外周血核苷酸结合寡聚化结构域样受体蛋白3/白细胞介素-1β、白细胞介素-18通路与重症肺炎支原体肺炎患儿预后关系及应用价值  

Relationship between NLRP3/IL-1,IL-18 pathway in peripheral bloodand the prognosis of SMMP children and its application value

作　　者：葛宾 崔慧贤[1] 梁坤 赵静维 邸翔 李淑娟[1] GE Bin;CUI Huixian;LIANG Kun;ZHAO Jingwei;DI Xiang;LI Shujuan(Department of Pediatric Medicine,Tangshan Maternal and Child Health Hospital,Tangshan 063000,China)

机构地区：[1]唐山市妇幼保健院儿内二科,河北唐山063000

出　　处：《陕西医学杂志》2024年第12期1658-1662,共5页Shaanxi Medical Journal

基　　金：河北省医学科学研究课题(20221763)。

摘　　要：目的:探讨外周血核苷酸结合寡聚化结构域样受体蛋白3(NLRP3)/白细胞介素-1β(IL-1β)、白细胞介素-18(IL-18)通路与儿童重症肺炎支原体肺炎(SMPP)预后的关系及应用价值。方法:前瞻性选取SMPP患儿113例,根据30 d预后分为预后良好组(81例)与预后不良组(32例),比较两组一般资料及外周血NLRP3、IL-1β、IL-18水平。Pearson法分析外周血NLRP3、IL-1β、IL-18与急性生理与慢性健康评价系统Ⅱ(APACHEⅡ)评分的关系;Logistic回归分析SMMP患儿预后不良的影响因素;受试者工作特征(ROC)曲线评价外周血NLRP3、IL-1β、IL-18对SMMP患儿预后的预测价值。结果:预后不良组患儿发病至入院时间>3 d比例、胸腔积液比例、APACHEⅡ评分以及外周血NLRP3、IL-1β、IL-18水平高于预后良好组(均P<0.05)。外周血NLRP3、IL-1β、IL-18水平与APACHEⅡ评分呈正相关(均P<0.05)。外周血NLRP3、IL-1β、IL-18预测SMPP患儿预后的最佳截断值分别为738.62、68.44、269.27 pg/ml,此时三者的曲线下面积(AUC)分别为0.815、0.806、0.817,敏感度分别为87.50%、84.37%、71.87%,特异度分别为64.20%、71.60%、77.78%。在校正其他因素前后,外周血NLRP3、IL-1β、IL-18高表达是SMPP患儿预后不良的独立危险因素(均P<0.05)。外周血NLRP3、IL-1β、IL-18联合预测SMPP患儿预后不良的AUC为0.923,敏感度为84.37%,特异度为90.12%,三项联合预测价值较单项指标更高(均P<0.05)。结论:外周血NLRP3/IL-1β、IL-18通路与SMPP患儿预后关系密切,NLRP3、IL-1β、IL-18高表达是患儿预后的独立危险因素,三项联合预测SMMP患儿预后不良的效能较高,可为临床降低预后不良风险提供帮助。Objective:To investigate the relationship between nucleotide-binding oligomeric domain-like receptor protein 3(NLRP3)/interleukin-1β(IL-1β)and interleukin-18(IL-18)pathway in peripheral blood and the prognosis of children with severe mycoplasma pneumonia(SMPP)and its application value.Methods:A total of 113 children with SMPP were prospectively selected and divided into good prognosis group(81 cases)and poor prognosis group(32 cases)based on 30-day prognosis.The baseline data,peripheral blood NLRP3,IL-1βand IL-18 levels of the two groups were compared.Pearson method was used to analyze the relationship between NLRP3,IL-1β,IL-18 in peripheral blood and APACHEⅡscore.Logistic regression was used to analyze the influencing factors of poor prognosis in children with SMMP.ROC curve was used to evaluate the predictive value of NLRP3,IL-1β,and IL-18 in peripheral blood for the prognosis of children with SMMP.Results:Compared with the good prognosis group,the poor prognosis group had significantly higher proportion of time from onset to admission>3 days,proportion of pleural effusion,APACHEⅡscore,and levels of NLRP3,IL-1βand IL-18 in peripheral blood(all P<0.05).The levels of NLRP3,IL-1βand IL-18 in peripheral blood were positively correlated with APACHEⅡscore(all P<0.05).The best cut-off values of NLRP3,IL-1β,and IL-18 in peripheral blood to predict the prognosis of SMPP children were 738.62,68.44,and 269.27 pg/ml,and the AUC of the three were 0.815,0.806,and 0.817,and the sensitivity was 87.50%,84.37%and 71.87%,and the specificity was 64.20%,71.60%and 77.78%.After adjusting for other factors,high expressions of NLRP3,IL-1β,and IL-18 in peripheral blood were independent risk factors for poor prognosis in children with SMPP(all P<0.05).The AUC of the combination of NLRP3,IL-1β,and IL-18 in peripheral blood for predicting poor prognosis in children with SMPP was 0.923,with a sensitivity of 84.37%and a specificity of 90.12%.The combined predictive value of the three indicators was higher than that of each in

关 键 词：重症肺炎支原体肺炎 核苷酸结合寡聚化结构域样受体蛋白3 白细胞介素-1Β 白细胞介素-18 预后 预测价值 儿童 

分 类 号：R563.1[医药卫生—呼吸系统]