血清RAGE、PBEF水平对重症肺炎患儿继发急性呼吸窘迫综合征的预测价值  

Predictive value of serum RAGE and PBEF levels in children with severe pneumonia secondary to acute respiratory distress syndrome

作　　者：王丽阳 王艺璁 刘欢 衣兰云 李慧玲 司媛 Wang Liyang;Wang Yicong;Liu Huan;Yi Lanyun;Li Huiling;Si Yuan(Department of Respiratory,Harbin Children's Hospital,Heilongjiang Province,Harbin 150001,China)

机构地区：[1]哈尔滨市儿童医院呼吸二科,哈尔滨150001

出　　处：《疑难病杂志》2024年第9期1085-1089,1099,共6页Chinese Journal of Difficult and Complicated Cases

基　　金：黑龙江省卫生健康委科研课题(2019-235)。

摘　　要：目的探讨血清晚期糖基化终产物受体(RAGE)、前B细胞克隆增强因子(PBEF)水平对重症肺炎(SP)患儿继发急性呼吸窘迫综合征(ARDS)的预测价值。方法选取2020年1月—2024年2月哈尔滨市儿童医院呼吸科及重症监护室收治的SP患儿875例,根据是否继发ARDS分为ARDS组83例和非ARDS组792例。采用酶联免疫吸附法检测血清RAGE、PBEF水平。Pearson相关系数分析血清RAGE、PBEF水平与儿童早期预警评分(PEWS)的相关性;以SP患儿继发ARDS为因变量,建立多因素非条件Logistic回归模型确定其影响因素;绘制ROC曲线评价血清RAGE、PBEF水平预测SP患儿继发ARDS的价值。结果875例SP患儿入院7 d内继发ARDS 83例(9.49%)。与非ARDS组比较,ARDS组血清RAGE、PBEF水平升高(t=8.801、9.082,P均<0.001);血清RAGE、PBEF水平与PEWS评分均呈正相关(r=0.691、0.625,P均<0.001);Logistic回归分析结果表明,PEWS评分增加、机械通气时间延长、氧指数增加、降钙素原升高、RAGE升高和PBEF升高是SP患儿继发ARDS的独立危险因素[OR(95%CI)=2.308(1.535~3.469)、2.525(1.619~3.938)、3.738(2.123~6.581)、6.916(3.034~15.768)、1.085(1.061~1.109)、1.464(1.303~1.646)];RAGE、PBEF及二者联合预测SP患儿继发ARDS的曲线下面积分别为0.791、0.789、0.905,二者联合优于各自单独预测效能(Z=4.256、4.419,P均<0.001)。结论SP患儿血清RAGE、PBEF水平升高,两者均为其继发ARDS的独立危险因素,血清RAGE联合PBEF水平预测SP患儿继发ARDS的价值较高。Objective To investigate the predictive value of serum receptor for advanced glycation end products(RAGE)and pre B cell colony enhancing factor(PBEF)levels in children with severe pneumonia(SP)secondary to acute respiratory distress syndrome(ARDS).Methods Eight hundred and seventy-five cases of SP children admitted to the Respiratory Department and Intensive Care Unit of Harbin Children's Hospital from January 2020 to February 2024 were selected and divided into 83 cases in the ARDS group and 792 cases in the non-ARDS group according to whether they were secondary to ARDS.Serum RAGE and PBEF levels were detected by enzyme linked immunosorbent assay.Pearson's correlation coefficient was used to analyze the correlation between serum RAGE and PBEF levels and the scores of the pediatric early warning score(PEWS);a multifactorial unconditional logistic regression model was established to determine the factors influencing secondary ARDS in children with SP as the dependent variable;and ROC curves were plotted to evaluate the value of serum RAGE and PBEF levels in predicting secondary ARDS in children with SP.Results Eight hundred and seventy-five cases children with SP had secondary ARDS within 7 d of admission 83(9.49%).Compared with the non-ARDS group,serum RAGE and PBEF levels were elevated in the ARDS group(t=8.801,9.082,all P<0.001);and there was a positive correlation between serum RAGE and PBEF levels and PEWS scores(r=0.691,0.625,all P<0.001);Independent risk factors for secondary ARDS in children with SP were increased PEWS score,prolonged duration of mechanical ventilation,increased oxygen index,increased procalcitonin,increased RAGE,and increased PBEF[OR(95%CI)=2.308(1.535-3.469),2.525(1.619-3.938),3.738(2.123-6.581),6.916(3.034-15.768),1.085(1.061-1.109,1.464(1.303-1.646)];The area under the curve of RAGE,PBEF and the combination of the two for predicting secondary ARDS in children with SP was 0.791,0.789 and 0.905,respectively,and the combination of the two was superior to their respective individual predi

关 键 词：重症肺炎 急性呼吸窘迫综合征 晚期糖基化终产物受体 前B细胞克隆增强因子 儿童 

分 类 号：R725.6[医药卫生—儿科]