血清sFasL、MR-proADM与重症肺炎患儿病情进展及预后转归的关系

The association between serum sFasL and MR-proADM and disease progression and prognosis in children with severe pneumonia

摘要

目的 探讨血清可溶性Fas配体(sFasL)、中区肾上腺髓质素(MR-proADM)水平与重症肺炎患儿病情进展及预后转归的关系。方法 选取2020年9月至2023年9月期间于上海交通大学医学院附属第九人民医院就诊的112例重症肺炎患儿作为研究对象,根据病情进展将其分为重症组(n=72)和危重症组(n=40);另选取同期健康儿童64例作为对照组.治疗30天后,根据患儿的生存情况将其分为生存组(n=89)与死亡组(n=23).采用酶联免疫吸附法检测血清sFasL、MR-proADM水平;Spearman相关分析sFasL、MR-proADM水平与肺炎严重指数评分的相关性;多因素Logistic回归分析重症肺炎患儿死亡预后的影响因素;受试者工作特征(ROC)曲线评估血清sFasL、MR-proADM水平对重症肺炎患儿死亡的预测价值。结果 对照组、重症组、危重症组患儿血清sFasL、MR-proADM水平依次升高,差异有统计学意义(F值分别为234.738、181.025,P<0.05);与生存组相比,死亡组血清sFasL、MR-proADM水平升高,差异具有统计学意义(t值分别为7.895、7.294,P<0.05);Spearman相关分析结果显示,sFasL水平与序贯性器官功能衰竭(SOFA)、CURB-65、肺炎严重指数(PSI)评分均为正相关关系(r值分别为0.467、0.482、0.546,P<0.001),MR-proADM水平与SOFA、CURB-65、PSI评分也均为正相关关系(r值分别为0.623、0.541、0.578,P<0.001);Logistic回归分析结果显示降钙素酶(PCT)、C反应蛋白(CRP)、sFasL、MR-proADM水平升高均为重症肺炎患儿预后死亡的危险因素(OR值分别为1.722、1.648、1.931、1.873,P<0.05);ROC曲线结果显示,血清sFasL、MR-proADM水平单独及联合预测患儿预后死亡的曲线下面积(AUC)分别为0.830、0.800、0.935,且二者联合预测价值较高(Z值分别为2.088、2.066,P<0.05)。结论 血清sFasL、MR-proADM水平与重症肺炎患儿病情进展密切相关,且联合预测重症肺炎患儿预后转归的价值较高.

Abstract

Objective To investigate the relationship between serum levels of soluble Fas ligand (sFasL) and mid-regional proadrenomedullin (MR-proADM) and disease progression and prognosis in children with severe pneumonia. Methods A total of 112 children with severe pneumonia who were admitted to Shanghai Ninth People's Hospital of Shanghai Jiao Tong University School of Medicine from September 2020 to September 2023 were enrolled as the study subjects, and they were divided into severe group (n=72) and critical group (n=40) according to the progression of their disease. In addition, 64 healthy children were selected as the control group. After 30 days of treatment, the children were divided into survival group (n=89) and death group (n=23) according to their survival. Enzyme-linked immunosorbent assay was used to detect serum levels of sFasL and MR-proADM. Spearman correlation analysis analyzed the correlation between sFasL, MR-proADM levels and pneumonia severity index scores. Multivariate logistic regression analysis was performed to analyze the influencing factors of the prognosis of death in children with severe pneumonia. The receiver operating characteristic (ROC) curve evaluated the predictive value of serum sFasL and MR-proADM levels in children with severe pneumonia. Results Serum sFasL and MR-proADM levels of children in the control, severe, and critically ill groups were sequentially increased, and the difference was statistically significant (F-values were 234.738 and 181.025, respectively, P<0.05). Compared with the survival group, the serum sFasL and MR-proADM levels in the death group were obviously higher, and the difference was statistically significant (t-values were 7.895 and 7.294, respectively, P<0.05). The results of Spearman correlation analysis showed that the level of sFasL was positively correlated with the scores of sequential organ failure (SOFA), CURB-65 and pneumonia severity index (PSI) (r-values were 0.467, 0.482, 0.546, respectively, P<0.001), the MR-proADM level was positively correlated with SOFA, CURB-65, and PSI scores (r-values were 0.623, 0.541, 0.578, respectively, P<0.001). Logistic regression analysis showed that elevated levels of procalcitoninogen (PCT), C-reactive protein (CRP), sFasL and MR-proADM were all risk factors for death in children with severe pneumonia (OR values were 1.722, 1.648, 1.931 and 1.873, respectively, P<0.05). The results of ROC curve showed that the area under the curve (AUC) of serum sFasL and MR-proADM levels in predicting prognostic death of children alone and in combination were 0.830, 0.800 and 0.935, respectively, and the combined predictive value of the two was higher (Z-values were 2.088 and 2.066, respectively, P<0.05). Conclusion Serum sFasL and MR-proADM levels were closely related to the progression of severe pneumonia, and the value of joint prediction of prognosis in children with severe pneumonia was higher.

关键词

可溶性Fas配体 / 中区肾上腺髓质素 / 重症肺炎患儿 / 病情进展 / 预后转归

Key words

soluble Fas ligand / mid-regional proadrenomedullin / children with severe pneumonia / disease progression / prognostic outcome

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