对照组。比较3组血清PGRN、IL-21、4-HNE、常规炎症因子[C-反应蛋白(CRP)、IL-6、降钙素原(PCT)]水平。比较SP组不同病情程度[采用小儿危重症评分(PCIS)评估]患儿血清PGRN、IL-21、4-HNE水平。比较SP组治疗后3个月不同预后患儿治疗前后血清PGRN、IL-21、4-HNE、CRP、IL-6、PCT水平及变化值(以△表示对应指标治疗前后变化值的绝对值)。采用Pearson相关分析血清PGRN、IL-21、4-HNE水平与CRP、IL-6、PCT水平、PCIS的相关性。绘制受试者工作特征(ROC)曲线分析△PGRN、△IL-21、△4-HNE、△CRP、△IL-6、△PCT对SP患儿预后不良的预测价值。采用净重新分类指数(NRI)、综合判别改善指数(IDI)评价新预测方案(△PGRN、△IL-21、△4-HNE、△CRP、△IL-6、△PCT联合预测)与常规预测方案(△CRP、△IL-6、△PCT联合预测)对SP患儿预后不良的预测价值。结果SP组血清PGRN、IL-21、4-HNE、CRP、IL-6、PCT水平均高于轻症组与对照组,且轻症组血清PGRN、IL-21、4-HNE、CRP、IL-6、PCT水平均高于对照组,差异均有统计学意义(P<0.05)。SP组中,极危重患儿3例,危重26例,非危重81例。危重或极危重患儿血清PGRN、IL-21、4-HNE水平均高于非危重患儿,差异均有统计学意义(P<0.05)。Pearson相关分析结果显示,SP组血清PGRN、IL-21、4-HNE水平与血清CRP、IL-6、PCT水平均呈正相关(P<0.05),与PCIS均呈负相关(P<0.05)。SP组中,预后不良25例,预后良好85例;两组治疗后血清PGRN、IL-21、4-HNE、CRP、IL-6、PCT水平均低于同组治疗前,差异均有统计学意义(P<0.05)。预后不良患儿治疗前Objective To investigate the correlation of serum levels of Granuloprotein precursor(PGRN),IL-21 and 4-hydroxynonenal(4-HNE)with the severity and prognosis of children with severe pneumonia(SP),and the predictive value of poor prognosis.Methods A total of 110 children with SP admitted to the hospital from January 2022 to January 2023 were selected as the SP group.In addition,55 children with mild pneumonia admitted to the hospital during the same period were randomly selected as the mild group and 55 healthy children as the control group.The serum levels of PGRN,IL-21,4-HNE,and conventional inflammatory factors[C-reactive protein(CRP),IL-6,procalcitonin(PCT)]were compared among the three groups.The serum levels of PGRN,IL-21,and 4-HNE in children with different severity of illness[Pediatric Critical illness score(PCIS)was used for evaluation]in SP group were compared.The serum levels and changes of PGRN,IL-21,4-HNE,CRP,IL-6,and PCT before and after treatment(the absolute value of the changes of the corresponding indexes before and after treatment was expressed as△)in children with different prognosis 3 months after treatment in the SP group were compared.Pearson correlation analysis was used to analyze the correlation between serum PGRN,IL-21,4-HNE levels and CRP,IL-6,PCT levels,PCIS.The receiver operating characteristic(ROC)curve was drawn to analyze the predictive value of△PGRN,△IL-21,△4-HNE,△CRP,△IL-6,and△PCTSP for poor prognosis in children with SP.The net reclassification index(NRI)and comprehensive discrimination improvement index(IDI)were used to evaluate the predictive value of the new prediction scheme(△PGRN,△IL-21,△4-HNE,△CRP,△IL-6,△PCT combined prediction)and the conventional prediction scheme(△CRP,△IL-6,△PCT combined prediction)for poor prognosis of children with SP.Results The SP group had significantly higher serum levels of PGRN,IL-21,4-HNE,CRP,IL-6 and PCT than the mild group and the control group(P<0.05),and the mild group had significantly higher serum levels of P

关 键 词：重症肺炎 儿童 颗粒蛋白前体 白细胞介素-21 4-羟基壬烯醛 

分 类 号：R174.1[医药卫生—妇幼卫生保健] R446.1[医药卫生—公共卫生与预防医学]