肺部超声联合血清环状RNA锚蛋白重复结构域36评估新生儿急性呼吸窘迫综合征治疗效果和严重程度的价值

The value of pulmonary ultrasound combined with serum circular RNA ankyrin repeat domain 36 in evaluating the therapeutic effect and severity of neonatal acute respiratory distress syndrome

目的探讨肺部超声(LUS)、血清环状RNA锚蛋白重复结构域36(circANKRD36)水平在新生儿急性呼吸窘迫综合征(NRDS)疾病严重程度及治疗效果中的评估价值。方法选择郑州大学附属郑州中心医院2020年1月至2022年4月治疗的109例NRDS病儿为研究对象,根据氧合指数(OI)分为重度组(48例)、中度组(35例)和轻度组(26例);根据是否需要使用肺表面活性物质(PS)替代治疗分为对照组(29例)和观察组(80例)。收集病儿资料,并对所有病儿治疗前、治疗后12 h、治疗后24 h、治疗后72 h进行LUS检查,采用实时荧光定量逆转录聚合酶链反应(qRT-PCR)法检测病儿各时间点血清circANKRD36水平;绘制受试者操作特征曲线(ROC曲线),分析LUS评分及血清circANKRD36水平对NRDS病儿疾病严重程度的评估价值。结果轻度组、中度组、重度组治疗前LUS评分及血清circANKRD36水平依次升高(P<0.05)。以轻度组为对照,LUS评分、血清circANKRD36水平及二者联合评估中度NRDS的曲线下面积(AUC)分别为0.81、0.70、0.86;以中度组为对照,各指标评估重度NRDS的AUC分别为0.81、0.76、0.86。观察组治疗前肺实变、胸膜线异常、肺泡间质综合征、支气管充气征、胸腔积液比例均高于对照组(P<0.05)。观察组治疗前、治疗后12 h、治疗后24 h的LUS评分及血清circANKRD36水平均高于对照组(P<0.05)。经重复测量方差分析,两组LUS评分及血清circANKRD36水平在组间、时间、组间和时间存在交互效应(P<0.05),且观察组随治疗时间延长,LUS评分及血清circANKRD36水平依次降低(P<0.05)。观察组总有效率为95.00%(76/80),显著高于对照组的总有效率72.41%(21/29)(P<0.05)。观察组治疗后72 h肺实变、胸膜线异常、肺泡间质综合征、支气管充气征、胸腔积液比例显著低于治疗前(P<0.05)。结论LUS评分及血清circANKRD36水平可评估NRDS病儿疾病严重程度,且二者联合的评估价值更高,同时可实时监测病儿治疗效果。

Objective To investigate the evaluation value of lung ultrasound(LUS)and serum levels of circular RNA ankyrin repeat domain 36(circANKRD36)for the severity of disease and treatment effect with neonatal acute respiratory distress syndrome(NRDS).Methods A total of 109 children with NRDS treated in Zhengzhou Central Hospital Affiliated to Zhengzhou University from January 2020 to April 2022 were regarded as the research objects,and they were grouped into severe group(48 cases),moderate group(35 cases)and mild group(26 cases)according to the oxygenation index(OI).The patients were grouped into control group(29 cases)and observation group(80 cases)according to whether pulmonary surfactant(PS)replacement therapy was needed.The data of the children were collected,LUS was examined before treatment,12 hours after treatment,24 hours after treatment,and 72 hours after treatment in all children,and 72 hours after treatment.The serum circANKRD36 level of children at various time points was detected by real-time fluorescent quantitative PCR(qRT-PCR);receiver operating characteristic(ROC)curve was drawn to analyze the value of LUS score and serum circANKRD36 level in assessing disease severity in children with NRDS.Results The LUS score and serum circANKRD36 level in mild group,moderate group and severe group increased in sequence before treatment(P<0.05).With the mild group as the control,the area under the curve(AUC)of LUS score,serum circANKRD36 level and their combined assessment for moderate NRDS was 0.81,0.70,and 0.86,respectively;with the moderate group as the control,the AUC of each index for evaluating severe NRDS was 0.81,0.76,and 0.86,respectively.The proportions of lung consolidation,abnormal pleural line,alveolar interstitial syn-drome,air bronchi sign,and pleural effusion in the observation group were higher than those in the control group(P<0.05).The LUS score and serum circANKRD36 level in the observation group before treatment,12 hours after treatment and 24 hours after treatment were higher than those in the control group(P<0.05).After repeated measures analysis of variance,the LUS scores and serum circAN-KRD36 levels in the two groups had interactive effects between groups,time,between groups,and time(P<0.05),and the LUS scores and serum circANKRD36 levels in the observation group decreased with the prolongation of treatment time(P<0.05).The total effective rate of the observation group was 95.00%(76/80),which was significantly higher than that of the control group[72.41%(21/29),P<0.05].The proportions of lung consolidation,abnormal pleural line,alveolar interstitial syndrome,air bronchus sign and pleural effu-sion in the observation group were obviously lower than before treatment(P<0.05).Conclusion LUS score and serum circANKRD36 level can evaluate the severity of the disease in children with NRDS,and the combination of the two has a higher evaluation value,and can monitor the treatment effect of children in real time.