T淋巴细胞亚群、Th1/Th2细胞和血清SAA变化对急诊儿童急性重症肺炎心肌损伤的预测

Prediction of myocardial injury in children with acute severe pneumonia in emergency department by T lymphocyte subsets,Th1/Th2 cells and serum SAA expression

目的分析T淋巴细胞亚群、辅助性T细胞1/辅助性T细胞2(Th1/Th2)和血清淀粉样蛋白A(SAA)对急诊儿童急性重症肺炎心肌损伤的预测价值。方法选取儿童急性重症肺炎心肌损伤60例为观察组,轻症肺炎50例为对照组,同期体检健康儿童58例为健康组。检测心肌损伤指标、免疫球蛋白(Ig)、淋巴细胞亚群(CD^(+))、动脉血气及乳酸清除率。分析急性重症肺炎心肌损伤的影响因素,以及各指标对急性重症肺炎患儿心肌损伤的预测价值。结果观察组和对照组CD3^(+)、CD4^(+)、Th1/Th2、IgA、IgM、IgG、氧分压(PaO 2)低于健康组,肌钙蛋白I、肌酸激酶同工酶(CK-MB)、SAA、CD8^(+)、CD19^(+)、CD23^(+)、CD40^(+)、乳酸清除率高于健康组,且观察组变化更为显著(P<0.05)。SAA、CD8^(+)、CD3^(+)、CD4^(+)、Th1/Th2是急性重症肺炎心肌损伤的影响因素(P<0.05)。T淋巴细胞亚群、Th1/Th2细胞和SAA联合预测急性重症肺炎心肌损伤的曲线下面积高于各指标单独应用(P<0.05)。结论T淋巴细胞亚群、Th1/Th2细胞和血清SAA对急诊儿童急性重症肺炎心肌损伤具有较高的预测价值。

Aim To analyze the prediction of myocardial injury in children with acute severe pneumonia in emergency department by lymphocyte subsets,helper T cell 1/Helper T cell 2(Th1/Th2)and serum amyloid A(SAA)expression changes.Methods 60 children with acute severe pneumonia myocardial injury were selected as the observation group,50 children with mild pneumonia were selected as the control group,and 58 healthy children who underwent physical examination during the same period were selected as the health group.Myocardial injury index,immunoglobulin(Ig)level,lymphocyte subsets(CD^(+)),arterial blood gas and lactate clearance rate were detected.The influencing factors of myocardial injury in acute severe pneumonia,and the value of various indicators in predicting adverse prognosis in children with acute severe pneumonia myocardial injury were analyzed.Results CD3^(+),CD4^(+),Th1/Th2,IgA,IgM,IgG,oxygen partial pressure(PaO 2)of observation group and control group was lower than that of the healthy group,while troponin I,creatine kinase isoenzyme(CK-MB)SAA,CD8^(+),CD19^(+),CD23^(+),CD40^(+),the lactate clearance rate is higher than that of the healthy group,and the observation group showed more significant changes(P<0.05).SAA,CD8^(+),CD3^(+),CD4^(+),and Th1/Th2 were the influencing factors of myocardial injury in acute severe pneumonia(P<0.05).The area under the curve of T lymphocyte subpopulations,Th1/Th2 cells,and SAA combined prediction of acute severe pneumonia myocardial injury was higher than that of individual indicators(P<0.05).Conclusion The changes of T lymphocyte subsets,Th1/Th2 cells and serum SAA expression have high application value in the prediction of myocardial injury in children with acute severe pneumonia in emergency department.