PCT、IFN-γ、NT-ProBNP与D-D联合评估儿童肺炎预后的价值

Value of the combination of PCT,IFN-γ,NT-ProBNP and D-D in evaluating the prognosis of severe pneumonia in children

目的 探讨降钙素原(PCT)、γ-干扰素(IFN-γ)、氨基末端脑钠肽前体(NT-ProBNP)与D-二聚体(D-D)联合评估儿童肺炎预后的价值。方法 选取2020年5月-2022年6月南阳医学高等专科学校第一附属医院收治的101例肺炎患儿作为肺炎组,选取同期体检中心101名健康儿童作为对照组,比较两组、不同病情患儿、存活者与病死者入院治疗前24 h内血清PCT、IFN-γ、NT-ProBNP与D-D水平,采用Pearson分析血清各指标与肺炎严重指数(PSI)评分相关性,采用Logistic回归分析肺炎患儿预后的影响因素,绘制各指标预测肺炎患儿预后的受试者工作特征(ROC)曲线。结果 肺炎组治疗前24 h内血清PCT、IFN-γ、NT-ProBNP、D-D水平较对照组高(P<0.05);低危、中危、高危患儿血清PCT、IFN-γ、NT-ProBNP、D-D水平依次升高(P<0.05),且均高于对照组(P<0.05),血清PCT、IFN-γ、NT-ProBNP、D-D均与PSI评分呈正相关(P<0.05);病死者血清PCT、IFN-γ、NT-ProBNP、D-D水平均高于存活者(P<0.05);血清PCT、IFN-γ、NT-ProBNP、D-D水平和肺炎患儿预后有密切关联(P<0.05);PCT+IFN-γ+NT-ProBNP+D-D预测预后的敏感度和特异度分别为85.42%、100.00%。结论 PCT、IFN-γ、NT-ProBNP、D-D在肺炎患儿中高表达,并随肺炎严重程度升高而呈上升趋势,与PSI评分呈正相关。联合检测时对肺炎患儿预后具有较高预测价值,可为临床决策及分层干预提供参考。

OBJECTIVE To investigate the combination of procalcitonin(PCT),interferon-(IFN-),amino-terminal pro-brain natriuretic peptide(NT-ProBNP)and D-dimer(DD)in the prognosis of pneumonia in children.METHODS Total of 11 children with pneumonia admitted to the First Affiliated Hospital of Nanyang Medical College from May 2020 to Jun 2022 were enrolled as the pneumonia group;101 healthy children under physical examination were in the control group.The serum levels of PCT,IFN-γ,NT-ProBNP and D-D were compared between the two groups,among children with different conditions,between survivors and dead within 24h before hospitalization.The correlation between serum indexes and pneumonia severity index(PSI)score was analyzed by Pearson.Multivariate Logistic regression analysis was used to analyze the influencing factors for the prognosis in children with pneumonia,and the subject working characteristic curve(ROC)curve of each index in predicting the prognosis of children with pneumonia was drawn.RESULTS The levels of PCT,IFN-γ,NT-ProBNP and DD in the pneumonia group within 24h before hospitalization were higher than those in the control group(P<0.05).The levels of serum PCT,IFN-γ,NT-ProBNP and DD among the low-risk,intermediate-risk and high-risk child patients increased(P<0.05),which were higher than those in the control group(P<0.05).Serum PCT,IFN-,NT-ProBNP and DD were positively correlated with PSI score(P<0.05).Serum PCT,IFN-γ,NT-ProBNP,DD levels in death were higher than those in survivors(P<o.05);serum PCT,IFN-,NT-ProBNP and DD levels were closely correlated with the prognosis of children with pneumonia(P<o.05).The sensitivity and specificity of the combination of PCT,IFN-,NT-ProBNP and D-D in predicting prognosis were 85.42%and 100.00%,respectively.CONCLUSION PCT,IFN-γ,NT-ProBNP and D-D levels are highly expressed in children with pneumonia,positively correlated with PSI score with the increase of pneumonia severity,and show upward trend.Combined detection has high predictive value for prognosis in children with pneumonia and can be used for clinical decision-making and the reference of hierarchical interventions.