肝素结合蛋白对儿童重症腺病毒肺炎的诊断价值

Value of heparin-binding protein in the diagnosis of severe adenovirus pneumonia in children

目的 探讨血清肝素结合蛋白(heparin-binding protein,HBP)对儿童重症腺病毒肺炎早期诊断的价值。方法 前瞻性纳入2019年2月至2021年8月南华大学附属长沙中心医院儿科收治的确诊为腺病毒肺炎的80例患儿为研究对象,按照重症肺炎标准分为重症腺病毒肺炎组(40例)和非重症腺病毒肺炎组(40例),比较2组入院24 h内的血清HBP、白细胞介素-6 (interleukin-6,IL-6)、肿瘤坏死因子-α(tumor necrosis factor alpha,TNF-α)、白细胞计数、血小板(platelet,PLT)、C反应蛋白等炎症指标水平的差异,并采用受试者工作特征(receiver operating characteristic,ROC)曲线分析其对重症腺病毒肺炎的早期诊断价值。结果 重症腺病毒肺炎组血清HBP水平[(46±16)ng/mL]高于非重症组[(28±13)ng/mL](P<0.05);重症腺病毒肺炎组TNF-α、IL-6、PLT水平也更高(P<0.05)。HBP对重症腺病毒肺炎的早期诊断ROC曲线下面积为0.804,取最佳截断值为31.76 ng/mL时,其灵敏度为80.0%,特异度为70.0%。HBP联合其他指标对重症腺病毒肺炎的早期诊断ROC曲线分析显示,HBP+TNF-α、HBP+PLT、HBP+IL-6、HBP+TNF-α+IL-6和HBP+TNF-α+IL-6+PLT的曲线下面积分别为0.866、0.850、0.863、0.886、0.894。结论 血清HBP可作为重症腺病毒肺炎早期诊断的一个生物标志物,联合TNF-α、IL-6和PLT可提高其诊断价值。

Objective To study the value of serum heparin-binding protein(HBP) in the early diagnosis of severe adenovirus pneumonia in children. Methods A total of 80 children who were admitted to the Department of Pediatrics,Changsha Central Hospital Affiliated to University of South China, from February 2019 to August 2021 and were diagnosed with adenovirus pneumonia were enrolled as subjects. According to the diagnostic criteria for severe pneumonia, they were divided into two groups: severe adenovirus pneumonia(40 children) and non-severe adenovirus pneumonia(40 children). The two groups were compared in terms of the serum levels of inflammatory markers within 24 hours after admission, such as HBP, interleukin-6(IL-6), tumor necrosis factor-α(TNF-α), white blood cell count,platelet count(PLT), and C-reactive protein. The receiver operating characteristic(ROC) curve was plotted to identify the value of these inflammatory markers in the early diagnosis of severe adenovirus pneumonia. Results Compared with the non-severe adenovirus pneumonia group, the severe adenovirus pneumonia group had a significantly higher serum level of HBP [(46±16) ng/mL vs(28±13) ng/mL, P<0.05], as well as significantly higher levels of TNF-α, IL-6,and PLT(P<0.05). HBP had an area under the ROC curve(AUC) of 0.804 in the early diagnosis of severe adenovirus pneumonia, with a sensitivity of 80.0% and a specificity of 70.0% at the optimal cut-off value of 31.76 ng/mL. The ROC curve analysis of HBP combined with other indicators for the early diagnosis of severe adenovirus pneumonia showed that HBP+TNF-α, HBP+PLT, HBP+IL-6, HBP+TNF-α+IL-6, and HBP+TNF-α+IL-6+PLT had an AUC of 0.866, 0.850,0.863, 0.886, and 0.894, respectively. Conclusions Serum HBP may be used as a biomarker for the early diagnosis of severe adenovirus pneumonia, and its combination with TNF-α, IL-6, and PLT can improve its diagnostic value.