血清淀粉样蛋白A和25-羟维生素D水平与反复呼吸道感染患儿预后的相关性

Correlation between the serum amyloid A and 25-hydroxyvitamin D levels and prognosis in children with recurrent respiratory tract infection

目的 探讨血清淀粉样蛋白A(SAA)、25-羟维生素D[25(OH)D]水平与反复呼吸道感染(RRTI)患儿预后的相关性。方法 选择2019年6月至2020年6月南阳市中心医院收治的58例RRTI患儿为研究对象(观察组),另选择同期来院体检的健康儿童40例作为对照组。采集所有受试者空腹外周静脉血3~5 mL,采用免疫散射比浊法检测受试者血清中SAA水平,化学发光法检测受试者血清25(OH)D水平。观察组患儿随访1 a,根据治疗效果将患儿分为预后良好组(n=36)和预后不良组(n=22)。收集2组患儿的临床资料,采用单因素和多因素logistic回归分析影响RRTI患儿预后的因素。采用Spearman相关分析SAA、25(OH)D水平与RRTI患儿预后的相关性,并绘制受试者操作特征(ROC)曲线评估血清SAA、25(OH)D水平对RRTI患儿预后的预测价值。结果 观察组患儿血清SAA水平显著高于对照组,25(OH)D水平显著低于对照组(P<0.05)。单因素分析结果显示,患儿的家族呼吸系统疾病史、父母职业接触化工物品、患儿是否吸二手烟、家庭养宠物占比及SAA、25(OH)D水平与RRTI患儿预后有关(P<0.05);患儿的性别、年龄、体质量指数、父母文化程度、出生时是否发生窒息、是否早产与RRTI患儿预后无关(P>0.05)。Logistic回归分析结果显示,家族呼吸系统疾病史、患儿吸二手烟、家庭养宠物及SAA高水平、25(OH)D低水平是影响RRTI患儿预后的因素(P<0.05)。Spearman相关分析结果显示,SAA水平与RRTI患儿预后呈负相关(r=-0.737,P<0.05),25(OH)D水平与RRTI患儿预后呈正相关(r=0.491,P<0.05)。ROC曲线分析结果显示,SAA水平预测RRTI患儿预后的最佳截断值、曲线下面积、灵敏度、特异度分别为4.37 mg·L^(-1)、0.798(95%可信区间0.742~0.865)、79.20%、62.10%,25(OH)D水平预测RRTI患儿预后的最佳截断值、曲线下面积、灵敏度、特异度分别为15.74μg·L^(-1)、0.836(95%可信区间0.794~0.921)、86.80%、61.20%。结论 SAA在RRTI患儿中呈高表达,25(OH)D在RRTI患儿中呈低表达,SAA、25(OH)D水平是影响患儿预后的因素,对患者预后有较高的预测价值。

Objective To explore the correlation between the serum amyloid A(SAA)and 25-hydroxyvitamin D[25(OH)D]levels with prognosis of recurrent respiratory tract infection(RRTI)in children.Methods A total of 58 children with RRTI admitted to Nanyang Central Hospital from June 2019 to June 2020 were selected as the research subjects(observation group),and 40 healthy children who came to the hospital for physical examination during the same period were selected as the control group.The 3-5 mL of fasting peripheral venous blood were collected from all subjects,and the serum level of SAA of the subjects was detected by immune scattering turbidimetry,the serum level of 25(OH)D of the subjects was detected by chemiluminescence method.The patients in the observation group were followed up for 1 year,and they were divided into the good prognosis group(n=36)and the poor prognosis group(n=22)based on the treatment effect.The clinical data of patients in the two groups were collected,then the factors affecting the prognosis of children with RRTI was analyzed by the univariate and multivariate logistic regression analysis.The correlation between the serum SAA,25(OH)D levels and prognosis of children with RRTI was analyzed by Spearman correlation analysis.Receiver operating characteristic(ROC)curve was drawn to evaluate the predictive value of serum SAA and 25(OH)D levels for prognosis in children with RRTI.Results The serum SAA level of subjects in the observation group was significantly higher than that in the control group,and the serum 25(OH)D level was significantly lower than that in the control group(P<0.05).The results of univariate analysis showed that the family history of respiratory disease,parental occupational exposure to chemicals,whether the children smoked second-hand smoke,the proportion of family kept pets and the SAA,25(OH)D levels were related to the prognosis of children with RRTI(P<0.05);the gender,age,body mass index,parental education level,occurrence of asphyxia at birth and premature birth were not related to the prognosis of children with RRTI(P>0.05).Logistic regression analysis results showed that family history of respiratory diseases,children smoked second-hand smoke,family kept pets,high level of SAA,low level of 25(OH)D were factors affecting the prognosis of RRTI children(P<0.05).Spearman correlation analysis showed that the SAA level was negatively correlated with the prognosis of children with RRTI(r=-0.737,P<0.05);and the 25(OH)D level was positively correlated with the prognosis of children with RRTI(r=0.491,P<0.05).The ROC curve analysis results showed that the optimal cut-off points,area under curve,sensitivity and specificity of SAA level in predicting the prognosis of children with RRTI were 4.37 mg·L^(-1),0.798(95%confidence interval 0.742-0.865),79.20%and 62.10%,respectively;the optimal cut-off points,area under curve,sensitivity and specificity of 25(OH)D level in predicting the prognosis of children with RRTI were 15.74μg·L^(-1),0.836(95%confidence interval 0.794-0.921),86.80%and 61.20%,respectively.Conclusion SAA is highly expressed in children with RRTIs,and 25(OH)D is lowly expressed in children with RRTI.The levels of SAA and 25(OH)D are factors affecting the prognosis of children with RRTI,and they have high predictive value for the prognosis of patients.