血清心肌酶、CRP、HMGB1、MMP-9水平在新生儿肺炎感染类型鉴别及病情评估中的应用价值

Application value of changes of serum myocardial enzymes,CRP,HMGB1,MMP-9 levels in the identification and assessment of neonatal pneumonia infection types

目的探讨血清心肌酶[肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)]、C反应蛋白(CRP)、高迁移率族蛋白B1(HMGB1)、基质金属蛋白酶9(MMP-9)水平变化在新生儿肺炎感染类型鉴别及病情评估中的应用价值。方法前瞻性选取西安高新医院新生儿科2016年8月至2019年8月收治的106例新生儿肺炎患儿,其中病毒感染38例作为病毒感染组,细菌感染68例作为细菌感染组。检测并比较两组患儿的血清CK、CK-MB、CRP、HMGB1、MMP-9水平,采用受试者工作特征(ROC)曲线评价血清CK、CK-MB、CRP、HMGB1、MMP-9对新生儿肺炎感染类型的鉴别诊断价值。比较细菌感染、病毒感染不同病情程度患儿血清CK、CK-MB、CRP、HMGB1、MMP-9水平,Spearman秩相关性分析各血清指标与细菌感染、病毒感染病情程度的关系。结果病毒感染组患儿的血清CK、CK-MB水平明显高于细菌感染组,CRP、HMGB1、MMP-9明显低于细菌感染组,差异均有显著统计学意义(P<0.01);ROC曲线分析显示,血清CRP AUC(0.808)最大,且其诊断特异度89.71%最高,MMP-9诊断敏感度92.11%最高,两者联合诊断AUC为0.889,敏感度为71.05%,特异度为95.59%;病毒感染重度患儿血清CK、CK-MB、CRP、HMGB1、MMP-9明显高于轻度患儿,差异均有显著统计学意义(P<0.01);细菌感染重度患儿血清CK、CK-MB、CRP、HMGB1、MMP-9明显高于轻度患儿,差异均有显著统计学意义(P<0.01);Spearman秩相关性分析结果显示,血清CK、CK-MB、CRP、HMGB1、MMP-9与病毒感染、细菌感染的新生儿肺炎病情程度均呈正相关(P<0.05)。结论血清CK、CK-MB、CRP、HMGB1、MMP-9可有效鉴别新生儿感染类型,其中CRP联合MMP-9诊断价值最佳,且均可作为评估病情的重要指标。

Objective To investigate serum myocardial enzymes(creatine kinase [CK], creatine kinase isoenzyme [CK-MB]), C-reactive protein(CRP), high mobility group protein B1(HMGB1), and matrix metalloproteinase 9(MMP-9) level changes in the identification of neonatal pneumonia infection types and its application in disease assessment. Methods From August 2016 to August 2019, a total of 106 cases of neonatal pneumonia admitted to the Department of Neonatology, Xi’an Gao Xin Hospital were prospectively selected. Among them, 38 cases of virus infection were regarded as the virus infection group, and 68 cases of bacterial infection were regarded as the bacterial infection group.Serum levels of CK, CK-MB, CRP, HMGB1, and MMP-9 were measured and compared between the two groups, and the receiver operating characteristic(ROC) curve was used to evaluate the differential diagnosis value of serum CK,CK-MB, CRP, HMGB1, and MMP-9 for neonatal pneumonia infection types. The serum levels of CK, CK-MB, CRP,HMGB1, MMP-9 in children with different degrees of bacterial infection and viral infection were compared, and the relationship between each serum index and the severity of bacterial infection and viral infection was analyzed by Spearman rank correlation. Results Serum CK and CK-MB levels of children in the viral infection group were significantly higher than those in the bacterial infection group, while CRP, HMGB1 and MMP-9 were significantly lower than those in the bacterial infection group, and the differences were statistically significant(all P<0.01). ROC curve analysis showed that the AUC of serum CRP(0.808) was the largest, and its diagnostic specificity was the highest for 89.71%,and MMP-9 had the highest diagnostic sensitivity of 92.11%. The AUC of the two combined diagnosis was 0.889, the sensitivity was 71.05%, and the specificity was 95.59%. Serum levels of CK, CK-MB, CRP, HMGB1, and MMP-9 in children with severe viral infection were significantly higher than those in children with mild infection, and the differences were statistically significant(all P<0.01). Serum CK, CK-MB, CRP, HMGB1, MMP-9 in children with severe bacterial infection were significantly higher than those in children with mild infection, and the differences were statistically significant(all P<0.01). The results of Spearman rank correlation analysis showed that serum CK, CK-MB, CRP, HMGB1,and MMP-9 were positively correlated with the severity of neonatal pneumonia caused by viral and bacterial infections(all P<0.05). Conclusion Serum CK, CK-MB, CRP, HMGB1, MMP-9 can effectively identify the types of neonatal infections. Among them, CRP combined with MMP-9 has the best diagnostic value, which can be used as an important factor in evaluating the condition.