血清PA联合LDH、Hcy水平对重症肺炎患儿并发心肌损害的预测研究

Prediction of serum PA combined with LDH and Hcy levels on myocardial damage in children with severe pneumonia

目的探讨血清前白蛋白(PA)联合乳酸脱氢酶(LDH)、同型半胱氨酸(Hcy)水平对重症肺炎患儿并发心肌损害的预测效能。方法选取医院2019年1月~2021年6月收治的258例重症肺炎患儿设为疾病组,另选取同期健康体检的260例健康儿童设为对照组,均采用酶联免疫吸附试验检测2组血清PA、LDH、Hcy水平并对比。另统计疾病组治疗期间心肌损害发生情况,对比有无并发心肌损害的患儿血清PA、LDH、Hcy水平,采用Logistic多元回归分析法分析疾病组并发心肌损害的影响因素,并绘制受试者工作特征(ROC)曲线分析血清PA联合LDH、Hcy水平对疾病组并发心肌损害的预测效能。结果疾病组血清PA水平低于对照组(P<0.05),LDH、Hcy水平高于对照组(P<0.05);疾病组心肌损害发生率为13.19%;心肌损害发生组血清PA水平低于未发生组(P<0.05),LDH、Hcy水平均高于未发生组(P<0.05);Logistic多元回归分析显示年龄≤3岁、发病至入院时间>3d、合并低氧血症、低蛋白血症、低钾血症、呼吸衰竭与血清PA水平降低、LDH和Hcy水平升高均为影响重症肺炎患儿并发心肌损害的危险因素(P<0.05);血清PA联合LDH、Hcy水平预测疾病组并发心肌损害的灵敏度、特异度、曲线下面积(AUC)分别为94.12%、86.16%、0.944,联合预测灵敏度和AUC均高于单一指标评价(P<0.05),特异度与单一指标评价对比差异均无统计学意义(P>0.05)。结论重症肺炎患儿血清PA水平降低、LDH和Hcy水平升高,均为其并发心肌损害的危险因素,且均对重症肺炎患儿并发心肌损害具有一定的预测价值,但以三者联合价值预测效能更高。

Objective To investigate the predictive effect of serum prealbumin(PA)combined with lactate dehydrogenase(LDH)and homocysteine(Hcy)on myocardial damage in children with severe pneumonia.Methods A total of 258 children with severe pneumonia treated in the hospital from January 2019 to June 2021 were selected as the disease group,and 260 healthy children who underwent physical examination in the same period were selected as the control group.The levels of serum PA,LDH,and Hcy in the two groups were detected by enzyme-linked immunosorbent assay and compared.In addition,the occurrence of myocardial damage in the disease group during treatment was counted,and the levels of serum PA,LDH,and Hcy in children with and without myocardial damage were compared.The influencing factors of myocardial damage in the disease group were analyzed by Logistic regression analysis,and the receiver operating characteristic(ROC)curve was drawn to analyze the predictive efficacy of serum PA combined with LDH and Hcy levels on myocardial damage in the disease group.Results The level of serum PA in the disease group was lower than that in the control group(P<0.05),and the levels of LDH and Hcy were higher than those in the control group(P<0.05).The incidence of myocardial damage was 13.19%.The level of serum PA in the myocardial damage group was lower than that in the non-concurrent group(P<0.05),and the levels of LDH and Hcy were higher than those in the non-concurrent group(P<0.05).Logistic multiple regression analysis showed that age≤3 years old,time from onset to admission>3 days,combined with hypoxemia,hypoproteinemia,hypokalemia,and respiratory failure,decreased serum PA level,and increased LDH and Hcy levels were the risk factors of myocardial damage in children with severe pneumonia(P<0.05).The sensitivity,specificity,and area under the curve(AUC)of serum PA combined with LDH and Hcy in predicting myocardial damage in the disease group were 94.12%,86.16%,and 0.944,respectively.The sensitivity and AUC of combined prediction were significantly higher than those of single index evaluation(P<0.05),and there was no significant difference between the specificity and single index evaluation(P>0.05).Conclusion The decrease in serum PA level and the increase of LDH and Hcy levels in children with severe pneumonia are risk factors for myocardial damage,and they have certain predictive values for myocardial damage in children with severe pneumonia,but the combined value of the three is more effective in predicting myocardial damage.