中性粒细胞CD_(11b)、可溶性CD_(14)亚型和线粒体偶联因子-6在新生儿败血症病情转归危险度分层中的作用及对临床的指导意义

The role of neutrophil CD_(11b),soluble CD_(14) subtype and mitochondrial coupling factor-6 in the risk stratification of disease outcome in neonatal sepsis and its clinical significance

目的探讨中性粒细胞CD11b(nCD11b)、可溶性CD14亚型(sCD14-St)和线粒体偶联因子-6(CF-6)在新生儿败血症病情转归危险度分层中的作用及对临床的指导意义。方法回顾性分析2019年7月至2020年3月山西省儿童医院121例败血症新生儿的临床资料。根据新生儿危重症评分(NCIS)将新生儿分为非危重组(NCIS>90分)35例,危重组(NCIS 70~90分)49例,极危重组(NCIS<70分)37例;预后不良(死亡)25例,预后良好(存活)96例。新生儿于治疗前检测C反应蛋白(CRP)、降钙素原(PCT)、nCD11b、sCD14-St和CF-6。nCD11b、sCD14-St和CF-6与病情程度的相关性采用Spearman分析;绘制受试者工作特征(ROC)曲线,分析nCD11b、sCD14-St和CF-6预测败血症新生儿不良转归的价值。结果危重组和极危重组nCD11b、sCD14-St、CF-6、PCT和CRP明显高于非危重组[(414.68 ± 93.29)和(532.74 ± 101.85)MFI比(325.45 ± 71.90)MFI、(892.40 ± 113.72)和(1 249.53 ± 95.41) ng/L比(784.66 ± 103.72)ng/L、(84.79 ± 28.35)和(121.66 ± 34.27)ng/L比(42.59 ± 13.51)ng/L、(19.24 ± 6.30)和(34.96 ± 11.95)μg/L比(8.89 ± 2.24)μg/L、(109.49 ± 36.77)和(247.13 ± 82.06)mg/L比(56.84 ± 17.25)mg/L],极危重组明显高于危重组,差异均有统计学意义(P<0.05)。Spearman相关分析结果显示,nCD11b、sCD14-St和CF-6与病情程度呈正相关(r = 0.719、0.813和0.823,P<0.01)。预后不良新生儿nCD11b、sCD14-St、CF-6、PCT和CRP明显高于预后良好新生儿[(618.58 ± 146.92) MFI比(374.55 ± 120.03) MFI、(1 516.91 ± 194.38) ng/L比(828.13 ± 175.67) ng/L、(165.84 ± 25.63)ng/L比(62.51 ± 16.75)ng/L、(43.46 ± 10.14)μg/L比(20.19 ± 6.30)μg/L和(321.09 ± 94.56)mg/L比(88.24 ± 29.19)mg/L],差异有统计学意义(P<0.01)。ROC曲线分析结果显示,nCD11b、sCD14-St和CF-6预测败血症新生儿不良转归的曲线下面积(AUC)分别为0.763、0.796和0.838(95%CI 0.678~0.836、0.713~0.864和0.760~0.899),三者联合的AUC为0.921(95%CI 0.858~0.962)。结论 nCD11b、sCD14-St和CF-6与新生儿败血症病情程度和预后有关,可作为病情转归危险度分层及评估预后的标志物。

Objective To investigate the role of neutrophil CD11b(nCD11b),soluble CD14 subtype(sCD14-St)and mitochondrial coupling factor-6(CF-6)in the risk stratification of disease outcome in neonatal sepsis and its clinical significance.Methods The clinical data of 121 septic neonates from July 2019 to March 2020 in Shanxi Children′s Hospital were retrospectively analyzed.According to the neonatal critical illness score(NCIS),the neonates were divided into non-critical group(NCIS>90 scores)with 35 cases,critical group(NCIS 70 to 90 scores)with 49 cases,very critical group(NCIS<70 scores)with 37 cases.There were 25 cases with poor prognosis(death),and 96 cases with good prognosis(survival).The C-reactive protein(CRP),procalcitonin(PCT),nCD11b,sCD14-St and CF-6 before treatment were detected.The correlation between nCD11b,sCD14-St,CF-6 and disease severity was analyzed by Spearman method;the value of nCD11b,sCD14-St and CF-6 in predicting poor disease outcome in sepsis neonates was analyzed by the receiver operating characteristic(ROC)curve.Results The nCD11b,sCD14-St,CF-6,PCT and CRP in critical group and very critical group were significantly higher than those in non-critical group:(414.68±93.29)and(532.74±101.85)MFI vs.(325.45±71.90)MFI,(892.40±113.72)and(1249.53±95.41)ng/L vs.(784.66±103.72)ng/L,(84.79±28.35)and(121.66±34.27)ng/L vs.(42.59±13.51)ng/L,(19.24±6.30)and(34.96±11.95)μg/L vs.(8.89±2.24)μg/L,(109.49±36.77)and(247.13±82.06)mg/L vs.(56.84±17.25)mg/L;the indexes in very critical group were significantly higher than those in critical group,and there were statistical differences(P<0.05).Spearman correlation analysis result showed that nCD11b,sCD14-St and CF-6 were positively correlated with disease severity in sepsis neonates(r=0.719,0.813 and 0.823;P<0.01).The nCD11b,sCD14-St,CF-6,PCT and CRP in poor prognosis neonates were significantly higher than those in good prognosis neonates:(618.58±146.92)MFI vs.(374.55±120.03)MFI,(1516.91±194.38)ng/L vs.(828.13±175.67)ng/L,(165.84±25.63)ng/L vs.(62.51±16.75)ng/L,(43.46±10.14)μg/L vs.(20.19±6.30)μg/L and(321.09±94.56)mg/L vs.(88.24±29.19)mg/L,and there were statistical differences(P<0.01).ROC curve analysis result showed that the area under the curve(AUC)of nCD11b,sCD14-St and CF-6 for predicting poor disease outcome in sepsis neonates were 0.763,0.796 and 0.838(95%CI 0.678 to 0.836,0.713 to 0.864 and 0.760 to 0.899),and the AUC of combination the 2 indexes was 0.921(95%CI 0.858 to 0.962).Conclusions The nCD11b,sCD14-St and CF-6 are associated with the disease severity and prognosis in sepsis neonates,and can be used as markers for risk stratification of disease outcome and assessment prognosis.