血清1,25（OH）2D3、EOS%联合APACHEⅡ评分评估小儿肺炎病情严重程度的价值

Clinical value of serum 1,25-dihydroxyvitamin D3, eosinophil percentage, and APACHE Ⅱ score in assessing the severity of pediatric pneumonia

摘要:

目的 探讨血清1，25二羟维生素D₃［1，25（OH）₂D₃］和嗜酸性粒细胞百分比（EOS%）联合急性生理与慢性健康评价评分表（APACHEⅡ）评估在小儿肺炎病情严重程度的价值。方法 选取2019年10月—2023年12月秦皇岛市妇幼保健院收治的123例小儿肺炎患者作为观察组，根据病情严重程度再分为轻症组（79例）和重症组（44例）。同时选取60例该院同期体检健康儿童作为对照组。比较不同组别的血清1，25（OH）₂D₃、EOS%表达水平和APACHEⅡ评分，比较血清1，25（OH）₂D₃、EOS%、APACHEⅡ评分与肺功能指标［潮气量（VT）、呼吸频率（RR）、吸呼比（TI/TE）、呼气峰时长占总呼气时间百分比（TPTEF/TE）］的相关性。通过受试者工作特征（ROC）曲线评估1，25（OH）₂D₃、EOS%和APACHEⅡ评分的联合使用在评估疾病严重程度的有效性。结果 观察组1，25（OH）₂D₃水平低于对照组（P <0.05），血清EOS%高于对照组（P <0.05）。重症组1，25（OH）₂D₃水平低于轻症组（P <0.05），EOS%和APACHEⅡ评分均高于轻症组（P <0.05）。重症组患儿VT、TI/TE及TPTEF/TE低于轻症组（P <0.05），RR高于轻症组（P <0.05）。Pearson相关性分析结果显示，1，25（OH）₂D₃水平与VT、TI/TE、TPTEF/TE均呈正相关（r =0.395、0.478、0.344，均P <0.05），与RR呈负相关（r =-0.236，P <0.05）。EOS%与VT、TI/TE、TPTEF/TE均呈负相关（r =-0.319、-0.290、-0.308，均P <0.05），与RR呈正相关（r =0.301，P <0.05）。APACHEⅡ评分与VT、TI/TE、TPTEF/TE呈负相关（r =-0.285、-0.503、-0.302，均P <0.05），与RR呈正相关（r =0.324，P <0.05）。ROC曲线分析结果显示，1，25（OH）₂D₃、EOS%和APACHE Ⅱ评分联合预测的曲线下面积最大，为0.993（95% CI：0.983，1.000）；敏感性最高，为90.9%（95% CI：0.783，0.975）；特异性最高，为100.0%（95% CI：0.954，1.000）。结论 血清1，25（OH）₂D₃水平和EOS%联合APACHEⅡ评分与小儿肺炎的严重程度密切相关，3项指标联合检测可有效评估病情严重程度。

Abstract:

Objective To analyze the clinical value of serum 1,25-dihydroxyvitamin D₃ [1,25(OH)₂D₃] and eosinophil percentage (EOS%) combined with the Acute Physiology and Chronic Health Evaluation (APACHE) Ⅱ score in assessing the severity of pediatric pneumonia.Methods A total of 123 pediatric pneumonia patients admitted to Qinhuangdao Maternal and Child Health Hospital from October 2019 to December 2023 were enrolled and divided into the mild (n = 79) and severe (n = 44) groups based on disease severity. Additionally, 60 healthy children undergoing routine health examinations in the hospital during the same period served as controls. Serum levels of 1,25(OH)₂D₃, EOS%, and APACHE Ⅱ scores were compared among the groups, and their correlations with pulmonary function parameters [tidal volume (VT), respiratory rate (RR), inspiratory-to-expiratory ratio (TI/TE), and time to peak expiratory flow as a percentage of total expiratory time (TPTEF/TE) ] were analyzed. The predictive efficacy of combining 1,25(OH)₂D₃, EOS%, and APACHE Ⅱ scores for disease severity was evaluated using the receiver operating characteristic (ROC) curve analysis.Results Compared with the controls, the pneumonia patients exhibited significantly lower serum 1,25(OH)₂D₃ levels and higher EOS% (P < 0.05). The severe group showed lower 1,25(OH)₂D₃ levels but higher EOS% and APACHE Ⅱ scores than the mild group (P < 0.05). The children in the severe group had reduced VT, TI/TE, and TPTEF/TE, along with elevated RR, compared with the mild group (P < 0.05). Pearson correlation analysis indicated positive correlations between 1,25(OH)₂D₃ levels and VT, TI/TE, and TPTEF/TE (r = 0.395, 0.478 and 0.344, all P < 0.05), but a negative correlation with RR (r = -0.236, P < 0.05). EOS% was negatively correlated with VT, TI/TE, and TPTEF/TE (r = -0.319, -0.290 and -0.308, all P < 0.05), and positively correlated with RR (r = 0.301, P < 0.05). APACHE II scores were negatively correlated with VT, TI/TE, and TPTEF/TE (r = -0.285, -0.503 and -0.302, all P < 0.05), and positively correlated with RR (r = 0.324, P < 0.05). ROC curve analysis showed that the combined prediction using 1,25(OH)?D?, EOS%, and APACHE II scores yielded the largest area under the curve 0.993 (95% CI: 0.983, 1.000), with the highest sensitivity 90.9% (95% CI: 0.783, 0.975) and specificity 100.0% (95% CI: 0.954, 1.000).Conclusion Serum 1,25(OH)₂D₃, EOS% and the APACHE Ⅱ score are closely associated with the severity of pediatric pneumonia, and their combination could serve as effective biomarkers for clinical assessment.