血清血管生成素2和表面活性蛋白D在儿童急性呼吸窘迫综合征的动态变化及临床价值

Dynamic changes and clinical value of serum angiopoietin-2 and surfactant protein D in pediatric acute respiratory distress syndrome

目的研究儿童急性呼吸窘迫综合征(pARDS)患儿的血管生成素2(Ang-2)、表面活性蛋白D(SP-D)的动态变化与病情严重程度及预后的关系。方法采用巢式病例-对照研究方法,选择福建省妇幼保健院PICU 2018年6月至2021年5月收治的肺炎合并pARDS患儿80例(pARDS组)和相应年龄健康体检儿童19例作为正常对照组。按照氧合情况,pARDS患儿被分为轻度组(23例)、中度组(32例)和重度组(25例);按照出院时预后转归,分为生存组(67例)和死亡组(13例)。采用酶联免疫吸附法检测Ang-2、SP-D。比较不同严重程度pARDS患儿第1天Ang-2、SP-D水平的差异;比较生存组和死亡组患儿第1、3、8天Ang-2、SP-D水平的变化,绘制受试者工作特征(ROC)曲线比较第1、3、8天Ang-2、SP-D对pARDS预后的预测价值。结果(1)pARDS组患儿第1天Ang-2、SP-D水平较正常对照组明显升高(P<0.001)。(2)不同严重程度pARDS患儿Ang-2、SP-D水平差异有统计学意义(P<0.001),且随着疾病严重程度增加,Ang-2、SP-D水平逐步升高。(3)死亡组患儿在第1、3、8天Ang-2、SP-D水平均明显高于生存组(P<0.05)。(4)不同时间点Ang-2、SP-D水平对pARDS预后预测效能:第1、3、8天Ang-2预测pARDS患儿住院死亡的ROC曲线下面积分别为0.808、0.981、0.989,最佳截断值分别为6000、6971、4171 pg/mL时,灵敏度分别为84.6%、92.3%、92.3%,特异度分别为76.1%、97.0%、98.5%;第1、3、8天SP-D预测pARDS患儿住院死亡的ROC曲线下面积分别为0.689、0.993、0.983,最佳截断值分别为13544、16003、12294 pg/mL时,灵敏度分别为84.6%、100.0%、100.0%,特异度分别为46.3%、98.5%、97.0%。结论pARDS患儿血清Ang-2和SP-D水平随着病情加重而升高。不同预后pARDS患儿的Ang-2和SP-D水平在病程中的动态变化有差异,病程中监测血清Ang-2和SP-D对临床转归有一定的预测价值。

Objective To study the relationship between the dynamic changes of angiopoietin-2(Ang-2)and surfactant protein D(SP-D)in pediatric acute respiratory distress syndrome(pARDS)and the severity and prognosis of the disease.Methods Using nested case-control study method,80 children with pneumonia complicated with pARDS admitted to PICU at Fujian Maternal and Child Health Hospital from June 2018 to May 2021 were selected as pARDS group,and 19 healthy children with corresponding age were selected as control group.According to the oxygenation,the children in pARDS group were divided into three subgroups:mild group(23 cases),moderate group(32 cases)and severe group(25 cases).According to the prognosis at discharge,the children in pARDS group were divided into survival group(67 cases)and death group(13 cases).Ang-2 and SP-D were detected by enzyme-linked immunosorbent assay.The levels of Ang-2 and SP-D in children with pARDS of different severity on the first day were compared;The changes of Ang-2 and SP-D levels on the 1st,3rd and 8th day of children in survival group and death group were compared,and the receiver operating characteristic(ROC)curve was plotted to compare the predictive value of Ang-2 and SP-D for pARDS prognosis.Results(1)The levels of Ang-2 and SP-D on the first day in pARDS group were significantly higher than those in control group(P<0.001).(2)The levels of Ang-2 and SP-D on the first day in children with pARDS of different severity levels were significantly different(P<0.001),and the levels of Ang-2 and SP-D increased gradually with the increase of disease severity.(3)The levels of Ang-2 and SP-D in death group were significantly higher than those in survival group on the 1st,3rd and 8th day(P<0.05).(4)Prognostic efficacy of Ang-2 and SP-D levels in pARDS group at different time points:when the areas under the ROC curve predicted by Ang-2 on the 1st,3rd and 8th day for inpatient mortality in children with pARDS were 0.808,0.981 and 0.989,respectively;the optimal cut-off values were 6000 pg/mL,6971 pg/mL and 4171 pg/mL,respectively;the sensitivity was 84.6%,92.3%and 92.3%,respectively;and the specificity was 76.1%,97.0%and 98.5%,respectively.The areas under the ROC curve predicted by SP-D on the 1st,3rd and 8th day for inpatient mortality in children with pARDS were 0.689,0.993 and 0.983,respectively;the optimal cut-off values were 13544 pg/mL,16003 pg/mL and 12294 pg/mL,respectively;the sensitivity was 84.6%,100.0%and 100.0%,respectively;and the specificity was 46.3%,98.5%and 97.0%,respectively.Conclusion Serum Ang-2 and SP-D levels in children with pARDS increase with the aggravation of the disease.The dynamic changes of Ang-2 and SP-D in children with pARDS with different prognosis are different during the course of disease,and monitoring serum Ang-2 and SP-D during the course of disease has a certain predictive value for clinical outcome.