血清Endocan、补体C3a与重症肺炎患儿病情和预后转归的关系分析

Analysis of the relationship between serum Endocan, complement C3a, with the disease condition and prognosis in children with severe pneumonia

摘要

目的 探讨血清内皮细胞特异性分子(Endocan)-1、补体C3a与重症肺炎患儿病情和预后转归的关系。方法 选择2018年3月至2023年3月中国人民解放军联勤保障部队第961医院及齐齐哈尔市第一医院儿科收治的190例重症肺炎患儿(肺炎组)和95例年龄性别匹配的健康儿童(对照组)为研究对象.根据改良易感性、感染、反应和器官功能衰竭(PIRO)量表将重症肺炎患儿分为低风险组(59例)、中高风险组(76例)、极高风险组(55例).检测血清Endocan、补体C3a水平,统计重症肺炎患儿不良临床结局,分析影响重症肺炎患儿预后的因素及Endocan、补体C3a预测重症肺炎患儿发展结局的价值。结果 肺炎组血清Endocan、补体C3a水平均高于对照组,差异有统计学意义(t值分别为40.775、37.808,P<0.05);极高风险组血清Endocan、补体C3a水平高于中高风险组和低风险组,中高风险组血清Endocan、补体C3a水平高于低风险组,差异有统计学意义(F值分别为109.352、78.293,P<0.05);预后不良组改良极高风险、入住重症监护病房、呼吸衰竭比例高于预后良好组,血清Endocan、补体C3a水平高于预后良好组,差异均有统计学意义(t/χ²值介于5.435~33.346之间,P<0.05);多因素Logistic回归分析结果显示改良PIRO分级极高风险、高水平Endocan、高水平补体C3a是重症肺炎患儿预后不良的危险因素,其OR值及95%CI分别为2.186(1.177~4.061)、1.868(1.092~3.196)、1.667(1.120~2.482),P<0.05;联合Endocan、补体C3a、改良PIRO评分预测重症肺炎患儿发展结局的曲线下面积(AUC)为0.900,高于单独指标预测(Z值分别为3.542、6.317、2.627,P<0.05)。结论 重症肺炎患儿血清Endocan、补体C3a水平增高与病情加重、预后不良有关,可作为重症肺炎病情和预后评估的潜在标志物.

Abstract

Objective To investigate the relationship between serum endothelium cell specific molecule (Endocan)-1, complement C3a with the disease condition and prognosis in children with severe pneumonia. Methods A study was conducted on 190 children with severe pneumonia (pneumonia group) and 95 healthy children matched for age and sex (control group) admitted to 961 Hospital of the Joint Logistics Support Force of the People's Liberation Army and the First Hospital of Qiqihar from March 2018 to March 2023. The children with severe pneumonia were divided into a low-risk subgroup (59 cases), a moderate-to-high-risk subgroup (76 cases), and a very high-risk subgroup (55 cases) based on the modified predisposition, infection, response, and organ dysfunction (PIRO) score. Measure serum levels of Endocan and complement C3a, record adverse clinical outcomes in children with severe pneumonia, analyze factors influencing prognosis in these children, and the value of Endocan and complement C3a in predicting developmental outcomes of severe pneumonia in children. Results In the pneumonia group, serum levels of Endocan and complement C3a were higher compared to the control group, with statistically significant differences (t=40.775 and 37.808, respectively, P<0.05). Within the pneumonia group, the very high-risk subgroup exhibited higher levels of serum Endocan and complement C3a compared to the moderate-to-high-risk and low-risk subgroups. The moderate-to-high-risk subgroup also showed higher levels compared to the low-risk subgroup, with statistically significant differences (F=109.352 and 78.293, respectively, P<0.05). Among patients with poor prognosis, the modified very high-risk category, admission to the intensive care unit, and respiratory failure were higher than that in good prognosis group, and the serum Endocan and complement C3a levels were higher compared to the good prognosis group, with statistically significant differences (t/χ²=5.435-33.346, P<0.05). Multivariable logistic regression analysis showed that very high-risk according to the modified PIRO scale, high level of Endocan and high level of complement C3a were risk factors for poor prognosis children with severe pneumonia, with OR and 95% CI of 2.186 (1.177-4.061), 1.868 (1.092-3.196), and 1.667 (1.120-2.482), all P<0.05. Combining Endocan, complement C3a, and modified PIRO score to predict the outcomes of severe pneumonia children yielded an area under the curve (AUC) of 0.900, which was higher than the prediction using each individual indicator alone (Z=3.542, 6.317, and 2.627, all P<0.05). Conclusion Elevated serum levels of Endocan and complement C3a in children with severe pneumonia are associated with disease severity worsening and poor prognosis, and can be used as potential indicators for assessing the severity and prognosis of severe pneumonia.

关键词

内皮细胞特异性分子-1 / 补体C3a / 重症肺炎 / 预后

Key words

endothelial cell specific molecule-1 / complement C3a / severe pneumonia / prognosis

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