重症肺炎患儿C反应蛋白/前白蛋白、颗粒蛋白前体、沉默信息调节因子相关酶3的表达及其预后价值

C-reactive protein/prealbumin in children with severe pneumonia,granuloprotein precursors,silencing information regulators expression of related enzyme 3 and its prognostic value

目的探讨重症肺炎患儿血清颗粒蛋白前体(PGRN)、沉默信息调节因子相关酶3(SIRT3)水平、C反应蛋白/前白蛋白变化及其对预后价值。方法本研究为随机对照研究,选取2021年1月至2023年1月金水区总医院儿科收治的96例重症肺炎患儿作为重症肺炎组,男51例,女45例,年龄(5.89±1.08)岁,年龄范围为3~9岁;另选取同期郑州市金水区总医院儿科收治的48例轻中症肺炎患儿作为轻中症肺炎组,男28例,女20例,年龄(6.22±1.36)岁,年龄范围为2~10岁;选取同期于郑州市金水区总医院儿科行体格检查的32名健康小儿作为健康组,男21名,女11名,年龄(6.09±1.17)岁,年龄范围为2~11岁。比较三组纳入者血清PGRN、SIRT3水平及C反应蛋白/前白蛋白比值。重症肺炎组予以常规治疗,依据治疗后3个月内预后情况分为预后良好者63例、预后不良者33例。比较不同预后患儿治疗后14 d血清PGRN、SIRT3水平及C反应蛋白/前白蛋白比值。采用Pearson法分析血清PGRN、SIRT3水平、C反应蛋白/前白蛋白与急性生理功能和慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、急性肺损伤评分量表(LIPS)相关性;多因素logistic回归分析预后影响因素;采用受试者操作特征(ROC)曲线评价血清PGRN、SIRT3水平、C反应蛋白/前白蛋白对预后的预测价值。结果重症肺炎组纳入者血清PGRN水平[(36.52±10.63)μg/L]、C反应蛋白/前白蛋白比值(0.95±0.21)高于轻中症肺炎组[(28.46±6.32)μg/L,(0.42±0.11)]与健康组[(16.31±3.43)μg/L,(0.06±0.01)],血清SIRT3水平[(3.26±0.88)pg/ml]低于轻中症肺炎组[(8.22±1.74)pg/ml]与健康组[(15.27±3.09)pg/ml];预后不良患儿急性呼吸窘迫综合征占比[36.4%(12/33)]、严重肺部影像学改变占比[90.9%(30/33)]、APACHEⅡ评分[(21.96±4.32)分]、LIPS评分[(11.63±2.17)分]高于预后良好患儿[4.8%(3/63)、63.5%(40/63)、(15.20±3.52)分、(5.92±1.33)分],差异有统计学意义(P<0.05)。治疗后14 d,预后不良患儿血清PGRN水平[(28.84±8.61)μg/L]、C反应蛋白/前白蛋白比值(0.68±0.21)高于预后良好患儿[(20.52±3.84)μg/L、(0.22±0.05)];预后不良者血清SIRT3水平[(5.38±1.29)pg/ml]低于预后良好患儿[(8.55±2.15)pg/ml],差异有统计学意义(P<0.05)。PGRN、C反应蛋白/前白蛋白比值与APACHEⅡ、LIPS评分呈正相关,SIRT3与APACHEⅡ、LIPS评分呈负相关(P<0.05)。血清PGRN水平、C反应蛋白/前白蛋白比值升高为预后不良的独立危险因素,SIRT3水平升高为预后不良的独立保护因素(P<0.05)。ROC曲线结果显示,血清PGRN、SIRT3水平、C反应蛋白/前白蛋白联合预测预后的曲线下面积大于单项指标预测(P<0.05)。结论重症肺炎患儿血清PGRN水平、C反应蛋白/前白蛋白比值升高,而SIRT3水平降低,其与病情严重程度、预后不良密切相关,联合检测其水平对预后具有一定预测价值。

Objective To investigate the changes of serum granuloprotein precursor(PGRN),silence-information regulator associated enzyme 3(SIRT3),C-reactive protein/prealbumin and their prognostic value in children with severe pneumonia.Methods This study was a randomized controlled study,a total of 96 children with severe pneumonia admitted who received in the Pediatrics department of the the General Hospital of Jinshui District Zhengzhou City from January 2021 to January 2023 as the severe pneumonia group,including 51 males and 45 females,aged(5.89±1.08)years old,ranging from 3 to 9 years old.Another 48 children with mild to moderate pneumonia admitted who received in the Pediatrics department of the General Hospital of Jinshui District Zhengzhou City from during the same period were selected as the mild and moderate pneumonia group,including 28 males and 20 females,aged(6.22±1.36)years old,ranging from 2 to 10 years old.A total of 32 healthy children who have a physical examination of the General Hospital of Jinshui District Zhengzhou City from during the same period were selected as healthy group,including 21 males and 11 females,aged(6.09±1.17)years old,ranging from 2 to 11 years old.Serum levels of PGRN,SIRT3 and the ratio of C-reactive protein/prealbumin were compared among the 3 groups.The severe pneumonia group was given routine treatment,and was divided into 63 cases with good prognosis and 33 cases with poor prognosis according to the prognosis within 3 months after treatment.The serum levels of PGRN,SIRT3 and the ratio of C-reactive protein/prealbumin were compared 14 d after treatment in children with different prognosis.Pearson method was used to analyze the correlation between serum PGRN,SIRT3,C-reactive protein/prealbumin,acute physiology and chronic health e-valuationⅡ(APACHEⅡ)and lung injury prediction score(LIPS).Multivariate logistic regression analysis of prognostic factors,the predictive value of serum PGRN,SIRT3 and C-reactive protein/prealbumin were evaluated by receiver operating characteristic(ROC)curve.Results Serum PGRN level[(36.52±10.63)μg/L],C-reactive protein/prealbumin ratio(0.95±0.21)in severe pneumonia group were higher than those in mild and moderate pneumonia group[(28.46±6.32)μg/L,(0.42±0.11)]and healthy group[(16.31±3.43)μg/L,(0.06±0.01)],serum SIRT3 level[(3.26±0.88)pg/ml]was lower than that of mild and moderate pneumonia group[(8.22±1.74)pg/ml]and healthy group[(15.27±3.09)pg/ml].The ratio of acute respiratory distress[36.4%(12/33)],severe pulmonary imaging changes[90.9%(30/33)],APACHEⅡscore[(21.96±4.32)points]and LIPS score[(11.63±2.17)points]in children with poor prognosis were higher than those in children with good prognosis[4.8%(3/63),63.5%(40/63),(15.20±3.52)points,(5.92±1.33)points],the differences were statistically significant(P<0.05).At 14 d after the treatment,serum PGRN level[(28.84±8.61)μg/L]and C-reactive protein/prealbumin ratio(0.68±0.21)in children with poor prognosis were higher than those in children with good prognosis[(20.52±3.84)μg/L and(0.22±0.05)],the serum SIRT3 level in patients with poor prognosis[(5.38±1.29)pg/ml]was lower than that in children with good prognosis[(8.55±2.15)pg/ml],and the differences were statistically significant(P<0.05).PGRN and C-reactive protein/prealbumin ratio were positively correlated with APACHEⅡand LIPS scores,and SIRT3 was negatively correlated with APACHEⅡand LIPS scores(P<0.05).The increase of serum PGRN level and C-reactive protein/prealbumin ratio were independent risk factors for poor prognosis,and the increase of SIRT3 level was independent protective factor for poor prognosis(P<0.05).ROC curve results showed that the area under the curve of serum PGRN,SIRT3 and C-reactive protein/prealbumin combined predicted prognosis was larger than that predicted by single index(P<0.05).Conclusions Serum PGRN level,C-reactive protein/prealbumin level increased,and SIRT3 level decreased in children with severe pneumonia,which is closely related to the severity of the disease and poor prognosis,combined detection of their levels has a certain prognostic value.