血清E-选择素、维生素A与早产儿呼吸窘迫综合征严重程度的关系及对死亡的预测效能研究

The Relationship between Serum E-selectin and Vitamin A and the Severity of Respiratory Distress Syndrome in Premature Newborns and the Predictive Efficacy of Death

目的:探讨血清E-选择素、维生素A与早产儿呼吸窘迫综合征严重程度的关系及对死亡的预测效能。方法:选择2021年1月至2022年12月来我院诊治的早产儿82例。所有早产儿入院时均行胸部X线正位片检查,根据早产儿入院时胸部X线正位片描述,将呼吸窘迫综合征分为4级,行血清E-选择素、维生素A检测。分析82例早产儿中呼吸窘迫综合征的发生情况,对比呼吸窘迫综合征组与非呼吸窘迫综合征组的血清E-选择素、维生素A水平;分析呼吸窘迫综合征患儿中不同分级患儿的情况,对比不同分级患儿的血清E-选择素、维生素A水平;记录呼吸窘迫综合征早产儿的预后,对比生存组及死亡组的血清E-选择素、维生素A水平;使用ROC曲线分析血清E-选择素、维生素A对早产儿呼吸窘迫综合征的严重程度及死亡的预测价值。结果:非呼吸窘迫综合征组的血清E-选择素明显较呼吸窘迫综合征组低,血清维生素A明显较呼吸窘迫综合征组高(P<0.05)。不同分级呼吸窘迫综合征患儿血清E-选择素、维生素A水平对比有统计学意义(P<0.05);IV级组的血清E-选择素水平明显较Ⅰ级、Ⅱ级、Ⅲ级高,维生素A明显较低;Ⅲ级组血清E-选择素水平明显较Ⅰ级、Ⅱ级高,维生素A明显较低;Ⅱ级组血清E-选择素水平明显较Ⅰ级高,维生素A明显较低(P<0.05)。死亡组患儿的血清E-选择素水平明显较生存组低,维生素A明显较高(P<0.05)。新生儿呼吸窘迫综合征患儿中,轻症组26例,重症组36例,血清E-选择素的诊断灵敏度为0.962,特异度为0.914,截断值为63.185ng/L,AUC为0.979,95%CI为0.952~1.000,P=0.000;维生素A的诊断灵敏度为0.808,特异度为0.886,截断值为0.635μmol/L,AUC为0.891,95%CI为0.803~0.980,P=0.000。血清E-选择素的诊断灵敏度为0.907,特异度为0.895,截断值为72.560 ng/L,AUC为0.931,95%CI为0.869~0.994,P=0.000;维生素A的诊断灵敏度为0.721,特异度为0.842,截断值为0.570μmol/L,AUC为0.841,95%CI为0.747~0.936,P=0.000。结论:血清E-选择素、维生素A可用于评估早产儿呼吸窘迫综合征严重程度,预测呼吸窘迫综合征患儿的死亡。

Objective:To investigate the relationship between serum E-selectin and vitamin A and the severity of neonatal respiratory distress syndrome(ARDS)and their predictive efficacy in death.Methods:82 premature infants were selected from January 2021 to December 2022.All premature infants were examined by chest radiograph at admission.According to the description of chest radiograph at admission,respiratory distress syndrome was divided into 4 grades,and serum e-selectin and vitamin A were detected.The incidence of respiratory distress syndrome(ARDS)in 82 premature infants was analyzed.The serum E-selectin and vitamin A levels were compared between ARDS group and non-DS group.The levels of serum E-selectin and vitamin A in different grades of children with respiratory distress syndrome were compared.The prognosis of premature infants with respiratory distress syndrome was recorded,and the levels of serum E-selectin and vitamin A were compared between survival group and death group.ROC curve was used to analyze the predictive value of serum E-selectin and vitamin A on the severity and death of premature neonatal respiratory distress syndrome.Results:The serum E-selectin and serum vitamin A in the non-respiratory distress syndrome group were lower than those in the respiratory distress syndrome group(P<0.05).The levels of serum E-selectin and vitamin A in children with different grades of respiratory distress syndrome were significant(P<0.05).The level of serum E-selectin in grade IV group was higher than that in gradeⅠ,ⅡandⅢ,and vitamin A was lower than that in grade IV group.The level of serum E-selectin in groupⅢwas higher than that in groupⅠand groupⅡ,and vitamin A was lower.The level of serum E-selectin in groupⅡwas higher than that in groupⅠ,and vitamin A was significantly lower,all P<0.05.The level of serum E-selectin and vitamin A in the death group were lower than those in the survival group(P<0.05).The diagnostic sensitivity of serum e-selectin was 0.962,specificity was 0.914,truncation value was 63.185ng/L,AUC was 0.979,95%CI was 0.952~1.000,P=0.000.The diagnostic sensitivity of vitamin A was 0.808,specificity was 0.886,truncation value was 0.635μmol/L,AUC was 0.891,95%CI was 0.803-0.980,P=0.000.The diagnostic sensitivity of serum E-selectin was 0.907,specificity was 0.895,cut-off value was 72.560 ng/L,AUC was 0.931,95%CI was 0.869~0.994,P=0.000.The diagnostic sensitivity of vitamin A was 0.721,specificity was 0.842,truncation value was 0.570μmol/L,AUC was 0.841,95%CI was 0.747-0.936,P=0.000.Conclusion:Serum E-selectin,vitamin A can be used to evaluate the severity of premature neonatal respiratory distress syndrome and predict the death of infants with respiratory distress syndrome.