颗粒蛋白前体在小儿ARDS和重症肺炎中的价值研究

Detection value of PGRN in differentiating ARDS from severe pneumonia in children

目的探讨颗粒蛋白前体(PGRN)对小儿感染性因素所致急性呼吸窘迫综合征(ARDS)和重症肺炎的鉴别诊断价值。方法选取2017年9月至2018年12月在安徽医科大学第二附属医院儿童重症监护病房(PICU)诊断为ARDS患儿30例(ARDS组)、重症肺炎患儿30例(重症肺炎组)及心源性疾病并有呼吸困难表现的患儿20例(对照组)为研究对象,采用ELISA法检测患儿入院确诊为ARDS或重症肺炎时空腹血浆PGRN水平,测定氧合指数[动脉血氧分压/吸氧浓度(PaO2/FiO2)],进行小儿危重病例评分(PCIS),并对结果进行统计分析。结果三组患儿性别及年龄差异均无统计学意义(均P>0.05)。对照组、重症肺炎组、ARDS组患儿的PaO2/FiO2、PCIS均呈递减趋势(F值分别为706.094、123.331,均P<0.05)。对照组、重症肺炎组、ARDS组血浆PGRN水平呈递增趋势(F=407.585,P<0.05)。线性相关结果显示,血浆PGRN水平与氧合指数、PCIS均呈负相关(r分别为-0.806、-0.894,均P<0.05)。血浆PGRN水平对重症肺炎发展为ARDS有一定的预测价值(Z=17.924,P<0.05),ROC曲线下面积为0.901,发生ARDS的最佳截断值为138.862ng/mL,敏感度为90.4%,特异度为78.1%。结论血浆PGRN水平的检测有助于ARDS与重症肺炎早期鉴别诊断和病情严重程度的评估。

Objective To investigate the value of plasma progranulin(PGRN) for differential diagnosis of acute respiratory distress syndrome(ARDS) and severe pneumonia induced by infection in children.Methods A total of 30 ARDS children, 30 severe phenomena children, and 20 normal control children with cardiogenic disease and dyspnea in The Second Hospital of Anhui Medical University from September 2017 to December 2018 were collected as study objects. PGRN levels in children with ARDS or severe phenomena, partial pressure of oxygen in artery(PaO2)/fractional concentration of inspired oxygen(FiO2) were detected with ELISA, and pediatric critical illness score(PCIS) was evaluated. Results No significant difference existed in sex and age among all groups(all P>0.05). The plasma PGRN levels showed an incremental trend in normal control group, severe phenomena group and ARDS group(F=407.585, P<0.05), while PaO2/FiO2 and PCIS showed a downward trend(F value was 706.094 and 123.331, respectively, both P<0.05). Linear correlation showed that the plasma PGRN levels were negatively correlated with PaO2/FiO2 and PCIS(r value was-0.806 and-0.894, respectively, both P<0.05). The levels of plasma PGRN had predictive values for ARDS(Z=17.924, P<0.05). The area under the ROC curve was 0.901. The optimal cut-off value of diagnosing ARDS was 138.862 ng/ml, sensitivity was 0.904, and specificity was 0.781, respectively. Conclusion Detecting plasma PGRN levels is helpful for early differential diagnosis of ARDS and severe pneumonia in children as well as the evaluation of severity.