呼吸道合胞病毒性肺炎患儿治疗预后的影响因素及血清SP-D、sTREM-1、HBD-3的预测价值

Influencing factors of prognosis after antiviral therapy for respiratory syncytial virus pneumonia in children and predictive values of serum SP-D,sTREM-1 and HBD-3

摘要

目的 探究呼吸道合胞病毒性肺炎(RSVP)患儿抗病毒治疗预后的影响因素及血清肺表面活性物质蛋白-D(SP-D)、可溶性髓系细胞触发受体-1(sTREM-1)、β-防御素3(HBD-3)的预测价值。方法 回顾性分析我院218例RSVP患儿资料,根据病情严重程度将患儿分为低危组、中危组和高危组,比较三组血清SP-D、sTREM-1、HBD-3水平;根据治疗后的预后情况将RSVP患儿分为预后良好组和预后不良组,比较两组临床资料、血清SP-D、sTREM-1、HBD-3水平,采用二元Logistic回归法分析影响RSVP患儿预后的相关因素,采用受试者工作特征(ROC)曲线分析血清SP-D、sTREM-1、HBD-3对RSVP患儿预后的预测价值。结果 低危组血清SP-D、sTREM-1、HBD-3水平均显著低于中危组、高危组(F=48.912、60.382、25.752,P<0.05),中危组血清SP-D、sTREM-1、HBD-3水平均显著低于高危组(t=4.182、3.756、3.901,P<0.05);Spearman相关系数分析显示,血清SP-D、sTREM-1、HBD-3与RSVP患儿病情严重程度均呈显著正相关(r=0.511、0.576、0.463,P<0.05);预后不良组病程、体温、临床肺部感染评分(CPIS)、高危病患占比、血小板计数(PLT)、血清SP-D、sTREM-1、HBD-3水平均显著高于预后良好组(t=2.502、2.944、10.201,χ²=32.610,t=4.069、8.300、9.016、6.258,P<0.05);二元Logistic回归分析显示,CPIS评分升高(OR=2.835,P<0.05)、病情高危(OR=3.053,P<0.05)、血清SP-D(OR=2.392,P<0.05)、HBD-3(OR=2.275,P<0.05)、sTREM-1(OR=2.502,P<0.05)升高是影响RSVP患儿预后的危险因素(χ²=8.519、8.857、7.243、5.612、8.161,P<0.05);ROC曲线分析显示,血清SP-D、sTREM-1、HBD-3联合预测的曲线下面积(AUC)(0.933)大于各单项指标独立预测(AUC分别为0.837、0.843、0.776)(Z=2.314、3.687、2.845,均P<0.05),联合诊断价值更高。结论 呼吸道合胞病毒性肺炎患儿抗病毒治疗的预后受感染程度、病情、血清SP-D、sTREM-1、HBD-3等多种因素影响,其中,血清SP-D、sTREM-1、HBD-3对患者预后具有较高的预测价值。

Abstract

Objective To investigate influencing factors of prognosis after antiviral therapy for respiratory syncytial virus pneumonia (RSVP) in children,and to analyze predictive values of serum pulmonary surfactant protein-D (SP-D),soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) and human β-defensin 3 (HBD-3) for the disease. Methods Clinical data of 218 children with RSVP in our hospital were retrospectively analyzed.According to disease severity,the children were divided into low-risk group (n=88), intermediate-risk group (n=76) and high-risk group (n=54),and the serum levels of SP-D,sTREM-1 and HBD-3 of the children with RSVP were compared among the three groups.According to prognosis after antiviral treatment,the children with RSVP were divided into two groups:good prognosis group (n=167) and poor prognosis group (n=51),and their clinical data,serum SP-D,sTREM-1 and HBD-3 levels were compared between the two groups.Binary Logistic regression analysis was used to analyze related factors affecting prognosis of RSVP in children.Receiver operating characteristic (ROC) curve was used to analyze predictive values of serum SP-D,sTREM-1 and HBD-3 for prognosis after antiviral therapy of RSVP in children. Results The serum levels of SP-D,sTREM-1 and HBD-3 of the children in the low-risk group were significantly lower than those in the intermediate-risk group and the high-risk groups (F=48.912,60.382 and 25.752 respectively,all P<0.05),in turn,the serum levels of SP-D,sTREM-1 and HBD-3 of the children in the intermediate-risk group were significantly lower than those in the high-risk group (t=4.182,3.756 and 3.901 respectively,all P<0.05).Spearman correlation analysis showed that the serum SP-D,sTREM-1 and HBD-3 levels were all significantly positively correlated with disease severity of RSVP in children (r=0.511,0.576 and 0.463 respectively,all P<0.05).The course of disease,body temperature,clinical pulmonary infection score (CPIS),proportion of the children with high-risk RSVP,plasma platelet count (PLT),and serum levels of SP-D,sTREM-1 and HBD-3 of the children in the poor prognosis group were all significantly higher than those in the good prognosis group (t=2.502,2.944 and 10.201 respectively;χ ²=32.610;t=4.069,8.300,9.016 and 6.258 respectively,all P<0.05).Binary Logistic regression analysis showed that increased CPIS (OR=2.835,P<0.05),high-risk disease severity (OR=3.053,P<0.05),and elevated serum SP-D (OR=2.392,P<0.05),HBD-3 (OR=2.275,P<0.05) and sTREM-1(OR=2.502,P<0.05) levels were risk factors affecting prognosis after antiviral therapy of RSVP in children (Wald χ ²=8.519,8.857,7.243,5.612 and 8.161 respectively,all P<0.05). ROC curve analysis showed that the AUCs of serum SP-D,sTREM-1,HBD-3,and their combination for predicting prognosis after antiviral therapy of RSVP in children were 0.837,0.843,0.776 and 0.933 respectively,showing that the AUC of combination of the three indexes was greater than those of the three individual indexes (Z=2.314,3.687 and 2.845 respectively,all P<0.05). Conclusion The prognosis after antiviral therapy of RSVP in children is affected by infection degree,disease severity,serum SP-D,sTREM-1,HBD-3 levels and other factors,among which,serum SP-D,sTREM-1 and HBD-3 have high predictive values for prognosis after antiviral therapy of the disease.

关键词

儿童 / 呼吸道合胞病毒 / 肺炎 / 预后 / 肺表面活性物质蛋白-D / 可溶性髓系细胞触发受体-1 / β-防御素3

Key words

children / respiratory syncytial virus / pneumonia / prognosis / pulmonary surfactant protein-D / soluble triggering receptor expressed on myeloid cells-1 / human β-defensin 3

参考文献

[1] 石丽娟, 王美娟, 吴水燕, 等. 儿童重症博卡病毒与呼吸道合胞病毒肺炎的临床比较[J]. 中国妇幼健康研究, 2023,34(3): 81-86.

[2] 屈春燕, 张凡, 袁晓华, 等. 呼吸道合胞病毒感染性肺炎患儿血清miR-146a和miR-145与Th17/Treg水平及临床意义[J]. 中华预防医学杂志, 2024,58(11): 1733-1738.

[3] 王铖芸, 丁洁, 刘玲珍, 等. 小儿肺炎呼吸系统病原体检测及临床特征分析[J]. 转化医学杂志, 2025,14(9): 5-10.

[4] 葛丽丽, 许轩. 血清肺表面活性蛋白D、白介素-18、中性粒细胞与淋巴细胞比值与新生儿呼吸窘迫综合征严重程度及预后的关系分析[J]. 中国医刊, 2023,58(9): 1014-1017.

[5] Kimmoun A, Duarte K, Harjola V P, et al. Soluble triggering receptor expressed on myeloid cells-1 is a marker of organ injuries in cardiogenic shock:results from the CardShock Study[J]. Clin Res Cardiol, 2022,111(6): 604-613.

[6] Vitenberga Z, Pilmane M, Babjoniševa A. An Insight into COPD Morphopathogenesis:Chronic Inflammation,Remodeling,and Antimicrobial Defense[J]. Medicina (Kaunas), 2019,55(8): 496.

[7] 国家儿童健康与疾病临床医学研究中心, 中华医学会儿科学分会感染学组, 上海市医学会感染病分会, 等. 儿童呼吸道合胞病毒感染临床诊治中国专家共识(2023年版)[J]. 临床儿科杂志, 2024,42(1): 1-14.

[8] Gunalan A, Sistla S, Sastry A S, et al. Concordance between the National Healthcare Safety Network (NHSN) Surveillance Criteria and Clinical Pulmonary Infection Score (CPIS) Criteria for Diagnosis of Ventilator-associated Pneumonia (VAP)[J]. Indian J Crit Care Med, 2021,25(3): 296-298.

[9] Jabeen F, Mishra A, Mateen S, et al. Pneumonia in Geriatric Patients and Prediction of Mortality Based on the Pneumonia Severity Index (PSI),CURB-65,Frailty Index (FI),and FI-Lab21 Scores[J]. Cureus, 2024,16(6): 61719.

[10] 胡鹏, 毛佳颖, 陈梦思, 徐丽君, 赵淦. 严重急性呼吸道感染患儿不同标本的常见呼吸道病原体检测结果分析[J]. 转化医学杂志, 2025,14(5): 13-18.

[11] 魏金凤, 吴素玲. 不同年龄儿童RSV肺炎的临床特征及重症RSV肺炎危险因素分析[J]. 中国妇幼健康研究, 2022,33(7): 24-29.

[12] Saleh N Y, Ibrahem R A L, Saleh A A H, et al. Surfactant protein D:a predictor for severity of community-acquired pneumonia in children[J]. Pediatr Res, 2022,91(3): 665-671.

[13] Zhang G, Hu Y, Huang B, et al. The predictive value of PCT,SP-D and 8-iso-PGF2α for the development of severe pneumonia in children[J]. Afr Health Sci, 2024;24(3): 63-68.

[14] 董学广, 刘莉, 燕民, 等. 肺炎支原体肺炎患儿血清SP-D、Gal-3、CCL5水平与炎症因子和预后不良的关系研究[J]. 现代生物医学进展, 2022,22(16): 3126-3131.

[15] Dholariya S, Parchwani D N, Singh R, et al. Utility of P-SEP,sTREM-1 and suPAR as Novel Sepsis Biomarkers in SARS-CoV-2 Infection[J]. Indian J Clin Biochem, 2022,37(2): 131-138.

[16] Wang J, Zhao Y, Pan L, et al. The relationship between the expression of serum IL-18 mRNA,CC16,and sTREM-1 and the severity and prognosis of ventilator-associated pneumonia in elderly patients[J]. Ann Palliat Med, 2021,10(12): 12767-12774.

[17] 左玉, 王震文, 王栋, 等. 血清MCP-1、sTREM-1、sICAM-1在肺炎患儿表达水平及其与病情严重程度的相关性分析[J]. 标记免疫分析与临床, 2019,26(7): 1186-1189, 1195.

[18] 蔡昌君, 黄惠敏, 桂冬梅, 等. 人β-防御素-3调控呼吸道合胞病毒致哮喘幼鼠的气道重塑及白细胞激活[J]. 东南大学学报(医学版), 2022,41(2): 183-192.

[19] 王军, 翟惠芬, 吴艳军, 等. 社区获得性肺炎患者中与血清β-防御素2和β-防御素3相关的临床指标的相关性研究[J]. 临床和实验医学杂志, 2022,21(14): 1500-1505.

[20] 陈燕, 王昶, 李庚武. 肺炎支原体感染患儿NQO-1相对表达量、HBD-3水平与胸部CT影像特征及预后的相关性研究[J]. 国际放射医学核医学杂志, 2025,49(8): 489-497.