SP-A、CRP/ALB与新生儿肺炎合并NRDS病情严重程度的关系及预测价值

Relationship between SP-A,CRP/ALB and severity of neonatal pneumonia complicated with NRDS and their predictive value

目的探讨肺表面活性物质蛋白A(SP-A)、C反应蛋白与清蛋白比值(CRP/ALB)与新生儿肺炎合并新生儿呼吸窘迫综合征(NRDS)病情严重程度的关系及预测价值。方法选取2018年2月至2021年3月昆明市延安医院收治的82例新生儿肺炎合并NRDS患儿为研究对象,根据病情严重程度分为重度组(22例,机械通气时间>7 d)、非重度组(60例,机械通气时间≤7 d)。比较两组基线资料及CRP/ALB、SP-A水平。分析新生儿肺炎合并NRDS病情严重程度的影响因素。分析SP-A、CRP/ALB对新生儿肺炎合并NRDS病情严重程度的预测价值。比较不同CRP/ALB、SP-A水平患儿病情严重程度分布情况。结果重度组出生体质量、出生孕周、产前应用地塞米松患儿比例低于非重度组,差异有统计学意义(P<0.05)。重度组SP-A水平较非重度组低,CRP/ALB较非重度组高,差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,出生孕周长、出生体质量大、产前应用地塞米松、SP-A水平升高是新生儿肺炎合并NRDS病情严重程度的保护因素(P<0.05),CRP/ALB升高是新生儿肺炎合并NRDS病情严重程度的危险因素(P<0.05)。受试者工作特征曲线分析结果显示,SP-A、CRP/ALB联合检测预测新生儿肺炎合并NRDS病情严重程度的曲线下面积为0.964,高于2项单独检测。SP-A高水平组重度患儿所占比例低于低水平组,CRP/ALB高水平组重度患儿所占比例高于低水平组,差异有统计学意义(P<0.05)。结论重度新生儿肺炎合并NRDS患儿SP-A水平明显降低,CRP/ALB明显升高,SP-A、CRP/ALB联合检测在预测患儿病情严重程度方面具有较高的价值。

Objective To investigate the relationship between pulmonary surfactant protein A(SP-A),C-reactive protein to albumin ratio(CRP/ALB)and the severity of neonatal pneumonia complicated with neonatal respiratory distress syndrome(NRDS)and its predictive value.Methods From February 2018 to March 2021,82 children with neonatal pneumonia complicated with NRDS in Yan′an Hospital,Kunming were selected as the research objects.According to the severity of the disease,they were divided into severe group(22 cases,mechanical ventilation time>7 days)and non-severe group(60 cases,mechanical ventilation time≤7 days).Baseline data,CRP/ALB and SP-A levels were compared between the two groups.The influencing factors of the severity of neonatal pneumonia complicated with NRDS was analyzed.The predictive value of SP-A and CRP/ALB in the severity of neonatal pneumonia complicated with NRDS was analyzed.The distribution of disease severity in children with different levels of SP-A and CRP/ALB was compared.Results The birth weight,gestational weeks and the proportion of children who used dexamethasone before delivery in the severe group were lower than those in the non-severe group,and the differences were statistically significant(P<0.05).The level of SP-A in the severe group was lower than that in the non-severe group,and the CRP/ALB was higher than that in the non-severe group,and the differences were statistically significant(P<0.05).Multivariate Logistic regression analysis showed that long gestational weeks,large birth weight,used dexamethasone before delivery,and elevated SP-A levels were protective factors for the severity of neonatal pneumonia complicated with NRDS(P<0.05),while elevated CRP/ALB was a risk factor for the severity of neonatal pneumonia complicated with NRDS(P<0.05).Receiver operating characteristic curve analysis showed that the area under the curve of SP-A and CRP/ALB combined detection in predicting the severity of neonatal pneumonia complicated with NRDS was 0.964,which was higher than that of the two detected alone.The proportion of severe children in the SP-A high level group was lower than that in the low level group,and the proportion of severe children in the CRP/ALB high level group was higher than that in the low level group,and the differences were statistically significant(P<0.05).Conclusion SP-A level in severe neonatal pneumonia complicated with NRDS patients is significantly reduced,CRP/ALB is significantly increased,and the combined detection of SP-A and CRP/ALB is of high value in predicting the severity of the disease in patients.