炎性因子与新生儿肺炎的类型及预后相关性分析

Analysis of the correlation between inflammatory factors and the type and prognosis of neonatal pneumonia

目的 探讨血清炎症指标C-反应蛋白(CRP)、白细胞介素-10(IL-10)、单核细胞趋化蛋白-1(MCP-1)及白三烯B4(LTB4)与新生儿肺炎感染类型及预后关系。方法 选取2020年10月—2022年10月医院新生儿科收治的140例新生儿肺炎患儿作为研究对象,其中病毒感染65例作为病毒感染组,细菌感染75例作为细菌感染组,另选取同期于该院出生的健康新生儿100例作为对照组。采用酶联免疫吸附法(ELISA)检测3组对象血清CRP、IL-10、MCP-1、LTB4水平。采用Spearman秩相关性分析血清CRP、IL-10、MCP-1、LTB4水平与新生儿肺炎感染类型的关系。根据预后情况将患儿分为预后良好组(n=101)和预后不良组(n=39),比较2组患儿血清CRP、IL-10、MCP-1、LTB4水平,采用多因素logistic回归分析研究影响新生儿肺炎患儿预后不良的危险因素,采用受试者工作特征(ROC)曲线分析血清CRP、IL-10、MCP-1、LTB4水平对新生儿肺炎患儿预后的预测价值。结果 与对照组比较,病毒感染组、细菌感染组血清CRP、IL-10、MCP-1、LTB4水平较高(P<0.05);与病毒感染组比较,细菌感染组血清CRP、IL-10、MCP-1、LTB4水平较高(P<0.05)。Spearman秩相关性分析结果显示,血清CRP、IL-10、MCP-1、LTB4水平与新生儿肺炎感染类型成正相关关系(r值分别为0.520、0.551、0.325、0.303,P<0.05)。预后不良组血清CRP、IL-10、MCP-1、LTB4水平均高于预后良好组(P<0.05)。logistic回归分析显示,血清CRP、IL-10、MCP-1、LTB4水平升高均是新生儿肺炎患儿预后不良的独立危险因素(P<0.05)。ROC曲线显示,血清CRP、IL-10、MCP-1、LTB4水平预测新生儿肺炎患儿预后的AUC分别为0.742、0.770、0.761、0.751,灵敏度分别为75.00%、68.50%、66.50%、70.00%,特异度分别为76.00%、69.50%、68.50%、71.00%;四项联合检测时预测新生儿肺炎患儿预后的AUC为0.887,灵敏度和特异度分别为91.50%和92.50%。结论 血清CRP、IL-10、MCP-1、LTB4水平对新生儿肺炎感染类型的鉴别及预后预测有一定辅助作用。

Objective This paper aims to investigate the relationship between serum inflammatory markers of C-reactive protein(CRP), interleukin-10(IL-10), monocyte chemotactic protein-1(MCP-1) and leukotriene B4(LTB4) and the type and prognosis of neonatal pneumonia infection. Methods One hundred and forty cases of neonatal pneumonia admitted to the neonatal unit of our hospital from October 2020 to October 2022 were selected as the study subjects, of which 65 cases of viral infection were selected as the viral infection group and 75 cases of bacterial infection as the bacterial infection group, and 100 healthy neonates born in our hospital during the same period were selected as the control group. Serum levels of CRP, IL-10, MCP-1, and LTB4 were measured in three groups by enzyme-linked immunosorbent assay(ELISA). Spearman's rank correlation was used to analyze the relationship between serum levels of CRP, IL-10, MCP-1, LTB4 and the type of neonatal pneumonia infection. The children were divided into good prognosis group(n=101) and poor prognosis group(n=39) according to their prognosis, and the serum levels of CRP, IL-10, MCP-1, and LTB4 were compared between the two groups. Multi-factor logistic regression was used to analyze the risk factors affecting the poor prognosis of children with neonatal pneumonia, and the predictive value of serum CRP, IL-10, MCP-1, and LTB4 levels on the prognosis of children with neonatal pneumonia was analyzed using subject work characteristic(ROC) curves. Results Compared with the control group, the serum CRP, IL-10, MCP-1 and LTB4 levels in the viral infection group and bacterial infection group were higher(P<0.05);compared with the control group, serum CRP, IL-10, MCP-1, and LTB4 levels were higher in the viral infection group and bacterial infection group(P<0.05);compared with the viral infection group, serum CRP, IL-10, MCP-1, LTB4 levels were higher in the bacterial infection group(P<0.05). Spearman's rank correlation analysis showed that serum CRP, IL-10, MCP-1, and LTB4 levels were positively correlated with the type of neonatal pneumonia infection(r=0.520, r=0.551, r=0.325, r=0.303, P<0.05). Serum CRP, IL-10, MCP-1 and LTB4 levels were higher in the poor prognosis group than in the good prognosis group, and the difference was statistically significant(P<0.05). Logistic regression analysis showed that elevated levels of serum CRP, IL-10, MCP-1, and LTB4 were all independent risk factors for poor prognosis in children with neonatal pneumonia(P<0.05). The ROC curve results showed that the AUCs of serum CRP, IL-10, MCP-1, and LTB4 levels for predicting the prognosis of children with neonatal pneumonia were 0.742, 0.770, 0.761 and 0.751, respectively, and the sensitivities were 75.00%, 68.50%, 66.50%, 70.00%, and the specificities were 76.00%, 69.50%, 68.50%, 71.00%, respectively;the AUC for predicting the prognosis of children with neonatal pneumonia, when the four tests were combined, was 0.887, with sensitivity and specificity of 91.50% and 92.50%, respectively. Conclusion Serum CRP, IL-10, MCP-1, and LTB4 levels are useful for the identification of the type of neonatal pneumonia infection and prognosis prediction.