血清PTX3、copeptin联合测定对重症肺炎儿童预后的预测价值探讨

Predictive value of combined determination of serum PTX3 and copeptin in prognosis of children with severe pneumonia

目的研究血清正五聚蛋白3(pentraxin 3,PTX3)、和肽素(copeptin)联合测定对重症肺炎儿童预后的预测价值。方法选取我院收治的重症肺炎患儿100例。根据患儿随访6个月的预后情况,将患儿分为预后不良组(n=35例)和预后良好组(n=65例)。患儿入院后,常规记录患儿的基本资料,包括性别、年龄、血尿常规和病程,针对性的给予患儿氧气吸入、抗感染治疗和对症支持治疗等。收集患儿的疾病严重程度和合并症等。患儿进入儿科重症监护病房(pediatric intensive care unit,PICU)后,24 h监测患儿的心率、呼吸频率、pH值、动脉血氧分压、血钾、尿素氮/血肌酐、血钠、血红蛋白等,并根据患儿的测定结果进行小儿危重病例评分(pediatric critical illness score,PCIS)评分。患儿进入PICU 24 h内,采用酶联免疫吸附法测定患儿血清中copeptin水平和PTX3水平。比较重症肺炎儿童预后的单因素分析和Logistic多因素回归分析,通过ROC曲线评估血清PTX3、copeptin联合测定对重症肺炎儿童预后的预测价值。结果预后良好组和预后不良组患儿的性别和合并心力衰竭的比例、平均年龄、呼吸频率心率组间比较差异均不具有统计学意义(P>0.05);2组患者PCIS评分、疾病危重程度病例、血清PTX3、copeptin水平组间比较差异均有统计学意义(P<0.05)。根据单因素分析结果,将对重症肺炎儿童预后具有显著影响的因素纳入多因素分析,结果显示PCIS评分、血清PTX3、copeptin水平是重症肺炎患儿预后的独立影响因素。PTX3的ROC曲线的AUC为0.861(95%CI:0.804~0.911,P<0.001),敏感度为71.12%,特异度为62.32%;血清copeptin的ROC曲线的AUC为0.841(95%CI:0.801~0.900,P<0.001),敏感度为69.43%,特异度为65.21%;联合检测ROC曲线的AUC为0.888(95%CI:0.853~0.943,P<0.001),敏感度为78.66%,特异度为69.66%,提示血清PTX3、copeptin联合测定对重症肺炎儿童预后具有一定的预测价值。结论血清PTX3、copeptin联合测定对重症肺炎儿童预后具有良好的预测价值。

Objective To study the predictive value of serum pentraxin 3(PTX3)and copeptin in prognosis of children with severe pneumonia.Methods A total of 100 children with severe pneumonia admitted to our hospital were selected.According to the prognosis of children at 6-month follow-up,they were divided into poor prognosis group(n=35)and good prognosis group(n=65).After admission,the basic information of the children,including gender,age,blood and urine routine and course of disease,were recorded routinely,and targeted oxygen inhalation,anti-infection treatment and symptomatic support treatment were given.The disease severity and complications of the children were collected.After entering the pediatric Intensive Care Unit(PICU),the heart rate,respiratory rate,pH value,arterial oxygen partial pressure,blood potassium,urea nitrogen/serum creatinine,blood sodium,and hemoglobin were monitored for 24 h,and pediatric critical illness score(PCIS)was performed according to the measured results of the children.The serum copeptin level and PTX3 level were measured by enzyme-linked immunosorbent assay(ELISA)within 24 h after admission to NICU.Univariate analysis and multivariate Logistic regression analysis of the prognosis of children with severe pneumonia were compared,and receiver operating characteristic(ROC)curve was used to evalute the predictive value of combined determination of serum PTX3 and copeptin in prognosis of children with severe pneumonia.Results There was no significant difference in gender,the proportion of children with heart failure,average age,respiratory rate and heart rate between two groups(P>0.05).There were statistically significant differences between two groups in PCIS score,numbers of patients with critical disease,serum PTX3 and copeptin levels(P<0.05).According to the results of univariate analysis,the factors that had significant influence on the prognosis of children with severe pneumonia were included in multivariate analysis.The results showed that PCIS score,serum PTX3 and copeptin levels were independent influencing factors for the prognosis of children with severe pneumonia.The are under the ROC curve(AUC)of PTX3 were 0.861(95%CI:0.804-0.911,P<0.001),the sensitivity was 71.12%and the specificity was 62.32%.The AUC of the serum copeptin was 0.841(95%CI:0.801-0.900,P<0.001),with a sensitivity of 69.43%and a specificity of 65.21%.The AUC of the combined determination was 0.888(95%CI:0.853-0.943,P<0.001),with a sensitivity of 78.66%and a specificity of 69.66%,suggesting that the combined determination of serum PTX3 and copeptin had certain predictive value for the prognosis of children with severe pneumonia,suggesting that the combined determination of serum PTX3 and copeptin had certain predictive value for the prognosis of children with severe pneumonia.Conclusion The combined determination of serum PTX3 and copeptin has a good predictive value for the prognosis of children with severe pneumonia.