肺炎患儿血清炎症指标水平与心肌损害程度的相关性分析  

Analysis of correlation between level of serum inflammatory markers and degree of myocardial damage in children with pneumonia

作　　者：孟永胜 刘亚娜 石宏 MENG Yong-sheng;LIU Ya-na;SHI Hong(Pediatric Second Ward,Kaifeng Central Hospital,Kaifeng,Henan 475000,China)

机构地区：[1]开封市中心医院儿科二病区,河南开封475000

出　　处：《医药论坛杂志》2024年第12期1267-1271,共5页Journal of Medical Forum

摘　　要：目的探讨肺炎患儿降钙素原(PCT)、白介素-6(IL-6)、超敏C-反应蛋白(hs-CRP)与心肌损害程度的相关性。方法选取2020年4月至2023年4月开封市中心医院收治的153例肺炎患儿,按其住院期间是否发生心肌损害分为MD组(93例)与非MD组(60),其中MD组患儿美国纽约心脏病学会(NYHA)心功能分级Ⅱ级37例,Ⅲ级31例,IV级25例。比较两组一般资料及PCT、IL-6、hs-CRP水平;分析PCT、IL-6、hs-CRP不同NYHA分级、肌钙蛋白或肌酸激酶同工酶的相关性;采用ROC分析各变量预测心肌损害的效能。结果MD组肌钙蛋白(156.92±43.95)pg/mL、肌酸激酶同工酶(56.92±13.47)U/L高于非MD组(73.27±14.94)pg/mL、(18.47±3.59)U/L,住院时间(13.48±3.35)d长于非MD组(9.36±2.57)d(P<0.05);MD组PCT(10.58±1.48)pg/L、IL-6(293.27±78.28)pg/mL、hs-CRP(16.37±3.22)mg/mL高于非MD组(7.13±1.26)pg/L、(215.28±56.93)pg/mL、(9.74±1.47)mg/mL(P<0.05);NYHA IV组患儿PCT(16.27±1.37)pg/L、IL-6(336.83±57.84)pg/mL、hs-CRP(21.97±4.95)mg/mL高于Ⅲ级患儿(12.39±1.64)pg/L、(289.37±66.82)pg/mL、(17.94±2.69)mg/mL,Ⅲ级患儿高于Ⅱ级患儿(7.67±1.39)pg/L、(243.34±59.47)pg/mL、(12.34±3.59)mg/mL(P<0.05);相关分析显示,PCT、IL-6、hs-CRP与肌钙蛋白呈正相关(r=0.572、0.482、0.588,P<0.05)、与肌酸激酶同工酶呈正相关(r=0.536、0.513、0.567,P<0.05);ROC分析显示,PCT预测肺炎患儿心肌损害的AUC值为0.875、最佳截断值为9.72 pg/L、灵敏度为82.85%、特异度为86.79;IL-6 AUC值为0.819,最佳截断值为258.64 pg/mL,灵敏度为76.59%,特异度为82.54%;hs-CRP AUC值为0.853,最佳截断值为14.27 mg/mL,灵敏度为81.73%,特异度为84.67%;三者联合AUC值为0.943,灵敏度为93.73%,特异度为94.73%。结论PCT、IL-6、hs-CRP与肺炎患儿心肌损害程度存在相关性,可作为预测心肌损害的参考指标。Objective To investigate the correlation between procalcitonin(PCT),interleukin-6(IL-6),hypersensitive C-reactive protein(hs-CRP)and myocardial damage in children with pneumonia.Methods Totally 153 children with pneumonia admitted from April 2020 to April 2023 in Kaifeng Central Hospital were divided into the MD group(93 cases)and the non-MD group(60 cases)according to whether myocardial damage occurred during hospitalization.Among the children in the MD group,37 cases were classified as grade Ⅱ,31 cases as grade Ⅲ,and 25 cases as grade Ⅳ according to the New York College of Cardiology(NYHA).General data and levels of PCT,IL-6 and hs-CRP were compared between the two groups.The correlation between different NYHA grades,troponin or creatine kinase isoenzymes of PCT,IL-6 and hs-CRP was analyzed.ROC was used to analyze the effectiveness of each variable in predicting myocardial injury.Results Troponin(156.92±43.95)pg/mL and creatine kinase isoenzyme(56.92±13.47)U/L in MD group were higher than those in non-MD group(73.27±14.94)pg/mL,(18.47±3.59)U/L.The length of hospital stay(13.48±3.35)d was longer than that of the non-MD group(9.36±2.57)d(P<0.05).PCT(10.58±1.48)pg/L,IL-6(293.27±78.28)pg/mL and hs-CRP(16.37±3.22)mg/mL in MD group were higher than those in non-MD group(7.13±1.26)pg/L,(215.28±56.93)pg/mL,(9.74±1.47)mg/mL(P<0.05);the PCT(16.27±1.37)pg/L,IL-6(336.83±57.84)pg/mL and hs-CRP(21.97±4.95)mg/mL in NYHA IV group were higher than those in Grade Ⅲ group(12.39±1.64)pg/L,(289.37±66.82)pg/mL,(17.94±2.69)mg/mL;grade Ⅲ children were higher than grade Ⅱ children(7.67±1.39)pg/L,(243.34±59.47)pg/mL,(12.34±3.59)mg/mL(P<0.05).Correlation analysis showed that PCT,IL-6 and hs-CRP were positively correlated with troponin(r=0.572,0.482,0.588,P<0.05)and creatine kinase isoenzyme(r=0.536,0.513,0.567,P<0.05).ROC analysis showed that the AUC value of PCT for predicting myocardial damage in children with pneumonia was 0.875,the optimal cut-off value was 9.72 pg/L,the sensitivity was 82.85%,and the

关 键 词：肺炎 儿科 心肌损害 心功能 炎症指标 ROC分析 

分 类 号：R725.6[医药卫生—儿科]