血清LDH、SAA、IL-6联合检测在诊疗儿童感染性肺炎中的应用价值

Application value of combined detection of serum LDH, SAA and IL-6 in diagnosis and treatment of infectious pneumonia in children

摘要

目的 探讨血清乳酸脱氢酶(LDH)、淀粉样蛋白A(SAA)、白细胞介素-6(IL-6)联合检测在儿童感染性肺炎诊疗中的应用价值。方法 选取2020年3月至2023年3月于西北妇女儿童医院治疗的感染性肺炎患儿325例纳入肺炎组,另选取同期健康体检儿童325例纳入健康组,对比两组研究对象的血清LDH、SAA、IL-6水平,分析血清LDH、SAA、IL-6水平对儿童感染性肺炎的诊断价值.肺炎组患儿治疗7d后,根据其治疗转归情况,分为转归良好组234例与转归不良组91例,对比两组患儿治疗前及治疗7d后的血清LDH、SAA、IL-6水平和病例资料,并分析影响感染性肺炎患儿治疗转归的危险因素及治疗前血清LDH、SAA、IL-6水平对感染性肺炎患儿治疗转归不良的预测价值.采用Logistic回归分析感染性肺炎患儿治疗转归的影响因素,受试者工作特征(ROC)曲线分析血清LDH、SAA、IL-6对儿童感染性肺炎的诊断价值及疗效的预测价值。结果 治疗前肺炎组血清LDH、SAA、IL-6水平均明显高于健康组(t值分别为33.290、59.591、46.769,P<0.05).血清LDH、SAA、IL-6联合诊断儿童感染性肺炎的AUC为0.904(P<0.05),其明显高于各单指标的检测价值.转归不良组患儿治疗前及治疗7d后的血清LDH、SAA、IL-6水平均明显高于转归良好组(t值分别为11.124、6.902,15.782、13.943,27.139、8.095,P<0.05).Logistic回归分析显示,病程(OR=1.988)、呼吸频率(OR=2.065)、胸腔积液(OR=2.130)、多重感染(OR=2.210),以及治疗前血清LDH(OR=2.250)、SAA(OR=2.394)、IL-6(OR=2.537)水平均是影响感染性肺炎患儿治疗转归的危险因素(P<0.05).治疗前血清LDH、SAA、IL-6水平联合预测感染性肺炎患儿治疗转归不良的AUC为0.971(P<0.05),其明显高于各单项预测价值。结论 临床检测血清LDH、SAA、IL-6水平对儿童感染性肺炎的诊断价值较高,并有助于预测其治疗转归情况.

Abstract

Objective To investigate application value of combined detection of serum levels of lactate dehydrogenase (LDH), serum amyloid A protein (SAA) and interleukin-6 (IL-6) in diagnosis and treatment of infectious pneumonia in children. Methods A total of 325 children with infectious pneumonia who were treated in Northwest Women and Children's Hospital from March 2020 to March 2023 were selected as in pneumonia group, and other 325 healthy children who underwent physical examination during the same period were selected as health group. Serum LDH, SAA and IL-6 levels of the children were detected and compared between the two groups and diagnostic values of the three indexes for infectious pneumonia in children were analyzed. After 7 days of treatment, the children in the pneumonia group were divided into a good prognosis group (n=234) and poor prognosis group (n=91) according to their treatment outcome. The serum LDH, SAA, IL-6 levels and case data of the children were compared before treatment and after 7 days of treatment between the two groups. Logistic regression was used to analyze risk factors affecting treatment outcome of the children with infectious pneumonia and receiver operating characteristic (ROC) curve was used to analyze diagnostic values of serum LDH, SAA and IL-6 levels for infectious pneumonia in children and their predictive values for treatment efficacy. Results The serum levels of LDH, SAA and IL-6 of the children in the pneumonia group before treatment were significantly higher than those in the health group (t=33.290, 59.591 and 46.769 respectively, all P<0.05). The area under the curve (AUC) of combination of serum LDH, SAA and IL-6 for diagnosing infective pneumonia in children was 0.904 (P<0.05), which was significantly higher than the diagnostic values of single three indexes. The serum levels of LDH, SAA and IL-6 of the children in the poor prognosis group were significantly higher than those in the good prognosis group before treatment and after 7 days of treatment (t=11.124, 6.902, 15.782, 13.943, 27.139 and 8.095 respectively, all P<0.05). Logistic regression analysis showed that duration of disease (OR=1.988), respiratory rate (OR=2.065), pleural effusion (OR=2.130), multiple infections (OR=2.210), high serum LDH (OR=2.250), SAA (OR=2.394) and IL-6 (OR=2.537) levels before treatment were all risk factors affecting treatment outcome of the children with infectious pneumonia (all P<0.05). The area under the curve (AUC) of combination of serum LDH, SAA and IL-6 levels before treatment for predicting poor outcome of the children with infectious pneumonia was 0.971 (P<0.05), which was significantly higher than the predictive values of single three indexes. Conclusion The combined detection of serum levels of LDH, SAA and IL-6 has high diagnostic value for infectious pneumonia in children and can predict outcome of the treatment.

关键词

乳酸脱氢酶 / 淀粉样蛋白A / 白细胞介素-6 / 感染性肺炎

Key words

lactate dehydrogenase / serum amyloid A protein / interleukin-6 / infectious pneumonia

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