肺炎支原体肺炎患儿血清淀粉样蛋白A和人软骨糖蛋白-39水平监测及其预测价值

Monitoring of serum amyloid A and human cartilage glycoprotein-39 levels of children with mycoplasma pneumoniae pneumonia and the prognostic value

目的探讨肺炎支原体肺炎(MPP)患儿血清淀粉样蛋白A(SAA)和人软骨糖蛋白-39(HC-gp39)水平及其对预后的预测价值。方法对徐州市中心医院2018年10月至2019年12月收治的86例MPP患儿(研究组)与同期于本院进行体检的79例健康儿童(对照组)的临床资料进行回顾性分析。比较研究组患儿入院时与对照组儿童体检时、研究组重症与轻症患儿血清SAA和HC-gp39水平。分析研究组患儿预后不良发生率,比较预后不良与预后良好患儿入院时、治疗后3 d和治疗后1周的血清SAA和HC-gp39水平及变化率。采用Logistic回归分析MPP患儿预后不良的影响因素;采用受试者工作特征(ROC)曲线下面积(AUC)分析血清SAA和HC-gp39水平对MPP患儿预后不良的预测价值。结果研究组患儿血清SAA和HC-gp39水平均高于对照组(t=49.374、P<0.001,t=49.374、P<0.001)。研究组重症患儿占比为45.35%(39/86),重症患儿血清SAA和HC-gp39水平均高于轻症患儿(t=13.411、P<0.001,t=10.426,P<0.001),差异均有统计学意义。研究组患儿预后不良发生率为6.98%(6/86);入院时、治疗后3 d和治疗后1周,预后不良患儿血清SAA和HC-gp39水平均逐渐升高,预后良好患儿则均逐渐降低;预后不良和预后良好患儿治疗后1周较入院时血清SAA变化率分别为(57.10±6.59)%和(-77.12±9.87)%,血清HC-gp39变化率分别为(58.63±7.79)%和(-29.09±4.18)%,差异均有统计学意义(SAA:t=4.873、P<0.001;HC-gp39:t=15.588、P<0.001)。MPP患儿预后不良者重症率、SAA变化率和HC-gp39变化率均显著高于预后良好者[100.00%vs.41.25%:χ^(2)=7.773、P=0.005,(52.49±6.59)%vs.(-77.12±9.87)%:t=4.873、P<0.001,(58.63±7.79)%vs.(-29.09±4.18)%:t=15.588、P<0.001],且重症(OR=6.386、P=0.003)、SAA变化率(OR=7.892、P<0.001)和HC-gp39变化率(OR=8.654、P=0.001)均为MPP患儿预后不良的危险因素;SAA变化率和HC-gp39变化率单独预测预后不良的最佳截断点分别为45.07%和41.19%,灵敏度分别为83.33%和66.67%,特异度分别为82.15%和87.65%,AUC分别为0.817、0.765;SAA变化率联合HC-gp39变化率预测预后不良的灵敏度、特异度和AUC分别为66.67%、97.50%和0.906,SAA变化率、HC-gp39变化率联合预测预后不良的特异度、AUC均高于单独指标预测(特异度:χ^(2)=11.123、P=0.001,χ^(2)=4.783、P=0.029;AUC:Z=3.012、P=0.031,Z=4.258、P=0.014)。结论MPP患儿血清SAA、HC-gp39水平高于健康儿童,重症、预后不良MPP患儿SAA变化率、HC-gp39变化率均更高,且二者是预后不良的危险因素,二者变化率联合应用可预测MPP的预后。

Objective To investigate the levels of serum amyloid A(SAA)and human cartilage glycoprotein-39(HC-gp39)of children with mycoplasma pneumoniae pneumonia(MPP),and to explore their prognostic value.Methods The clinical data of 86 children with MPP admitted to Xuzhou Central Hospital from October 2018 to December 2019(study group)and 79 healthy children who underwent physical examination during the same period(control group)were reviewed,retrospectively.The levels of SAA and HC-gp39 between cases in study group and control group,severe cases and mild cases in study group were compared,respectively.The incidence of poor prognosis of cases in study group was analyzed,serum SAA,HC-gp39 levels and change rates of poor prognosis cases and good prognosis cases were compared at admission,3 days after treatment and 1 week after treatment,respectively.The influencing factors of poor prognosis of children with MPP were analyzed by Logistic regression analysis.The predictive value of serum SAA and HC-gp39 on the prognosis of MPP were evalued by area under curve(AUC)of receiver operating characteristic(ROC).Results The levels of serum SAA and HC-gp39 of cases in study group were higher than those of control group(t=49.374,P<0.001;t=49.374,P<0.001).Among study group,45.35%(39/86)children were severe cases.The levels of serum SAA and HC-gp39 of severe cases were higher than those of mild cases,with significant differences(t=13.411,P<0.001;t=10.426,P<0.001).The incidence of poor prognosis in study group was 6.98%(6/86).The levels of serum SAA and HC-gp39 of poor prognosis cases increased gradually,which decreased gradually in cases with good prognosis.Compared with the indexes at admission,the change rates of serum SAA and HC-gp39 of poor prognosis cases and good prognosis cases 1 week after treatment were[(57.10±6.59)%vs.(-77.12±9.87)%]and[(58.63±7.79)%vs.(-29.09±4.18)%],with significant differences(SAA:t=4.873,P<0.001,HC-gp39:t=15.588,P<0.001).Severity rate,SAA and HC-gp39 change rates of cases with poor prognosis were significantly higher than those with good prognosis[100.00%vs.41.25%:χ^(2)=7.773,P=0.005;(52.49±6.59)%vs.(-77.12±9.87)%:t=4.873,P<0.001;(58.63±7.79)vs.(-29.09±4.18):t=15.588,P<0.001],and severity(OR=6.386,P=0.003),SAA change rate(OR=7.892,P<0.001)and HC-gp39 change rate(OR=8.654,P=0.001)were all risk factors for poor prognosis.The best cut-off points of SAA and HC-gp39 change rates in predicting poor prognosis alone were 45.07%and 41.19%,the sensitivity were 83.33%and 66.67%,and the specificity were 82.15%and 87.65%,and the AUC were 0.817 and 0.765,respectively.The sensitivity,specificity and AUC of SAA combined with HC-gp39 change rates in predicting poor prognosis were 66.67%,97.50%and 0.906,respectively,the specificity and AUC of SAA combined with HC-gp39 change rates for prediction were higher than individual index(specificity:χ^(2)=11.123,P=0.001;χ^(2)=4.783,P=0.029;AUC:Z=3.012,P=0.031;Z=4.258,P=0.014).Conclusions The serum levels of SAA and HC-gp39 of MPP children were higher than those of healthy children.The SAA change rate and HC-gp39 change rate were higher in children with severe MPP and poor prognosis,which were both risk factors for poor prognosis,and the combination of SAA and HC-gp39 change rates could predict the prognosis of MPP.