血清褪黑素、和肽素与肺炎合并心力衰竭新生儿病情和预后的关系

Relationships of serum melatonin,copeptin with the condition of disease and prognosis of neonates with pneumonia complicated by heart failure

摘要

目的 探讨血清褪黑素、和肽素与肺炎合并心力衰竭(HF)新生儿病情和预后的关系。方法 选取2020年1月至2024年7月在我院治疗的115例肺炎合并HF新生儿作为病例组及健康新生儿50例作为对照组,检测肺炎合并HF新生儿治疗前的血清褪黑素、和肽素水平。肺炎合并HF新生儿根据Ross评分分为轻度组(n=50)、中度组(n=37)和重度组(n=28)。根据肺炎合并HF新生儿治疗后的预后情况分为预后良好组(n=82)和预后不良组(n=33)。采用Logistic回归分析影响肺炎合并HF新生儿预后的因素。采用受试者工作特征曲线(ROC)分析血清褪黑素、和肽素对肺炎合并HF新生儿预后不良的预测价值。结果 与对照组比较,轻、中、重度组的褪黑素、和肽素水平依次升高(F值分别为101.448、238.305,均P<0.05)。预后不良组住院时间长于预后良好组,射血分数(EF)低于预后良好组,病情严重程度(重度)比例、血清脑钠肽(BNP)、肌钙蛋白I(cTnI)、肌酸肌酶同工酶(CK-MB)、褪黑素、和肽素水平高于预后良好组(t/χ²值分别为3.191、-3.773、8.404、20.003、2.928、4.792、6.109、10.727,P<0.05)。病情严重程度、血清BNP、褪黑素与和肽素水平升高为预后不良的危险因素[OR及其95%CI分别为1.550(1.370~1.846)、3.357(2.375~4.335)、2.250(2.179~2.414)、2.423(2.301~2.684],均P<0.05)。血清褪黑素、和肽素预测肺炎合并HF新生儿预后不良的曲线下面积(AUC)分别为0.830、0.785,二者联合预测的AUC为0.909,联合预测的效能优于单独预测(Z_褪黑素 vs. 联合=2.347,Z_和肽素 vs. 联合=3.466,均P<0.05)。结论 肺炎合并HF新生儿中血清褪黑素、和肽素水平异常升高,且其升高程度与病情严重程度有关,二者联合检测对肺炎合并HF新生儿预后不良有较高的预测价值。

Abstract

Objective To explore the relationship between serum melatonin,copeptin and the condition and prognosis of neonates with pneumonia complicated by heart failure (HF). Methods 115 neonates with pneumonia complicated by HF who were treated in our hospital from January 2020 to July 2024 were selected as the case group,and 50 healthy neonates were selected as the control group.The levels of serum melatonin and copeptin before treatment were detected in the neonates with pneumonia complicated by HF.The neonates with pneumonia complicated by HF were divided into mild group (n=50),moderate group (n=37),and severe group (n=28) according to the Ross score.The neonates with pneumonia complicated by HF were divided into good prognosis group (n=82) and poor prognosis group (n=33) according to the prognosis after treatment.Logistic regression analysis was used to analyze the factors influencing the prognosis of neonates with pneumonia complicated by HF.The receiver operating characteristic (ROC) curve was used to analyze the predictive value of serum melatonin and copeptin for poor prognosis of neonates with pneumonia complicated by HF. Results Compared with the control group,the levels of melatonin and copeptin in the mild,moderate and severe groups increased successively (F=101.448,238.305,respectively,P<0.05).The length of hospital stay in the poor prognosis group was longer than that in the good prognosis group,the ejection fraction (EF) was lower than that in the good prognosis group,and the proportion of severe condition,serum brain natriuretic peptide (BNP),cardiac troponin I (cTnI),creatine kinase isoenzyme MB (CK-MB),melatonin,and copeptin levels were higher than those in the good prognosis group (t/χ²=3.191,-3.773,8.404,20.003,2.928,4.792,6.109,10.727,respectively,P<0.05).Severe condition,elevated serum BNP,melatonin and copeptin levels were risk factors for poor prognosis [OR and 95%CI were 1.550(1.370-1.846),3.357(2.375-4.335),2.250(2.179-2.414),2.423(2.301-2.684),P<0.05].The area under the curve (AUC) of serum melatonin and copeptin for predicting poor prognosis of neonates with pneumonia complicated by HF was 0.830 and 0.785,respectively.The AUC of combined prediction of serum melatonin and copeptin was 0.909,which was better than the single prediction (Z_Melatonin vs. combined=2.347,Z_{copeptin vs .combined}=3.466,P<0.05). Conclusion The levels of serum melatonin and copeptin in neonates with pneumonia complicated by HF were abnormally elevated,and the degree of elevation was related to the severity of the condition.The combined detection of serum melatonin and copeptin has a high predictive value for poor prognosis of neonates with pneumonia complicated by HF.

关键词

新生儿 / 肺炎 / 心力衰竭 / 褪黑素 / 和肽素 / 预后 / 预测价值

Key words

neonate / pneumonia / heart failure / melatonin / copeptin / prognosis / predictive value

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基金资助

四川省医学科研课题(S21109)