新生儿持续肺动脉高压血清正五聚蛋白3、硒蛋白P的表达及其与短期预后的关系

Expression of serum pentraxin 3 and selenoprotein P in persistent pulmonary hypertension and their relationship with short-term prognosis

目的探讨不同病情严重程度新生儿持续肺动脉高压(PPHN)血清正五聚蛋白3(PTX-3)、硒蛋白P(SeP)的表达及其与短期预后的关系。方法选择2019年5月至2021年7月河北省邯郸市中心医院收治的173例PPHN患儿为研究组,根据患儿病情严重程度分为轻度组58例、中度组60例与重度组55例,另选择本院同时间段39例足月分娩正常新生儿为对照组,检测并比较各组血清PTX-3、SeP水平。随访28天后根据患儿的预后分为生存组151例与死亡组19例,多因素Logistic回归分析影响PPHN患儿治疗后28天内死亡的因素,绘制受试者工作特征(ROC)曲线及计算曲线下面积(AUC)判定PTX-3、SeP水平对其的预测价值。结果重度组、中度组、轻度组及对照组血清PTX-3、SeP水平均依次降低,差异有统计学意义(F值分别为91.456、278.351,P<0.05);多因素Logistic回归结果显示,新生儿低血压、新生儿酸中毒、血清PTX-3高水平、血清SeP高水平为PPHN患儿治疗后28天内死亡的危险因素(OR值介于1.136~2.823之间,P<0.05);ROC曲线结果显示,血清PTX-3、SeP水平及二者联合预测PPHN患儿治疗后28天内死亡的AUC(95%CI)分别为0.761(0.563~0.958)、0.749(0.570~0.923)、0.836(0.725~0.946)。结论PPHN患儿血清PTX-3、SeP水平随着病情的加重而升高,合并新生儿低血压、新生儿酸中毒及治疗前高水平血清PTX-3、SeP的PPHN患儿,短期死亡风险较高。治疗前血清PTX-3、SeP水平对PPHN患儿短期预后预测具有一定的价值,且联合检测的预测价值更高。

Objective To investigate the expression of serum pentraxin 3(PTX-3)and selenoprotein P(SeP)in persistent pulmonary hypertension of the newborn(PPHN)of different severity and their relationship with short-term prognosis.Methods A total of 173 children with PPHN who were treated in Handan Central Hospital of Hebei Province from May 2019 to July 2021 were selected as the study group.According to the severity of the disease,the children were divided into mild group(n=58),moderate group(n=60)and severe group(n=55).In addition,39 normal full-term neonates in the same period of time in our hospital were selected as the control group.The levels of serum PTX-3 and SeP in each group were detected and compared.After 28 days of follow-up,the patients were divided into survival group(n=151)and death group(n=19)according to their prognosis.Multivariate logistic regression analysis was used to analyze the factors affecting the death within 28 days after PPHN children treatment,draw the receiver operating characteristic(ROC)curve and calculate the area under the curve(AUC)to determine the predictive value of PTX-3 and SeP levels.Results The levels of serum PTX-3 and SeP in severe group,moderate group,mild group and control group decreased in turn,with a statistically significant difference(F=91.456 and 278.351,respectively,P<0.05).Multivariate logistic regression showed that neonatal hypotension,neonatal acidosis,high level of serum PTX-3 and high level of serum SeP were the risk factors for death within 28 days after PPHN children treatment(OR=1.136-2.823,respectively,P<0.05).ROC curve results showed that the AUC(95%CI)predicted by serum PTX-3,SeP levels and their combination to death within 28 days after PPHN children treatment were 0.761(0.563-0.958),0.749(0.570-0.923)and 0.836(0.725-0.94),respectively.Conclusion The levels of serum PTX-3 and SeP in children with PPHN increased with the severity of the disease.PPHN children with neonatal hypotension,neonatal acidosis and high levels of serum PTX-3 and SeP before treatment have a high risk of short-term death.Serum PTX-3 and SeP levels before treatment have a certain value in predicting the short-term prognosis of PPHN children,and the predictive value of combined detection is higher.