重症肺炎患儿预后的影响因素及可溶性髓样细胞触发受体-1和高迁移率族蛋白B1对其预测价值

Factors influencing the prognosis of children with severe pneumonia and the predictive value of sTREM-1and HMGB1

目的分析重症肺炎患儿预后的影响因素及可溶性髓样细胞触发受体-1(sTREM-1)、高迁移率族蛋白B1(HMGB1)对其预测价值。方法回顾性纳入2020年1月-2022年9月苏州市吴江区儿童医院收治的重症肺炎患儿153例的临床资料进行研究,诊疗规范治疗1周后根据患儿预后将其分为预后良好组(n=118)和预后不良组(n=35);分析两组临床资料及血清sTREM-1、HMGB1水平,通过多因素Logistic回归分析法分析重症肺炎患儿预后的影响因素,并绘制受试者工作特征(ROC)曲线分析血清sTREM-1、HMGB1水平对重症肺炎患儿预后不良的预测价值。结果153例重症肺炎患儿预后不良情况35例,预后不良发生率为22.88%;多因素Logistic分析结果显示,病变累及多个肺叶、致病菌种类、序贯器官衰竭估计(SOFA)评分是重症肺炎患儿预后不良的危险因素(P<0.05);预后不良组血清sTREM-1、HMGB1水平高于预后良好组(P<0.05);ROC曲线显示sTREM-1、HMGB1单独及联合检测预测重症肺炎患儿不良预后的曲线下面积(AUC)分别为0.850、0.742、0.925,敏感性为81.36%、62.86%、88.57%,特异性为80.00%、80.51%、88.98%,联合检测均最高。结论重症肺炎患儿病变累及多个肺叶、致病菌种类、SOFA评分为重症肺炎患儿发生预后不良的危险因素。联合检测血清sTREM-1、HMGB1水平预测患儿预后的价值较高。

OBJECTIVE To analyze the factors influencing the prognosis of children with severe pneumonia and the predictive value of soluble myeloid cell trigger receptor-1(sTREM-1)and high mobility group protein B1(HMGB1).METHODS The clinical data of 153children with severe pneumonia admitted to Wujiang District Children′s Hospital of Suzhou City from Jan.2020to Sep.2022were retrospectively included in the study,and the children were divided into a good prognosis group(n=118)and a poor prognosis group(n=35)according to their prognosis after 1week of standardized treatment.The clinical data and serum sTREM-1and HMGB1levels of the two groups were analyzed.The influencing factors of prognosis of children with severe pneumonia were analyzed by multivariate logistic regression analysis,and the predictive value of sTREM-1and HMGB1on the poor prognosis of children with severe pneumonia was analyzed by receiver operating characteristics(ROC)curve.RESULTS A total of 35cases of 153children with severe pneumonia had a poor prognosis,and the incidence of poor prognosis was 22.88%.The results of multivariate logistic analysis showed that lesion involving multiple lobes of the lungs,causative pathogen species,and score of sequential organ failure assessment(SOFA)were the risk factors for poor prognosis in children with severe pneumonia(P<0.05).The levels of serum sTREM-1and HMGB1in poor prognosis group were higher than those in good prognosis group(P<0.05).The ROC curve showed that the area under the curve(AUC)of sTREM-1and HMGB1alone and in combination to predict poor prognosis in children with severe pneumonia was 0.850,0.742,and 0.925,respectively,with sensitivities of 81.36%,62.86%,88.57%,and specificities of 80.00%,80.51%,88.98%,with the combination detection being the highest.CONCLUSION In children with severe pneumonia,lesions involving multiple lobes of the lungs,causative pathogenic bacteria,and score of SOFA were risk factors for poor prognosis in children with severe pneumonia.The combined detection of serum levels of sTREM-1and HMGB1was of high value in predicting the prognosis of children.