血清孤儿核受体4A1对儿童难治性肺炎支原体肺炎的预测价值

Predictive value of serum nuclear receptor 4A1 level for refractory Mycoplasma pneumoniae pneumonia in children

摘要

目的 探讨血清孤儿核受体4A1(NR4A1)对儿童难治性肺炎支原体肺炎(RMPP)的预测价值。方法 选取2022年4月至2023年4月河北北方学院附属第一医院收治的200例肺炎支原体肺炎(MPP)患儿为研究对象,依据病情分为普通肺炎支原体肺炎(GMPP)组(n=132)、RMPP组(n=68).比较各组血清NR4A1及临床资料的差异;Pearson法分析血清NR4A1与血清C反应蛋白(CRP)水平、白介素-6(IL-6)、白介素-8(IL-8)的相关性;受试者工作特征(ROC)曲线分析血清NR4A1对儿童RMPP的预测价值。结果 RMPP组住院时间、高热率、胸腔积液、肺实变、肺不张、中性粒细胞百分比(NEUT%)均较GMPP组增高,白蛋白较GMPP组降低,差异均有统计学意义(t/Z/χ²值介于6.386~41.599之间,P<0.05);RMPP组血清NR4A1较GMPP组降低,CRP、IL-6、IL-8较GMPP组增高,差异均有统计学意义(t值介于10.279~16.889之间,P<0.05);急性期RMPP患儿血清NR4A1较恢复期降低,CRP、IL-6、IL-8较恢复期增高,差异均有统计学意义(t值介于6.367~16.889之间,P<0.05);Pearson相关性分析显示,血清NR4A1与CRP、IL-6、IL-8呈负相关性(r值分别为-0.335、-0.507、-0.291,P<0.05);ROC曲线分析显示,血清NR4A1预测RMPP的曲线下面积(AUC)为0.870(95%CI:0.821~0.919),最佳截断值为0.89,灵敏度和特异度分别为74.21%、92.60%。结论 RMPP患儿血清NR4A1低表达,且与病情恢复程度、炎症因子表达相关,对儿童RMPP具有较好的预测价值.

Abstract

Objective To investigate predictive value of serum nuclear receptor 4A1 (NR4A1) for refractory Mycoplasma pneumoniae pneumonia (RMPP) in children. Methods 200 children with Mycoplasma pneumoniae pneumonia (MPP) who admitted to The First Affiliated Hospital of Hebei North University from April 2022 to April 2023 were selected as the study subjects, and they were divided into general Mycoplasma pneumoniae pneumonia (GMPP) group (n=132) and RMPP group (n=68) according to disease condition of the child. The differences in serum NR4A1 level and clinical data of the children were compared between the two groups. Pearson correlation analysis was used to analyze correlations of serum NR4A1 with serum C-reactive protein (CRP), interleukin-6 (IL-6) and interleukin-8 (IL-8). Receiver operating characteristic (ROC) curve was used to analyze predictive value of serum NR4A1 for RMPP in children. Results Compared with GMPP group, length of hospital stay, high fever rate, incidences of pleural effusion, lung consolidation, pulmonary atelectasis and neutrophil percentage (NEUT%) of the children in RMPP group were higher than those in GMPP group, while the serum albumin level was lower, and the differences were statistically significant (t/Z/χ² values ranged from 6.386 to 41.599, all P<0.05). The serum NR4A1 level of the children in RMPP group was lower than that in GMPP group, while the serum levels of CRP, IL-6 and IL-8 were higher than those in GMPP group, and the differences were statistically significant (t values ranged from 10.279 to 16.889, all P<0.05). The serum NR4A1 level of the children in acute RMPP stage was lower than that in recovery RMPP stage, while the serum levels of CRP, IL-6 and IL-8 were higher than those in recovery stage, and the differences were statistical significant (t value ranged from 6.367-16.889, all P<0.05). Pearson correlation analysis showed that the serum NR4A1 was negatively correlated with CRP, IL-6 and IL-8 (r=-0.335, -0.507 and -0.291 respectively, all P<0.05). ROC curve analysis showed that the area under the curve (AUC) of serum NR4A1 for predicting RMPP was 0.870 (95%CI: 0.821-0.919), the best cut-off value was 0.89, and the sensitivity and the specificity were 74.21% and 92.60%, respectively. Conclusion The expression of NR4A1 in serum is low in children with RMPP, and is related to recovery degree of the disease and expression of inflammatory factors, therefore, it has a good predictive value for RMPP in children.

关键词

孤儿核受体4A1 / 难治性肺炎支原体肺炎 / 儿童 / 肺炎支原体 / 炎症因子

Key words

NR4A1 / refractory Mycoplasma pneumoniae pneumonia / children / Mycoplasma pneumoniae / inflammatory factor

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基金资助

河北省2021年度医学科学研究课题计划(20211026)