新生儿肺炎炎症指标、心肌标志物、血气分析动态变化及临床意义

Dynamic Changes and Clinical Significance of Inflammatory Markers,Myocardial Markers and Blood Gas Analysis in Neonatal Pneumonia

目的:观察新生儿肺炎(neonatal pneumonia)患儿的炎症指标、心肌标志物及动脉血血气分析,了解其动态变化,为临床诊疗提供参考。方法:选择2019年1月-2020年10月在本院新生儿科住院并确诊为新生儿肺炎患儿106例作为病例组,其中轻症肺炎组60例,重症肺炎组46例;另外选择同期非感染新生儿50例为对照组,检测炎症指标、心肌标志物及血气分析等检测结果。结果:(1)三组患儿白细胞(WBC)计数比较,差异无统计学意义(P>0.05);轻症、重症肺炎组患儿白细胞介素-6(IL-6)、血清淀粉样蛋白A(SAA)水平均高于对照组,差异有统计学意义(P<0.05)。(2)重症肺炎组天门冬氨酸氨基转移酶(AST)、乳酸脱氢酶(LDH)、肌酸激酶同工酶MB(CK-MB)、心肌肌钙蛋白T(cTnT)等心肌标志物水平与对照组比较,差异均有统计学意义(P<0.05);轻症肺炎组CK-MB、cTnT水平高于对照组(P<0.05)。(3)轻症、重症肺炎组与对照组比较,以及轻症肺炎组与重症肺炎组比较,pH值、二氧化碳分压(PCO_(2))、氧分压(PO_(2))、剩余碱(BE)和标准碳酸氢盐(SB)差异均有统计学意义(P<0.05)。结论:新生儿肺炎患儿血清IL-6、SAA等炎症因子及心肌标志物和血气结果均发生明显改变,有助于尽早判断新生儿肺炎的病情。

Objective:To observe the inflammatory markers,myocardial markers and arterial blood gas analysis in children with neonatal pneumonia,understand their dynamics,and provide reference for clinical diagnosis and treatment.Method:A total of 106 children diagnosed with neonatal pneumonia in the department of Neonatology of our hospital from January 2019 to October 2020 were selected as the case group,including 60 cases of mild pneumonia and 46 cases of severe pneumonia;in addition,50 non-infected newborns in the same period were selected as the control group,and the results of inflammatory parameters,myocardial markers and blood gas analysis were measured.Result:(1) There was no significant difference in white blood cell (WBC) count among the three groups (P>0.05),and the levels of interleukin-6 (IL-6) and serum amyloid A (SAA) in the mild pneumonia group and the severe pneumonia group were higher than those in the control group,and the differences were statistically significant (P<0.05).(2) The levels of aspartate aminotransferase (AST),lactate dehydrogenase (LDH),creatine kinase isoenzyme MB (CK-MB),cardiac troponin T (cTnT) and other myocardial markers in the severe pneumonia group were significantly different from those in the control group (P<0.05);the levels of CK-MB and cTnT in the mild pneumonia group were higher than those in the control group (P<0.05).(3) There were significant differences in pH,partial pressure of carbon dioxide (PCO_(2)),partial pressure of oxygen (PO_(2)),base excess (BE) and standard bicarbonate (SB) between the mild pneumonia group and the severe pneumonia group and the control group,the mild pneumonia group and the severe pneumonia group (P<0.05).Conclusion:Serum IL-6,SAA and other inflammatory factors,myocardial markers and blood gas results are significantly changed in children with neonatal pneumonia,which is helpful to determine the condition of neonatal pneumonia as early as possible.