高迁移率族蛋白B1联合急性生理学评分对重症肺炎患儿诊断价值及预后价值的研究

The Study of the Value of High Mobility Group Protein B1 Combined with Acute Physiological Score in the Diagnosis and Prognosis of Children with Severe Pneumonia

背景小儿重症肺炎是临床常见的呼吸系统危重症,准确评估其预后是合理临床决策的关键。高迁移率族蛋白B1(HMGB1)水平及急性生理学评分(APS)对成人危重症预后意义较高,但对重症肺炎患儿的诊断及预后价值尚不明确。目的探讨HMGB1水平联合APS在重症肺炎患儿诊断及预后中的价值。方法选取2020年5月至2021年2月在郑州大学附属儿童医院治疗的55例重症肺炎患儿(重症肺炎组),根据预后情况将患儿分为转归亚组(n=41)和预后不良亚组(n=14);选取同期在本院治疗的普通肺炎患儿60例(普通肺炎组)及健康体检儿童40例(对照组)。比较各组儿童入院时HMGB1水平及APS,分析HMGB1水平与APS相关性,采用多因素Logistic回归分析探讨影响重症肺炎预后的因素,采用受试者工作特征(ROC)曲线分析HMGB1水平、APS及两者联合对重症肺炎患儿诊断及预后的价值。结果重症肺炎组HMGB1水平、APS高于普通肺炎组(P<0.05);预后不良亚组HMGB1水平、APS高于转归亚组(P<0.05)。Pearson相关分析显示,重症肺炎组HMGB1水平与APS呈正相关(r=0.542,P<0.001)。多因素Logistic回归分析显示,HMGB1水平〔OR=8.411,95%CI(1.411,50.137),P<0.05〕、APS〔OR=5.724,95%CI(1.108,29.572),P<0.05〕是重症肺炎患儿预后不良的影响因素。HMGB1水平及APS联合诊断重症肺炎患儿的ROC曲线下面积为0.975〔95%CI(0.918,0.996)〕,最佳截断值为-0.203,灵敏度为98.18%,特异度为96.67%;HMGB1水平及APS联合诊断重症肺炎患儿预后的ROC曲线下面积为0.923〔95%CI(0.819,0.978)〕,最佳截断值为-0.030,灵敏度为97.56%,特异度为92.86%。结论HMGB1水平和APS均是重症肺炎患儿预后不良的影响因素,两者联合可进一步提高对重症肺炎患儿预后的诊断能力。

Background Severe pneumonia in children is a common respiratory critical illness,and accurate assessment of its prognosis is the key to reasonable clinical decision-making.High mobility group protein B1(HMGB1)and acute physiology score(APS)have high prognostic significance for adult critically ill patients,but the value of diagnosis and prognosis in children with severe pneumonia is still unclear.Objective To investigate the value of HMGB1 combined with APS in the diagnosis and prognosis of children with severe pneumonia.Methods The data of 55 children with severe pneumonia(severe pneumonia group)treated in Children's Hospital affiliated to Zhengzhou University from May 2020 to February 2021 were collected and the childrenwere divided into the improvement subgroup(n=41)and the poor outcome subgroup(n=14)according to the prognosis.Data of 60 children with common pneumonia(common pneumonia group)and 40 children with healthy physical examination(control group)who were treated in this hospital during the same period.The APS score and HMGB1 level at admission of each groupwere compared.The correlation between APS and HMGB1 was analyzed.The risk factors affecting the prognosis of severe pneumonia were analyzed by multivariate Logistic regression.The value of HMGB1,APS and combined variables in the diagnosis and prognosis of children with severe pneumonia was analyzed by ROC curve.Results The HMGB1 level and APS score of the severe pneumonia group were significantly higher than those of the normal pneumonia group(P<0.05);the HMGB1 level and APS score of the poor prognosis subgroup were significantly higher than those of the prognosis subgroup(P<0.05).The results of correlation analysis showed that there was a positive correlation between HMGB1 and APS in severe pneumonia group(r=0.542,P<0.001).Multivariate Logistic regression analysis showed that HMGB1 level〔OR=8.411,95%CI(1.411,50.137),P<0.05〕,APS score〔OR=5.724,95%CI(1.108,29.572),P<0.05〕were the influence factors for poor prognosis in children with severe pneumonia.The area under ROC curve for the combined diagnosis of HMGB1 and APS for the diagnostic value was 0.975〔95%CI(0.918,0.996)〕,and the optimal cut-off value was-0.203,and the sensitivity was 98.18%,and the specificity was 96.67%.The area under ROC curve for the combined diagnosis of HMGB1 and APS for the prognosis of pneumonia was 0.923〔95%CI(0.819,0.978)〕,and the optimal cut-off value was-0.030,and the sensitivity was 97.56%,and the specificity was 92.86%.Conclusion Both HMGB1 level and APS score at admission are influence factors for the poor prognosis of severe pneumonia,and the combination of the two can further improve the diagnostic performance and prognosis of pneumonia.