涎液化糖链抗原6联合巨噬细胞移动抑制因子对新生儿呼吸窘迫综合征预后的预测价值分析

Prognostic value of Krebs von den Lungen-6 combined with macrophage migration inhibitory factor in neonatal respiratory distress syndrome

摘要:

目的 分析涎液化糖链抗原6（KL-6）联合巨噬细胞移动抑制因子（MIF）对新生儿呼吸窘迫综合征（NRDS）预后的预测价值。方法 回顾性分析2021年3月—2023年8月西北妇女儿童医院收治的87例NRDS患儿的临床资料。于入院后2 h且分娩后6 h内采用酶联免疫吸附试验检测KL-6、MIF水平，检测动脉血氧分压（PaO₂）、动脉血二氧化碳分压（PaCO₂）、氧合指数（OI）。给予患儿呼吸支持肺泡表面活性物质替代、体外膜肺氧合、营养支持、抗感染及液体管理等对症及综合治疗。随访3个月，根据患儿预后情况将其分为预后良好组和预后不良组；比较两组患儿的基础资料和血清学指标；采用多因素一般Logistic回归模型分析NRDS患儿预后的影响因素，绘制受试者工作特征（ROC）曲线。结果 87例NRDS患儿，有22例（25.29%）患儿出现预后不良，其中有11例放弃治疗，6例患儿转院，5例患儿死亡。预后不良组新生儿急性生理学评分围生期补充Ⅱ（SNAPPE-Ⅱ）评分和肺部超声评分（LUSS）评分均高于预后良好组（P <0.05）。预后不良组KL-6水平和MIF水平均高于预后良好组（P <0.05）。多因素一般Logistic回归分析结果：KL-6水平高［O^R =3.508（95% CI：1.199，10.263）］、MIF水平高［O^R =4.993（95% CI：1.707，14.608）］、SNAPPE-Ⅱ评分高［O^R =5.743（95% CI：1.963，16.803）］和LUSS评分高［O^R =4.933（95% CI：1.686，14.433）］均为NRDS患儿预后不良的危险因素（P <0.05）。ROC曲线分析结果：KL-6、MIF、SNAPPE-Ⅱ评分、LUSS评分联合预测NRDS患儿预后不良的曲线下面积为0.906（95% CI：0.812，1.000），敏感性为90.91%（95% CI：0.797，1.000），特异性为93.85%（95% CI：0.827，1.000），联合预测效能较好。结论 KL-6水平高、MIF水平高、SNAPPE-Ⅱ评分高和LUSS评分高均为NRDS患儿预后不良的危险因素，且KL-6、MIF、SNAPPE-Ⅱ评分、LUSS评分联合预测NRDS患儿预后不良的风险较高，早期识别和纠正可逆因素有助于改善NRDS患儿预后。

Abstract:

Objective To analyze the predictive value of Krebs von den Lungen-6 (KL-6) combined with macrophage migration inhibitory factor (MIF) for the prognosis of neonatal respiratory distress syndrome (NRDS).Methods A total of 87 children with NRDS admitted to Northwest Women's and Children's Hospital from March 2021 to August 2023 were selected. The levels of KL-6 and MIF were detected by enzyme-linked immunosorbent assay (ELISA) within 2 hours after admission and 6 hours after delivery, as well as arterial partial pressure of oxygen (PaO₂), arterial partial pressure of carbon dioxide (PaCO₂), and oxygenation index (OI). Provide symptomatic and comprehensive treatment for the child patient, including respiratory support, alveolar surfactant replacement, extracorporeal membrane oxygenation, nutritional support, anti-infection and fluid management. The children were followed up for 3 months and divided into the good prognosis group and the poor prognosis group according to their prognosis. Compare the basic data and serological indicators of the two groups of children patients; Multivariate general Logistic regression model was used to analyze the influencing factors of prognosis in children with NRDS, and the receiver operating characteristic (ROC) curve was plotted.Result Among the 87 children with NRDS, 22 cases (25.29%) had a poor prognosis. Among them, 11 cases gave up treatment, 6 cases were transferred to other hospitals, and 5 cases died. The Acute Physiology score, perinatal Supplementary Ⅱ (SNAPPE-Ⅱ) score and lung ultrasound score (LUSS) score in the poor prognosis group were all higher than those in the good prognosis group (P < 0.05). The levels of KL-6 and MIF in the poor prognosis group were both higher than those in the good prognosis group (P < 0.05).Results of multivariate general Logistic regression analysis showed that high level of KL-6 [O^R = 3.508 (95% CI: 1.199, 10.263) ], high level of MIF [O^R = 4.993 (95% CI: 1.707, 14.608) ], high SNAPPE-Ⅱ score [O^R = 5.743 (95% CI: 1.963, 16.803) ], and high LUSS score [O^R = 4.933 (95% CI: 1.686, 14.433) ] were all risk factors for poor prognosis in children with NRDS (P < 0.05). ROC curve analysis results: The area under the curve for the combined prediction of poor prognosis in children with NRDS by KL-6, MIF, SNAPPE-Ⅱ score, and LUSS score was 0.906 (95% CI: 0.812, 1.000), and the sensitivity was 90.91% (95% CI: (0.797, 1.000), specificity was 93.85% (95% CI: 0.827, 1.000), and the combined predictive efficacy was good.Conclusion High KL-6 level, high MIF level, high SNAPPE-Ⅱ score and high LUSS score are all risk factors for poor prognosis in children with NRDS. Moreover, the combined prediction of KL-6, MIF, SNAPPE-Ⅱ score, and LUSS score has a high predictive value for poor prognosis in children with NRDS. Early identification and correction of reversible factors can help improve the prognosis.