LTB4、SP-A及PA联合检测对新生儿肺炎的诊断价值及对危重度评价的意义

The value of combined detection of LTB4,SP-A and PA in the diagnosis of neonatal pneumonia and its significance in evaluation of severity

目的探讨白三烯B4(LTB4)、表面活性物质相关蛋白A(SP-A)及前清蛋白(PA)联合检测对新生儿肺炎的诊断价值及危重度评价的意义。方法选取该院2018年1月至2019年1月收治的98例新生儿肺炎患儿作为肺炎组,根据病情严重程度将肺炎组分为重度肺炎组(44例)和普通肺炎组(54例),根据儿科危重疾病评分(PCIS)将重度肺炎组分为极危重组(13例)、危重组(14例)、非危重组(17例)。另选取同期50例健康新生儿作为对照组。比较各组血清LTB4、SP-A、PA水平,Spearman相关分析重度肺炎组血清LTB4、SP-A、PA水平与PCIS的相关性,采用受试者工作特征曲线(ROC曲线)分析血清LTB4、SP-A、PA水平对新生儿肺炎的诊断价值。结果肺炎组血清LTB4、SP-A水平均明显高于对照组,PA水平明显低于对照组,差异均有统计学意义(P<0.05);重度肺炎组血清LTB4、SP-A水平均明显高于普通肺炎组,PA水平明显低于普通肺炎组,差异均有统计学意义(P<0.05);非危重组、危重组、极危重组血清LTB4、SP-A水平均逐渐提升,PA水平及PCIS逐渐降低,差异均有统计学意义(P<0.05);Spearman相关分析结果显示,重度肺炎组PCIS与血清LTB4、SP-A水平均呈负相关(r=-0.634、-0.695,P<0.05),与PA水平呈正相关(r=0.797,P<0.05);ROC曲线分析结果显示,LTB4+SP-A+PA[ROC曲线下面积(AUC)=0.898,95%CI:0.837~0.941]诊断新生儿肺炎的灵敏度和特异度高于LTB4(AUC=0.776,95%CI:0.700~0.841)、SP-A(AUC=0.767,95%CI:0.691~0.833)、PA(AUC=0.764,95%CI:0.688~0.830)单独诊断。结论新生儿肺炎血清LTB4、SP-A水平均明显升高,PA水平明显降低,与病情严重程度密切相关,3项联合检测可提升新生儿肺炎的诊断价值。

Objective To investigate the value of leukotriene B4(LTB4),surfactant protein A(SP-A)and prealbumin(PA)in the diagnosis of neonatal pneumonia and its significance in severity evaluation.Methods A total of 98 newborns with pneumonia admitted to the hospital from January 2018 to January 2019 were selected as the pneumonia group.According to the severity of the disease,the pneumonia group was divided into severe pneumonia group(44 cases)and common pneumonia group(54 cases).According to the Pediatric Critical Illness score(PCIS),the severe pneumonia group were divided into extremely critical group(13 cases),critical group(14 cases),non-critical group(17 cases),and 50 healthy newborns in the same period were selected as the control group.The levels of serum LTB4,SP-A and PA in each group were compared.Spearman correlation analysis was used to analyze the correlation between serum LTB4,SP-A and PA levels and PCIS in severe pneumonia group.Receiver operating characteristic curve(ROC curve)was used to analyze the diagnostic value of serum LTB4,SP-A and PA levels in neonatal pneumonia.Results The serum LTB4 and SP-A levels in the pneumonia group were significantly higher than those in the control group,and the PA level were significantly lower than that in the control group,and the differences were statistically significant(P<0.05).Serum LTB4 and SP-A levels in the severe pneumonia group were significantly higher than those in the common pneumonia group,and the PA level was significantly lower than that in the common pneumonia group,and the differences were statistically significant(P<0.05).Serum LTB4 and SP-A levels of neonates with severe pneumonia in non-critical,critical,and extremely critical pneumonia group gradually increased,and PA levels,PCIS scores gradually decreased,and the differences were statistically significant(P<0.05).Spearman correlation analysis showed that PCIS in severe pneumonia group was negatively correlated with serum LTB4 and SP-A levels(r=-0.634,-0.695,P<0.05),and positively correlated with PA levels(r=0.797,P<0.05).The ROC curve shows that AUC of LTB4+SP-A+PA was 0.898(95%CI:0.837-0.941),the sensitivity and the specificity in diagnosing neonatal pneumonia were higher than those of LTB4(AUC=0.776,95%CI:0.700-0.841),SP-A(AUC=0.767,95%CI:0.691-0.833),PA(AUC=0.764,95%CI:0.688-0.830)diagnosis.Conclusion Serum LTB4 and SP-A levels in neonatal pneumonia are significantly increased,and PA level is significantly reduced,which are closely related to the severity of the disease.Combined detection of 3 indexes can improve the diagnostic value for neonatal pneumonia.