新生儿肺部感染外周血炎症因子水平及胸部CT值变化

Changes of peripheral blood inflammatory factors and chest CT values in neonates with lung infection

目的探讨新生儿肺部感染不同时期外周血炎症因子水平和胸部CT值变化分析。方法选取2016年1月-2020年6月江西省景德镇市第二人民医院收治肺部感染新生儿86例,根据肺部感染严重程度分为轻症组(n=59)和重症组(n=27),另选同期年龄匹配未出现感染性疾病新生儿38名作为对照组,分析肺部感染患儿外周血中炎性因子水平、胸部CT值变化及其临床意义。结果轻症组和重症组的氧分压(PaO_(2))、氧合指数(PaO_(2)/FiO_(2))、干扰素-γ(IFN-γ)水平低于对照组(P<0.05),而动脉二氧化碳分压(PaCO_(2))、降钙素原(PCT)、C-反应蛋白(CRP)、白细胞计数(WBC)、白细胞介素-4(IL-4)、白细胞介素-6(IL-6)水平高于对照组(P<0.05);重症组的PaO_(2)、PaO_(2)/FiO_(2)、IFN-γ水平、胸部CT值低于轻症组(P<0.05),而PaCO_(2)和PCT、CRP、WBC、IL-4、IL-6水平高于轻症组(P<0.05)。PCT、IL-4、IL-6与CT值呈正相关(P<0.05),IFN-γ与CT值呈负相关(P<0.05)。受试者工作特征曲线(ROC)分析显示PCT、IL-4、IL-6、IFN-γ联合检测时ROC曲线下面积(AUC)为0.906(95%CI:0.833~0.980),联合检测AUC高于单独检测(P<0.05)。结论重症肺部感染新生儿外周血PCT、IL-4、IL-6水平和胸部CT值呈增长趋势,而IFN-γ水平呈降低趋势,PCT、IL-4、IL-6、IFN-γ联合检测可以提高新生儿重症肺部感染预测效能。

OBJECTIVE To explore the changes in levels of peripheral blood inflammatory factors and chest CT values in neonates with lung infection during different periods.METHODS A total of 86 neonates with lung infection admitted to Jingdezhen Second People′s Hospital were enrolled between Jan 2016 and Jun 2020.According to the severity of lung infection,they were divided into mild group(n=59)and severe group(n=27).And other 38 age-matched neonates without infectious diseases during the same period were enrolled as control group.The clinical significance of peripheral blood inflammatory factors changing and chest CT values were analyzed.RESULTS The arterial partial pressure of oxygen(PaO_(2)),oxygenation index(PaO_(2)/FiO_(2))and level of interferon-γ(IFN-γ)in mild and severe groups were significanly lower than those in control group(P<0.05),while arterial partial pressure of carbon dioxide(PaCO_(2)),levels of procalcitonin(PCT),C-reactive protein(CRP),white blood cell count(WBC),interleukin-4(IL-4)and interleukin-6(IL-6)were significanly higher than those in control group(P<0.05).PaO_(2),PaO_(2)/FiO_(2),IFN-γlevel and chest CT values in severe group were significanly lower than those in mild group(P<0.05),while PaCO_(2),levels of PCT,CRP,WBC,IL-4 and IL-6 were significanly higher than those in mild group(P<0.05).PCT,IL-4 and IL-6 were positively correlated with CT values(P<0.05),while IFN-γlevel was negatively correlated with them(P<0.05).Receiver operating characteristic curve(ROC)analysis showed that the area under the ROC curve(AUC)for combined detection of PCT,IL-4,IL-6,and IFN-γwas 0.906(95%CI:0.833-0.980).AUC of combined detection was significantly greater than that of single index(P<0.05).CONCLUSION The levels of peripheral blood PCT,IL-4,IL-6 and chest CT values were significantly increase,while IFN-γlevel was significantly decreased in neonates with severe lung infection.The combined detection of PCT,IL-4,IL-6 and IFN-γcan improve the predictive efficiency for severe lung infection.