外周循环PCT、CRP在肺炎患儿雾化治疗前后变化及对雾化疗效的评估价值

Changes of PCT and CRP in peripheral Circulation before and after Atomization Treatment in Children with Pneumonia and the Evaluation Value of Atomization Effect

目的 分析肺炎患儿雾化治疗前后外周循环降钙素原(PCT)、C反应蛋白(CRP)表达变化,并探究两者对患儿雾化疗效的评估价值。方法 于2019年5月至2022年1月期间选取睢县妇幼保健院儿科就诊患儿190例,其中细菌性感染38例(细菌性肺炎组),支原体性感染55例(支原体性肺炎组),病毒性感染47例(病毒性肺炎组),正常患儿50例(健康组)。肺炎患儿行雾化治疗后根据疗效分为有效组、无效组。分别采用化学发光免疫分析法和免疫透射比浊法检测所有入组对象的外周循环PCT、CRP水平。比较各组肺炎患儿治疗前和健康组的PCT、CRP水平的差异;比较PCT、CRP及肺炎患儿临床特征等参数在有效和无效中的差异,并采用Logistic回归分析雾化疗效的影响因素;采用Spearman相关系数分析外周循环PCT、CRP水平与肺炎患儿雾化疗效的相关性;利用ROC曲线探讨PCT、CRP预测肺炎患儿雾化疗效的临床效能。结果 细菌性肺炎组、支原体性肺炎组、病毒性肺炎组患儿的外周循环PCT、CRP水平均高于健康组,差异有统计学意义(P<0.05),细菌性肺炎组患儿外周循环PCT、CRP水平均高于支原体性肺炎组和病毒性肺炎组,支原体肺炎性患儿外周循环PCT、CRP水平均高于病毒性肺炎组,差异有统计学意义(P<0.05)。肺炎患儿雾化后1 d、雾化后3 d、雾化后7 d外周循环PCT、CRP水平均低于雾化前,差异有统计学意义(P<0.05),雾化后7 d外周循环PCT、CRP水平均低于肺炎患儿雾化后1 d、雾化后3 d,差异有统计学意义(P<0.05),雾化后3 d外周循环PCT、CRP水平均低于肺炎患儿雾化后1 d,差异有统计学意义(P<0.05)。有效组、无效组患儿在疾病程度、肺功能指标、外周循环PCT、CRP水平上对比,差异有统计学意义(P<0.05)。Logistic结果显示外周循环PCT、CRP表达升高为影响肺炎患儿雾化疗效的因素,差异有统计学意义(P<0.05)。Spearman相关性分析显示,PCT、CRP分别与肺炎患儿雾化疗效正相关,差异有统计学意义(r=0.712,0.700,P<0.001)。ROC曲线显示,PCT、CRP联合指标较单独预测的价值更高,其曲线下面积为0.897。结论 外周循环PCT、CRP在肺炎患儿雾化前后存在明显的动态改变现象,临床可经监测外周循环PCT、CRP水平来早期评估患儿雾化疗效,以利于患儿预后恢复。

Objective To analyze the changes of the expression of procalcitonin(PCT) and C-reactive protein(CRP) in the peripheral circulation of children with pneumonia before and after atomization therapy, and to explore the value of both in evaluating the efficacy of atomization therapy in children. Methods From May 2019 to January 2022, 190 children were selected from the department of pediatrics of Sui County Maternal and Child Health Hospital, including 38 bacterial infections(bacterial pneumonia group), 55 mycoplasma infections(mycoplasma pneumonia group), 47 viral infections(viral pneumonia group),and 50 normal children(healthy group). Children with pneumonia were divided into effective group and ineffective group according to the curative effect after atomization treatment. The levels of PCT and CRP in peripheral circulation of all subjects were detected by chemiluminescence immunoassay and immune transmission turbidimetry. The difference of PCT and CRP levels between each group of children with pneumonia before treatment and the healthy group was compared;The difference of PCT, CRP and clinical characteristics of children with pneumonia in effective group and ineffective group was compared, and logistic regression was used to analyze the influencing factors of atomization efficacy;Spearman correlation coefficient was used to analyze the correlation between the levels of PCT and CRP in peripheral circulation and the efficacy of nebulization in children with pneumonia;The ROC curve was used to explore the clinical efficacy of PCT and CRP in predicting atomization efficacy in children with pneumonia. Results The levels of PCT and CRP in the peripheral circulation of children in bacterial pneumonia group, mycoplasma pneumonia group and viral pneumonia group were significantly higher than those of the healthy group(P<0.05). The levels of PCT and CRP in peripheral circulation of children in bacterial pneumonia group were higher than those of children in mycoplasma pneumonia group and viral pneumonia group, the levels of PCT and CRP in peripheral circulation of children in mycoplasma pneumonia group were higher than those of children in viral pneumonia group, the difference was significant(P<0.05). The levels of PCT and CRP in the peripheral circulation of children with pneumonia 1 day, 3 days and 7days after atomization were lower than those before atomization, with statistical significance(P<0.05). The levels of PCT and CRP in the peripheral circulation of children with pneumonia 7 days after atomization were lower than those 1 day and 3 days after atomization, with statistical significance(P<0.05). The levels of PCT and CRP in the peripheral circulation of children with pneumonia 3 days after atomization were lower than those 1 day after atomization, with statistical significance(P<0.05).There were significant differences between the effective group and the ineffective group in disease degree, pulmonary function index, PCT and CRP levels of peripheral circulation(P<0.05). Logistic results showed that the increased expression of PCT and CRP in the peripheral circulation was the factor affecting the efficacy of atomization in children with pneumonia, and the difference was statistically significant(P<0.05). Spearman correlation analysis showed that PCT and CRP were positively correlated with the efficacy of atomization in children with pneumonia(r=0.712, 0.700, P<0.001). The ROC curve shows that the combined index of PCT and CRP is more valuable than the single prediction, and its area under the curve is 0.897. Conclusion There are obvious dynamic changes in PCT and CRP in peripheral circulation before and after nebulization in children with pneumonia. The clinical efficacy of nebulization can be evaluated early by monitoring the level of PCT and CRP in peripheral circulation to facilitate the recovery of the prognosis of children.