肺部超声联合白细胞介素在新生儿感染性肺炎诊断和预后评估中的价值研究

Study on the value of lung ultrasound combined with interleukin in the diagnostic and prognostic evaluation of neonatal infectious pneumonia

目的探讨肺部超声联合白细胞介素23(IL-23)、IL-17在新生儿感染性肺炎中的诊断和预后评估价值。方法选取河北省石家庄市人民医院2020年6月至2023年8月收治124例新生儿感染性肺炎患儿作为肺炎组,根据新生儿危重症评分分为非危重组(>90分,72例)和危重组(≤90分,52例)。另选取同期因黄疸住院未合并肺部并发症的124例新生儿作为对照组。根据新生儿感染性肺炎治疗7 d后超声检查情况及症状将患儿分为预后良好组和预后不良组。所有患儿入院后接受肺部超声检查评价肺部超声评分,采用酶联免疫吸附试验法检测血清IL-23、IL-17水平。比较各分组类别患儿肺部超声评分和血清IL-23、IL-17水平,采用受试者工作特征(ROC)曲线分析以上指标对新生儿感染性肺炎的诊断和预后评估价值。结果肺炎组肺部超声评分和血清IL-23、IL-17水平均高于对照组(均P<0.05);危重组肺部超声评分和血清IL-23、IL-17水平均明显高于非危重组(均P<0.05);预后良好组肺部超声评分和血清IL-23、IL-17水平均明显低于预后不良组(均P<0.05)。ROC曲线分析结果显示,肺部超声评分、IL-23、IL-17联合诊断新生儿感染性肺炎的曲线下面积为0.901,显著大于各指标单独诊断(Z=4.209、3.492、3.748,均P<0.05);三者联合评估新生儿感染性肺炎预后的曲线下面积为0.954,显著高于各指标单独评估(Z=2.472、2.048、2.839,均P<0.05)。结论新生儿感染性肺炎患儿肺部超声评分和血清IL-23、IL-17水平均明显升高,其水平与病情及预后密切相关。三者联合对新生儿感染性肺炎诊断和预后评估的效能较佳。

Objective To investigate the diagnostic and prognostic evaluation value of lung ultrasound combined with interleukin-23(IL-23)and interleukin-17 in neonatal infectious pneumonia.Methods A total of 124 neonates with infectious pneumonia admitted to Shijiazhuang People′s Hospital,Hebei Province from June 2020 to August 2023 were selected as the pneumonia group.According to the neonatal critical illness score,they were divided into non-critical group(>90,72 cases)and critical group(≤90,52 cases).Another 124 neonates hospitalized for jaundice without pulmonary complications during the same period were selected as the control group.According to the ultrasound examination and symptoms after 7 d of treatment,the neonates with infectious pneumonia were divided into good prognosis group and poor prognosis group.All children underwent lung ultrasound examination after admission to evaluate the lung ultrasound score,and the serum levels of IL-23 and IL-17 were measured by enzyme-linked immunosorbent assay.The lung ultrasound scores and serum levels of IL-23 and IL-17 in each group were compared.The receiver operating characteristic(ROC)curve was used to analyze the value of the above indexes in the diagnostic and prognostic evaluation of neonatal infectious pneumonia.Results The lung ultrasound score and serum levels of IL-23 and IL-17 in the pneumonia group were higher than those in the control group(all P<0.05).The lung ultrasound score and serum levels of IL-23 and IL-17 in the critical group were significantly higher than those in the non-critical group(all P<0.05).The lung ultrasound score and serum levels of IL-23 and IL-17 in the good prognosis group were significantly lower than those in the poor prognosis group(all P<0.05).ROC curve analysis showed that the area under the curve(AUC)of lung ultrasound score combined with IL-23 and IL-17 in the diagnosis of neonatal infectious pneumonia was 0.901,which was significantly larger than that of each index alone(Z=4.209,3.492,3.748,all P<0.05).The AUC of the combination of the three indicators in evaluating the prognosis of neonatal infectious pneumonia was 0.954,which was significantly larger than that of each indicator alone(Z=2.472,2.048,2.839,all P<0.05).Conclusion The lung ultrasound scores and serum levels of IL-23 and IL-17 were significantly increased in the neonates with infectious pneumonia,and the levels of them were closely related to the severity and prognosis of the disease.The combination of the three methods has better efficacy in the diagnosis and prognosis evaluation of neonatal infectious pneumonia.