心型脂肪酸结合蛋白预测儿童肺炎合并急性呼吸窘迫综合征预后

Heart-type fatty acid-binding protein predicts the prognosis of pediatric severe pneumonia complicated by acute respiratory distress syndrome

目的探讨心型脂肪酸结合蛋白（heart-type fatty acid binding protein, H-FABP）在重症肺炎合并急性呼吸窘迫综合征（acute respiratory distress syndrome，ARDS）患儿预后评估中的价值。方法回顾性分析2016年11月至2017年10月上海交通大学附属儿童医院PICU收治的59例重症肺炎合并ARDS患儿的临床资料，根据氧合指数（PaO2/FiO2）分为轻-中度ARDS组（100 mmHg〈PaO2/FiO2≤300 mmHg，1 mmHg＝0.133 kPa）和重度ARDS组（PaO2/FiO2≤100 mmHg）；按28 d生存情况分为生存组（n＝47）和死亡组（n＝12）。选取同期急诊病房收治的42例普通肺炎患儿作为对照。入PICU 6 h内，检测患儿H-FABP、N末端脑利钠肽、肌酸激酶同工酶（CK-MB）、肌钙蛋白I、血乳酸等指标，通过受试者工作特征曲线（ROC）评估H-FABP对重症肺炎合并ARDS患儿预后的预测价值。结果59例重症肺炎中，轻-中度ARDS 47例，重度ARDS 12例，总病死率20.3%（12/59）。入PICU 6 h内，重度ARDS组H-FABP、N末端脑利钠肽、CK-MB、血乳酸水平[分别为8.8（4.6，13.4） ng/ml、904（209，11 336）pg/ml、29.5（19.2，82.5） U/L和4.6（1.5，6.1）mmol/L]显著高于轻-中度ARDS组和普通肺炎组（P〈0.001）；死亡组患儿血清H-FABP[7.8（4.1，39.7） ng/ml]显著高于生存组[4.7（3.0，6.0） ng/ml]（P＝0.031）。ROC曲线分析显示，H-FABP评估重症肺炎患儿28 d死亡的ROC曲线下面积为0.783（95%CI 0.532-0.894，P〈0.05），最佳临界点（cut-off值）为6.8 ng/ml，对应敏感度为74.3%，特异度为87.0%。结论H-FABP是重症肺炎合并ARDS发生心肌损害的敏感指标，有预测预后的价值。

Objective To investigate the prognostic value of heart-type fatty acid-binding protein （H-FABP） in pediatric patients with severe pneumonia complicated by acute respiratory distress syndrome （ARDS）. Methods We performed a retrospective study to summarize the medical records of 59 pediatric patients with severe pneumonia complicated by ARDS admitted to the PICU at Shanghai Children＇s Hospital between November 2016 and October 2017. According to the ratio of PaO2 to FiO2 ,the 59 cases were divided into mild-moderate ARDS group （ n = 47 ） （ 100 mmHg 〈 PaO2/FiO2 ≤ 300 mmHg, 1 mmHg = 0. 133 kPa） and severe ARDS group （n = 12）（ PaO2/FiO2≤ 100 mmHg）. The cases were devided into survival group and death group according to survival situation on day 28. Forty-two cases with pneumonia were enrolled as con- trol. The data of patient demographics, clinical characteristics, cardiac function indexes, blood biochemical indicators within 6 hours after admission including H-FABP, N-terminal B-type natriuretic peptide, CK-MB, cardiactroponin-I and lactic acid, complications and survival status were collected and analyzed. The receiver operating characteristic（ROC） curve was used to evaluate the power of variables for 28-day mortality in patients with severe pneumonia complicated by ARDS. Results A total of 59 patients with severe pneumonia were enrolled in our study. The 28-day mortality rate was 20. 3% （12/59）. The serum levels of H-FABP, N-terminal B-type natriuretic peptide, CK-MB and lactic acid were significantly higher in severe ARDS group [ 8.8 （4.6,13.4） ng/ml, 904 （209,11 336 ） pg/ml, 29. 5 （ 19. 2,82. 5 ） U/L and 4. 6 （ 1.5,6. 1 ） mmol/L, re- spectively] than those in mild-moderate ARDS group, as well as control group （ all P 〈 0. 001 ）. The serum level of H-FABP was significantly higher in the non-survivor [ 7.8 （4. 1,39.7 ） ng/ml ] than that in survivor E 4. 7 （3.0,6. 0） ng/ml ] with ARDS （ P = 0. 031 ）. The ROC curve analysis indicated that the area under the ROC curve for H-FABP was 0. 783 （ 95% CI 0.532-0. 894, P 〈 0. 05 ）, and the optimal cut-off value for H-FABP was 6. 8 ng/ml with a sensitivity of 74. 3% and a specificity of 87.0% for predicting the prognosis in patients with ARDS. Conclusion H-FABP is a sensitive indicator for prognosis in pediatric patients with severe pneumonia complicated by ARDS.