闭塞性细支气管炎患儿血清LDH、SAA水平与病情严重程度及预后的关系

The Relationship Between the Expression of LDH and SAA in Serum and the Severity and Prognosis of Bronchiolitis Obliterans in Children

目的探讨闭塞性细支气管炎(BO)患儿血清乳酸脱氢酶(LDH)、淀粉样蛋白A(SAA)水平与病情严重程度及预后的关系。方法选取2020年5月至2023年5月本院收治的150例BO患儿作为观察组,根据患儿病情分为轻度组45例,中度组67例,重度组38例,另外选取150例同时期本院体检的健康儿童作为健康对照组。BO患儿经过治疗,根据治疗预后情况分为预后良好组(98例)和预后不良组(52例)。比较各组血清LDH、SAA水平;Pearson相关性分析血清LDH、SAA水平与肺功能指标每公斤体重潮气量(VT/kg)、达峰容积比(VPEF/VE)、达峰时间比(TPTEF/TE)的相关性;ROC曲线分析血清LDH、SAA对BO患儿预后不良的预测价值。结果与健康对照组相比,观察组血清LDH、SAA水平显著升高(P<0.05);轻度、中度、重度组BO患儿血清LDH、SAA水平及VT/kg、VPEF/VE、TPTEF/TE指标比较差异有统计学意义(P<0.05);与轻度组相比,中度组与重度组BO患儿血清LDH、SAA水平显著升高,VT/kg、VPEF/VE、TPTEF/TE指标显著降低(P<0.05);与中度组比较,重度组血清LDH、SAA水平显著升高,VT/kg、VPEF/VE、TPTEF/TE指标显著降低(P<0.05);BO患儿血清LDH、SAA水平与肺功能指标VT、VPEF/VE、TPTEF/TE呈负相关(P<0.001);与治疗前相比,治疗后血清LDH、SAA水平显著降低(P<0.05);与预后良好组相比,预后不良组血清LDH、SAA水平显著升高(P<0.05);ROC曲线分析显示血清LDH、SAA单独及二者联合预测BO患儿预后不良的AUC分别为0.869、0.782、0.931,而且二者联合的AUC要比单独预测的AUC高(Z=1.746,P=0.040;Z=3.434,P=0.001)。结论BO患儿血清LDH、SAA水平升高,与病情严重程度及预后有关,可能成为病情评估与预后判断的标志物。

Objective To explore the relationship between the expression of serum lactate dehydrogenase(LDH)and serum amyloid A(SAA)in children with bronchiolitis obliterans(BO)and the severity and prognosis.Methods A total of 150 children with BO who visited our hospital from May,2020 to May,2023 were regarded as the observation group.According to patients’condition,these patients were grouped into a mild group of 45 cases,a moderate group of 67 cases,and a severe group of 38 cases.In addition,150 healthy children who underwent physical examination in our hospital were enrolled as the healthy control group.After treatment,BO patients were further divided into a good prognosis group(98 cases)and a poor prognosis group(52 cases)based on the treatment prognosis.Levels of serum LDH and SAA in each group were compared;Pearson correlation was applied to evaluate the correlation between serum LDH,SAA levels and lung function indicators,such as tidal volume per kilogram body weight(VT/kg),peak volume ratio(VPEF/VE),and peak time ratio(TPTEF/TE);ROC curve was drawn to evaluate the predictive value of serum LDH and SAA for the poor prognosis in children with BO.Results Compared with the healthy control group,serum LDH and SAA levels in the observation group were significantly increased(P<0.05);There were statistically significant differences in serum LDH,and SAA levels,as well as VT/kg,VPEF/VE,and TPTEF/TE indicators among the mild,moderate,and severe BO groups(P<0.05);Compared with the mild group,serum LDH and SAA levels in the moderate and severe groups were significantly increased,while VT/kg,VPEF/VE,and TPTEF/TE indicators were significantly reduced(P<0.05);Compared with the moderate group,serum LDH and SAA levels in the severe group were significantly increased,while VT/kg,VPEF/VE,and TPTEF/TE indicators were significantly reduced(P<0.05);Serum LDH and SAA levels in children with BO were negatively correlated with lung function indicators VT/kg,VPEF/VE,and TPTEF/TE(P<0.001);Compared with before treatment,serum LDH and SAA levels were significantly decreased after treatment(P<0.05);Compared with the group with good prognosis,serum LDH and SAA levels in the group with poor prognosis were significantly increased(P<0.05);ROC curve analysis showed that AUCs of serum LDH and SAA alone and in combination for predicting poor prognosis in children with BO were 0.869,0.782,and 0.931,respectively.AUC of the two markers in combination was higher than AUC of alone(Z=1.746,P=0.040,Z=3.434,P=0.001).Conclusion Levels of serum LDH and SAA in children with BO are elevated.These markers are related to the severity and prognosis of condition,and may become novel markers for disease assessment and prognosis judgment.