ACE与ACE2在儿童重症肺炎支原体肺炎中的水平变化及预测价值  

Changes and predictive values of ACE and ACE2 levels in children with severe Mycoplasma pneumoniae pneumonia

作　　者：苏杭 毛丽[2] 张小峰[2] 赵家敏 倪倩[2] 张杰 SU Hang;MAO Li;ZHANG Xiaofeng;ZHAO Jiamin;NI Qian;ZHANG Jie(The Second Clinical Medical College,Lanzhou University,Lanzhou 730030,China;Department of Pediatric Respiratory,the Second Hospital,Lanzhou University,Lanzhou 730030,China;Department of Medical Records,the Second Hospital of Lanzhou University,Lanzhou 730030,China)

机构地区：[1]兰州大学第二临床医学院,甘肃兰州730030 [2]兰州大学第二医院小儿呼吸科,甘肃兰州730030 [3]兰州大学第二医院档案科,甘肃兰州730030

出　　处：《新医学》2024年第7期541-548,共8页Journal of New Medicine

基　　金：甘肃省自然科学基金(22JR5RA986);兰州市科技发展指导性计划项目(2020-ZD-98)。

摘　　要：目的探讨血管紧张素转化酶(ACE)与血管紧张素转化酶2(ACE2)在儿童重症肺炎支原体肺炎(SMPP)中的水平变化,并评估其在预测SMPP临床发展中的价值。方法选择2020年10月至2023年12月在兰州大学第二医院住院的71例普通肺炎支原体肺炎(MPP)患儿(MPP组)、63例重症肺炎支原体肺炎(SMPP)患儿(SMPP组),并选择同期20名健康体检儿童为健康对照组。测定并比较3组儿童血清中ACE与ACE2质量浓度,同时收集MPP组和SMPP组患儿的实验室检查指标结果进行比较及相关性分析,绘制受试者操作特征(ROC)曲线分析比较不同指标单独及联合预测SMPP的价值。结果3组儿童的血清ACE质量浓度中,SMPP组最高、健康对照组最低;血清ACE2质量浓度中,MPP组最高、健康对照组最低(P均<0.008);与MPP组相比,SMPP组白细胞计数、中性粒细胞百分比、C-反应蛋白(CRP)、淀粉样蛋白A、降钙素原、白介素-6(IL-6)、红细胞沉降率、D-二聚体(D-dimer)水平均升高(P<0.001)且与ACE质量浓度呈正相关(P<0.05)、与ACE2质量浓度呈负相关(P<0.05),SMPP组淋巴细胞百分比(LY%)降低(P<0.001)且与ACE2质量浓度呈正相关(P<0.05)、与ACE质量浓度呈负相关(P<0.05),SMPP组乳酸脱氢酶(LDH)水平较高(P<0.05)且与ACE2质量浓度呈负相关(P<0.05)、与ACE质量浓度无相关性(P>0.05),SMPP组单核细胞百分比(MO%)差异既无统计学意义也无相关性(P均>0.05);ROC曲线分析结果显示ACE、ACE2、CRP、D-dimer、LDH及ACE+ACE2联合检测、CRP+D-dimer+LDH联合检测对SMPP均具有预测价值,其中ACE+ACE2联合检测的预测价值最高,其AUC为0.991(95%CI 0.981~1.000)。结论ACE和ACE2水平很可能与SMPP患儿的病情发生、发展有关,可以作为预测SMPP的良好指标。Objective To investigate the changes of angiotensin-converting enzyme(ACE)and angiotensin-converting enzyme 2(ACE2)levels in children with severe Mycoplasma pneumoniae pneumonia(SMPP)and evaluates their clinical values in predicting the severity of SMPP.Methods A total of 71 children with Mycoplasma pneumoniae pneumonia(MPP group)and 63 with severe Mycoplasma pneumoniae pneumonia(SMPP group)admitted to the Second Hospital of Lanzhou University from October 2020 to December 2023 were recruited in this study.Additionally,20 healthy children undergoing routine health check-ups during this period were selected as the control group.The serum concentrations of ACE and ACE2 in the three groups were measured using the enzyme-linked immunosorbent assay(ELISA),and laboratory test results were collected for comparison and correlation analysis between the MPP and SMPP groups.The receiver operating characteristic(ROC)curve was delineated to assess the predictive values of one single index or combined for SMPP.Results In the three groups,the serum ACE level was the highest in the SMPP group and the lowest in the healthy control group.The serum ACE2 level was the highest in the MPP group and the lowest in the healthy control group(all P<0.008).Compared to the MPP group,the SMPP group exhibited significantly elevated white blood cell count(WBC),neutrophil percentage(NE%),C-reactive protein(CRP),serum amyloid A protein(SAA),procalcitonin(PCT),interleukin-6(IL-6),erythrocyte sedimentation rate(ESR),and D-dimer(all P<0.001)and these indexes were positively correlated with ACE levels(all P<0.05),but negatively correlated with ACE2 levels(all P<0.05).The lymphocyte percentage(LY%)was significantly reduced(P<0.001),which was positively correlated with ACE2 levels(P<0.05),whereas negatively correlated with ACE levels(P<0.05).Lactate dehydrogenase(LDH)was elevated(P<0.05),which was negatively correlated with ACE2 levels(P<0.05),but not correlated with ACE levels(P>0.05).The monocyte percentage(MO%)showed neither significant difference n

关 键 词：重症肺炎支原体肺炎 血管紧张素转换酶 血管紧张素转化酶2 肾素-血管紧张素系统 肺炎支原体肺炎 

分 类 号：R725.6[医药卫生—儿科]