HBP、LDH、D-D、IL-6在社区获得性肺炎患儿病情严重程度评估中的临床价值

Clinical Value of HBP,LDH,D-D and IL-6 in Evaluating Severity of Community-acquired Pneumonia in Children

目的分析肝素结合蛋白(HBP)、乳酸脱氢酶(LDH)、D-二聚体(D-D)及白细胞介素-6(IL-6)在社区获得性肺炎(CAP)患儿病情严重程度评估中的临床价值。方法选取2020年6月至2021年6月在潍坊市妇幼保健院就诊的68例CAP患儿作为研究对象,根据是否发生重症CAP分为非重症CAP组(35例)和重症CAP组(33例);选取同期30例健康体检儿童作为对照组。比较三组的血清HBP、LDH、D-D、IL-6水平,采用二分类Logistic回归分析研究影响重症CAP发生的因素,绘制受试者工作特征曲线(ROC曲线)检测各指标识别重症CAP的曲线下面积(AUC)、灵敏度、特异度。结果三组的血清HBP、LDH、D-D、IL-6水平比较差异有统计学意义(均P<0.01)。非重症CAP组、重症CAP组的血清HBP、LDH、D-D、IL-6水平均高于对照组(P<0.05),且重症CAP组均高于非重症CAP组[61(33,78)μg/L比32(21,41)μg/L、325(270,350)U/L比256(225,274)U/L、1.45(1.02,3.21)mg/L比0.84(0.60,0.97)mg/L、26.96(18.84,64.96)ng/L比5.92(3.91,15.83)ng/L](P<0.05)。Logistic回归分析显示,HBP、LDH、D-D、IL-6均是重症CAP发生的独立危险因素(P<0.05)。ROC曲线结果显示,血清HBP、LDH、D-D、IL-6以及联合检测预测重症CAP发生的AUC分别为0.783、0.802、0.870、0.867和0.971,4项指标联合检测预测重症CAP的灵敏度为90.90%,特异度为91.40%。结论血清HBP水平对判断CAP患儿病情严重程度有一定价值,血清HBP、LDH、D-D、IL-6是重症CAP发生的独立危险因素,联合检测有助于早期识别重症CAP。

Objective To analyze the clinical value of heparin binding protein(HBP),lactate dehydrogenase(LDH),D-dimer(D-D),and interleukin-6(IL-6)in the severity assessment of community-acquired pneumonia(CAP)in children.Methods A total of 68 children with CAP treated at Weifang Maternal and Child Health Hospital from Jun.2020 to Jun.2021 were included.They were divided into a severe CAP group(33 cases)and a non-severe CAP group(35 cases)according to whether severe CAP has occurred;30 healthy children undergoing physical examination during the same period were included as a control group.The serum levels of HBP,LDH,D-D,and IL-6 in the three groups were compared,and binary Logistic regression analysis was used to study the factors affecting the occurrence of severe CAP.A receiver operator characteristic curve(ROC curve)was drawn to detect the area under the curve(AUC),sensitivity,and specificity of each indicator in identifying severe CAP.Results There was a statistically significant difference in the levels of serum HBP,LDH,D-D,and IL-6 between the three groups(all P<0.01).The serum HBP,LDH,D-D,and IL-6 levels in the non-severe CAP group and severe CAP group were all higher than those in the control group(P<0.05),and the severe CAP group was higher than the non-severe CAP group[61(33,78)μg/L vs 32(21,41)μg/L,325(270,350)U/L vs 256(225,274)U/L,1.45(1.02,3.21)mg/L vs 0.84(0.60,0.97)mg/L,26.96(18.84,64.96)ng/L vs 5.92(3.91,15.83)ng/L](P<0.05).Logistic regression analysis showed that HBP,LDH,D-D,and IL-6 were independent risk factors for the occurrence of severe CAP(P<0.05).The ROC curve results showed that the AUC of serum HBP,LDH,D-D,IL-6,and combined detection for predicting the occurrence of severe CAP were 0.783,0.802,0.870,0.867,and 0.971,respectively.The sensitivity and specificity of the combined detection of the four indicators for predicting severe CAP were 90.90%and 91.40%,respectively.Conclusion The serum HBP level has certain value in determining the severity of CAP in children.Serum HBP,LDH,D-D,and IL-6 are independent risk factors for the occurrence of severe CAP.Combined detection is helpful for early identification of severe CAP.