心肌酶谱三项对儿童肺炎支原体肺炎病情和预后的评估价值

Value of three items myocardial enzyme spectrum in evaluating the disease severity and prognosis of mycoplasma pneumoniae pneumonia in children

目的:探究心肌酶谱三项对儿童肺炎支原体肺炎(mycoplasma pneumoniae pneumonia,MPP)病情和预后的评估价值。方法:选取2017年1月至2022年2月阜阳市妇女儿童医院收治的104例MPP患儿为研究对象,回顾性分析其临床资料,包括一般资料及实验室资料[乳酸脱氢酶(lactate dehydrogenase,LDH)、谷草转氨酶(aspartate aminotransferase,AST)、肌酸激酶同工酶(creatinine kinase-myocardial band,CK-MB)]。根据患儿病情程度分为轻症组(n=71)与重症组(n=33);再根据随访1年患儿有无肺部后遗症分为预后良好组(n=95)与预后不良组(n=9)。比较各组临床资料,用受试者操作特征(receiver operating characteristic,ROC)曲线分析血清AST、LDH、CK-MB对MPP患儿病情程度和预后的评估价值。结果:轻症组血清AST、LDH、CK-MB水平均明显低于重症组(均P<0.05);预后良好组血清AST、LDH、CK-MB水平均明显低于预后不良组(均P<0.05)。Logistic回归分析显示:AST、LDH、CK-MB均是MPP患儿重症及预后不良的独立危险因素(均P<0.05)。ROC曲线分析显示:血清AST、LDH、CK-MB诊断儿童重症MPP的曲线下面积(area under the curve,AUC)分别为0.944、0.961、0.657,预测儿童MPP预后不良的AUC分别为0.935、0.961、0.851,均以LDH的评估效能最高(病情:敏感度=93.94%,特异度=85.92%;预后:敏感度=88.89%,特异度=92.63%)。结论:心肌酶谱三项对儿童MPP病情严重程度和预后均具有较高的评估价值,血清AST、LDH、CK-MB水平越高提示患儿病情越重,更易出现预后不良。

Objective: To explore the evaluation value of three items of myocardial enzymes spectrum on the severity and prognosis of mycoplasma pneumoniae pneumonia(MPP) in children.Methods: A total of 104 children with MPP admitted to Fuyang Women and Children’s Hospital from January 2017 to February 2022 were selected as the research subjects. The clinical data were retrospectively analyzed, including general data and laboratory data [aspartate aminotransferase(AST), lactate dehydrogenase(LDH), creatinine kinasemyocardial band(CK-MB)]. The patients were divided into a mild group(n=71) and a severe group(n=33) according to the severity of the disease. They were regrouped according to the 1-year follow-up prognosis, and divided into a good prognosis group(n=95) and a poor prognosis group(n=9) according to the presence or absence of pulmonary sequelae. The clinical data of each group were compared. The receiver operating characteristic(ROC) curve was used to analyze the value of serum AST, LDH and CK-MB in evaluating the severity and prognosis of the MPP children.Results: The serum AST, LDH, and CK-MB levels in the mild group were significantly lower than those in the severe group(all P<0.05). The serum AST, LDH, and CK-MB levels in the good prognosis group were significantly lower than those in the poor prognosis group(all P<0.05). Logistic regression analysis showed that AST, LDH, and CK-MB were independent risk factors for severe MPP and poor prognosis(all P<0.05). ROC curve analysis showed that the area under the curve(AUC) of serum AST, LDH, and CK-MB in the diagnosis of severe MPP in children were 0.944, 0.961, and 0.657, the AUC of predicting poor prognosis of MPP in children were 0.935, 0.961, and 0.851, respectively. LDH had the highest evaluation efficiency(sensitivity for disease severity 93.94%, specificity for disease severity 85.92%;sensitivity for prognosis 88.89%, specificity for prognosis 92.63%).Conclusion: The three items of myocardial enzyme spectrum have high evaluation values for the condition and prognosis of MPP in children. The higher the serum AST, LDH, and CK-MB levels are, the more severe the disease is and the more likely the prognosis is poor.