重症肺炎患儿中性粒细胞弹性蛋白酶、血管细胞黏附分子-1的表达及其预后价值分析

Expressions and prognostic values of neutrophil elastase and VCAM-1 in children with severe pneumonia

摘要:

目的 探讨重症肺炎患儿中性粒细胞弹性蛋白酶（NE）、血管细胞黏附分子-1（VCAM-1）表达及其预后价值。方法 选取2020年1月—2022年1月聊城市第二人民医院收治的108例重症肺炎患儿作为研究组。另选取同期该院体检的96例健康儿童作为对照组。比较两组血清NE、VCAM-1水平。随访21 d后统计重症肺炎患儿生存情况，采用单因素分析影响重症肺炎患儿死亡的因素，并对影响患儿死亡的因素进行一般多因素Logistic回归分析，采用Pearson相关性分析血清NE、VCAM-1水平与重症肺炎患儿的儿童危重病例评分（PCIS）的相关性，采用受试者工作特征曲线（ROC）分析血清NE、VCAM-1水平预测重症肺炎患儿死亡的价值。结果 研究组NE、VCAM-1水平高于对照组（P <0.05）。死亡组与存活组性别、年龄、肺不张、胸腔积液、治疗药物、体温、心率、呼吸频率、空腹血糖、白细胞计数、中性粒细胞、肿瘤坏死因子α、降钙素原、乳酸脱氢酶比较，差异无统计学意义（P >0.05）。死亡组休克、病变累及多个肺叶构成比及APACHEⅡ评分，C反应蛋白、NE、VCAM-1水平高于存活组（P <0.05）。一般多因素Logistic回归分析结果显示：血清NE［O^R=3.762（95% CI：1.513，9.354）］、VCAM-1［O^R=3.622（95% CI：1.457，9.006）］、APACHEⅡ评分［O^R=3.267（95% CI：1.314，8.124）］、病变累及多个肺叶［O^R=3.200（95% CI：1.287，7.955）］是影响重症肺炎患儿死亡的危险因素（P <0.05）。Pearson相关性分析显示，血清NE、VCAM-1水平与重症肺炎患儿PCIS均呈负相关（r =-0.373和-0.544，均P <0.05）。血清NE、VCAM-1联合预测的敏感性、特异性和AUC分别为80.00%（95% CI：0.593，0.933）、97.59%（95% CI：0.916，0.998）、0.919（95% CI：0.851，0.963）。结论 重症肺炎患儿血清NE、VCAM-1水平均异常升高，两者与预后密切相关，临床检测血清NE、VCAM-1水平可以作为预测患儿死亡的敏感指标。

关键词:重症肺炎;儿童;中性粒细胞弹性蛋白酶;血管细胞黏附分子-1;预后

Abstract:

Objective To investigate the expressions and prognostic values of neutrophil elastase (NE) and vascular cell adhesion molecule-1 (VCAM-1) in children with severe pneumonia.Methods A total of 108 children with severe pneumonia admitted to our hospital from January 2020 to January 2022 were selected, and 96 healthy children who came to the hospital for physical examinations during the same period were selected. Serum levels of NE and VCAM-1 were compared between children with severe pneumonia and healthy children. After 21 days of follow-up, the survival of children with severe pneumonia was observed. The univariable analysis was performed to determine the factors affecting the death of children with severe pneumonia, which were further included for Logistic regression analysis. Pearson method was used to analyze the correlations between serum levels of NE and VCAM-1 and the Pediatric Critical Illness Score (PCIS) of children with severe pneumonia, and receiver operating characteristic (ROC) curve was applied to analyze the values of serum levels of NE and VCAM-1 for predicting the death of children with severe pneumonia.Results Serum levels of NE and VCAM-1 in children with severe pneumonia were higher than those in healthy children (P < 0.05). There was no difference in gender, age, pulmonary atelectasis, pleural effusion, drug treatment regimens, body temperature, heart rate, respiratory rate, fasting blood glucose, white blood cell count, neutrophil count, and levels of tumor necrosis factor-α, procalcitonin, and lactic dehydrogenase between the death group and the survival group (P > 0.05). The incidence of shock, the proportion of multi-lobar involvement, APACHE Ⅱ score, and the levels of C-reactive protein, NE and VCAM-1 were higher in the death group than those in the survival group (P < 0.05). The multivariable Logistic regression analysis showed that serum levels of NE [O^R = 3.762 (95% CI: 1.513, 9.354) ] and VCAM-1 [O^R = 3.622 (95% CI: 1.457, 9.006) ], APACHE II score [O^R = 3.267 (95% CI : 1.314, 8.124) ] and multi-lobar involvement [O^R = 3.200 (95% CI: 1.287, 7.955) ] were factors affecting the death in children with severe pneumonia (P < 0.05). The Pearson correlation analysis demonstrated that the serum levels of NE and VCAM-1 were both negatively correlated with PCIS of children with severe pneumonia (r = -0.373 and -0.544, both P < 0.05). The sensitivity, specificity, and the area under the ROC curve were 80.00% (95% CI: 0.593, 0.933), 97.59% (95% CI: 0.916, 0.998) and 0.919 (95% CI: 0.851, 0.963), respectively.Conclusions Serum levels of NE and VCAM-1 in children with severe pneumonia are abnormally elevated, both of which are closely related to the prognosis of these children. Thus, the serum levels of NE and VCAM-1 can be used as sensitive indicators to predict the death of children with severe pneumonia.

Key words:severe pneumonia;children;neutrophil elastase;vascular cell adhesion molecule-1;prognosis