支原体肺炎患儿血清S100A4和CXCL14的表达与病情程度及预后的相关性

Correlations of expression of serum S100A4 and CXCL14 with severity and prognosis of disease in children with Mycoplasma pneumoniae pneumonia

摘要

目的 探讨支原体肺炎(MPP)患儿血清钙结合蛋白A4(S100A4)和趋化因子配体14(CXCL14)表达与病情严重程度及预后的相关性。方法 选取2022年9月至2024年1月期间于华北医疗健康集团峰峰总医院就诊的214例MPP患儿为研究对象,将其作为MPP组,根据肺部感染评分(CPIS)将其分为轻症组(124例)与重症组(90例),根据预后将MPP患儿分为预后良好组(153例)和预后不良组(61例);另选取同期214例健康儿童作为对照组.采用酶联免疫吸附试验(ELISA)检测血清S100A4和CXCL14水平,分析其与临床相关指标的相关性;多因素Logistic回归分析MPP患儿预后影响因素;受试者工作特征(ROC)曲线评估血清S100A4和CXCL14对患儿预后的预测价值。结果 与对照组相比,MPP组血清S100A4、CXCL14水平显著升高(t值分别为29.249、24.057,P<0.05).重症组血清S100A4、CXCL14水平及CPIS评分显著高于轻症组(t值分别为14.076、15.499、25.672,P<0.05).预后良好组血清S100A4、CXCL14水平显著低于预后不良组(t值分别为12.667、11.071,P<0.05).MPP患儿S100A4水平与白细胞计数(WBC)、中性粒细胞、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)水平均呈显著正相关(r值分别为0.367、0.482、0.399、0.411,P<0.05);MPP患儿CXCL14水平与WBC、中性粒细胞、IL-6、TNF-α水平均呈显著正相关(r值分别为0.353、0.541、0.408、0.394,P<0.05);MPP患儿S100A4和CXCL14水平均与CPIS评分呈显著正相关(r_s值分别为0.386、0.478,P<0.05).多因素Logistic回归分析显示,血清S100A4[OR(95%CI):2.163(1.259~3.715)]和CXCL14[OR(95%CI):1.725(1.229~2.421)]水平升高、病情程度为重症[OR(95%CI):1.872(1.202~2.915)]均是MPP患儿预后不良的危险因素(P<0.05).血清S100A4和CXCL14水平单独及联合预测MPP患儿预后不良的曲线下面积(AUC)分别为0.879、0.874、0.965,其中二者联合预测价值较高。结论 MPP患儿血清S100A4和CXCL14水平均有升高,且其水平与病情严重程度及预后有关.

Abstract

Objective To explore correlations of expression of serum S100 calcium binding protein A4 (S100A4) and C-X-C motif chemokine ligand 14 (CXCL14) with severity and prognosis of Mycoplasma pneumoniae pneumonia (MPP) in children. Methods 214 children with MPP who admitted to our hospital from September 2022 to January 2024 were selected as study subjects (MPP group). The children with MPP were categorized into two subgroups according to clinical pulmonary infection score (CPIS) criteria: mild MPP group (n=124) and severe MPP group (n=90). Other 214 healthy children in the same period were enrolled as controls. The children with MPP were categorized into good prognosis group (153 cases) and poor prognosis group (61 cases) according to outcome of the children. Enzyme-linked immunosorbent assay (ELISA) was used to detect serum levels of S100A4 and CXCL14. Spearman and Pearson correlation analyses were employed to analyze correlations between these protein levels and pertinent clinical indicators. Multifactorial Logistic regression was used to analyze factors influencing prognosis of MPP in children. Receiver operating characteristic (ROC) curve was used to assess predictive values of serum S100A4 and CXCL14 for prognosis of MPP in children. Results The serum S100A4 and CXCL14 levels of the children with MPP in the MPP group were significantly higher than those in the control group (t=29.249 and 24.057 respectively, both P<0.05). And the serum S100A4 and CXCL14 levels, and CPIS score of the MPP children in the severe MPP group were significantly higher than those in the mild MPP group (t=14.076, 15.499 and 25.672 respectively, all P<0.05). The serum S100A4 and CXCL14 levels of the children with MPP in the good prognosis group were significantly lower than those in the poor prognosis group, and the differences were statistically significant (t=12.667 and 11.071 respectively, both P<0.05). The serum S100A4 level of the children with MPP was significantly positively correlated with white blood cell count (WBC), neutrophil, interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α) levels (r=0.367, 0.482, 0.399 and 0.411 respectively, all P<0.05). Also, the serum CXCL14 level of the children with MPP was significantly positively correlated with WBC, neutrophil, IL-6 and TNF-α levels (r=0.353, 0.541, 0.408, and 0.394 respectively, all P<0.05). And both serum S100A4 and CXCL14 levels were significantly positively correlated with CPIS scores in the children with MPP (r_s=0.386 and 0.478 respectively, both P<0.05). Multifactorial Logistic regression analysis shown that elevated serum levels of S100A4 [OR (95%CI): 2.163 (1.259-3.715)] and CXCL14 [OR (95%CI): 1.725 (1.229-2.421)], and severe MPP [OR (95%CI): 1.872 (1.202-2.915)] were all risk factors for poor prognosis of the children with MPP (all P<0.05). The areas under the curve (AUCs) of single serum S100A4 level and single serum CXCL14 level alone and their combination for predicting poor prognosis of the children with MPP were 0.879, 0.874 and 0.965 respectively, showing that the predictive power of the combination was higher (Z_{combination-S100A4}: 2.313, P=0.021, Z_{combination-CXCL14}=2.715, P=0.007). Conclusion The serum levels of S100A4 and CXCL14 of the children with MPP elevate, and their serum levels are related to severity and prognosis of the disease.

关键词

儿童 / 支原体肺炎 / 钙结合蛋白A4 / 趋化因子配体14 / 病情严重程度 / 预后

Key words

children / Mycoplasma pneumoniae pneumonia / S100 calcium binding protein A4 / C-X-C motif chemokine ligand 14 / severity of the disease / prognosis

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基金资助

2022年度邯郸市科技专项计划自筹经费项目(22422083089ZC)