腺病毒肺炎患儿血清YKL-40和NRAV及IL-18水平对预后的预测价值

Predictive values of serum YKL-40, NRAV and IL-18 levels for prognosis of adenovirus pneumonia in children

摘要

目的 探讨腺病毒肺炎患儿血清壳多糖酶3样蛋白1(YKL-40)、抗病毒应答负性调节因子(NRAV)及白细胞介素(IL)-18水平对预后的预测价值。方法 选取2020年1月至2024年1月就诊于石家庄市人民医院的112例腺病毒肺炎患儿为研究对象,根据出院时病情将患儿分为预后不良组(31例)与预后良好组(81例)。比较两组患儿的基线资料及血清YKL-40、NRAV、IL-18水平;采用Pearson相关分析探讨血清YKL-40、NRAV及IL-18水平与肺炎严重度指数(PSI)评分的相关性;采用Lasso-Logistic回归分析腺病毒肺炎患儿预后影响因素;以受试者工作特征(ROC)曲线评价血清YKL-40、NRAV、IL-18单独及联合预测腺病毒肺炎患儿预后的效能。结果 预后不良组的PSI评分显著高于预后良好组(t=5.969,P<0.05),并发症≥3种的比例显著高于预后良好组(χ²=5.219,P<0.05)。预后不良组的血清YKL-40、NRAV及IL-18水平均高于预后良好组,经比较差异均有统计学意义(t值分别为6.093、4.041、3.557,P<0.05)。腺病毒肺炎患儿血清YKL-40、NRAV及IL-18水平与PSI评分均呈正相关(r值分别为0.728、0.818、0.803,P<0.05)。Lasso-Logistic回归分析结果显示,YKL-40、NRAV及IL-18均为腺病毒肺炎患者预后影响因素(OR=1.307、1.460、1.227,P<0.05)。ROC曲线分析显示,血清YKL-40、NRAV、IL-18单独预测腺病毒肺炎患儿预后的曲线下面积(AUC)分别为0.800、0.833、0.806,三者联合预测的AUC最大(0.940),可同时获得较高的灵敏度及特异度,分别为90.32%和86.42%。结论 血清YKL-40、NRAV及IL-18水平与腺病毒肺炎患儿预后密切相关,联合检测血清YKL-40、NRAV及IL-18水平可预测患儿预后情况,为早期防治提供参考。

Abstract

Objective To investigate predictive values of serum levels of chitinase 3-like protein-1 (also called YKL-40), negative regulator of antiviral response (NRAV) and interleukin-18 (IL-18) for prognosis of adenovirus pneumonia in children. Methods A total of 112 children with adenovirus pneumonia who were treated in Shijiazhuang Municipal People's Hospital from January 2020 to January 2024 were selected as research subjects. According to condition of the disease at discharge, the children were divided into poor prognosis group (31 cases) and good prognosis group (81 cases). The baseline data and serum levels of YKL-40, NRAV and IL-18 of the children were compared between the two groups. Pearson correlation analysis was used to explore correlations of serum YKL-40, NRAV and IL-18 levels with pneumonia severity index (PSI) score. Lasso-Logistic regression was used to analyze influencing factors for prognosis of adenovirus pneumonia in children. Receiver operating characteristic (ROC) curve was used to evaluate efficacy of single serum YKL-40, single serum NRAV and single serum IL-18 levels alone and combination of these three indexes for predicting prognosis of adenovirus pneumonia in children. Results The PSI score of the children in the poor prognosis group was significantly higher than that of the children in the good prognosis group (t=5.969, P<0.05). The proportion of complications ≥3 in the poor prognosis group was higher than that in the good prognosis group, and the difference was statistically significant (χ²=5.219, P<0.05). The serum levels of YKL-40, NRAV and IL-18 of the children in the poor prognosis group were higher than those in the good prognosis group, and the differences were statistically significant (t=6.093, 4.041 and 3.557 respectively, all P<0.05). Pearson correlation analysis showed that serum YKL-40, NRAV and IL-18 levels were positively correlated with PSI score in the children with adenovirus pneumonia (r=0.728, 0.818 and 0.803 respectively, all P<0.05). Lasso-Logistic regression analysis showed that YKL-40, NRAV and IL-18 were influencing factors for prognosis of adenovirus pneumonia in children (OR=1.307, 1.460 and 1.227 respectively, all P<0.05). ROC curve analysis showed that the areas under the curve (AUCs) of single serum YKL-40, NRAV and IL-18 alone for predicting prognosis of adenovirus pneumonia in children were 0.800, 0.833 and 0.806 respectively, and the AUC of the combination of serum YKL-40, NRAV and IL-18 for predicting prognosis of adenovirus pneumonia in children was the largest (0.940), meanwhile, the sensitivity (90.32%) and the specificity (86.42%) were both higher. Conclusion Serum YKL-40, NRAV and IL-18 levels are closely related to prognosis of adenovirus pneumonia in children. Combined detection of serum YKL-40, NRAV and IL-18 levels can predict prognosis of the disease, and provide reference for early prevention and treatment.

关键词

儿童 / 腺病毒肺炎 / 预后 / 壳多糖酶3样蛋白1 / 抗病毒应答负性调节因子 / 白细胞介素-18

Key words

children / adenovirus pneumonia / prognosis / chitinase 3-like protein-1 / negative regulator of antiviral response / interleukin-18

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基金资助

河北省医学科学研究课题(20220547)