血清25羟维生素D与淀粉样蛋白A及半乳糖凝集素-3在小儿支原体肺炎中的水平及诊断价值

Levels and diagnostic value of serum 25 hydroxyvitamin D with amyloid A and galectin-3 in paediatric mycoplasma pneumonia

目的探讨支原体肺炎患儿血清25羟维生素D[25 hydroxyvitamin D,25-(OH)D3]与淀粉样蛋白A(serum amyloid A,SAA)及半乳糖凝集素-3(galactagogue-3,Gal-3)中的水平并判断其诊断价值。方法本研究于2022年5月—2023年5月共招募南阳医学高等专科学校第二附属医院收治的125例支原体肺炎患儿作为肺炎组,并纳入同期收治在本院进行体检的120例健康儿童为对照组,检测两组患儿的血清SAA、25-(OH)D3和Gal-3水平。并根据肺炎组患儿的病情严重程度将其分为轻症组(n=73)和重症组(n=52),采用Pearson相关性分析法分析上述标志物与疾病严重程度的相关性,并利用受试者工作曲线(ROC)分析血清因子水平的诊断效能。结果肺炎组的血清SAA、Gal-3水平高于对照组,25-(OH)D3水平较低(均P<0.05)。重症组患儿的血清SAA、Gal-3水平均较轻症组偏高,25-(OH)D3水平较高(均P<0.05)。支原体肺炎患儿的血清SAA、Gal-3水平均与疾病严重程度呈正相关(r=0.662,0.714,P<0.05);与血清25-(OH)D3水平呈负相关(r=-0.411,P<0.05)。ROC曲线分析结果显示,血清25-(OH)D3、Gal-3和SAA水平单独检测诊断小儿支原体肺炎的AUC分别为0.647(0.520~0.774)、0.750(0.638~0.862)和0.845(0.756~0.933)。三项血清指标联合检测的AUC升高至0.938(0.889~0.987),敏感度和特异度分别为96.88%和77.56%。在评估疾病严重程度方面,血清Gal-3、SAA和25-(OH)D3水平对疾病炎症程度的AUC依次为0.797(0.693~0.900)、0.660(0.529~0.791)和0.554(0.419~0.689),联合检测的AUC为0.875(0.794~0.956)。结论血清SAA、Gal-3和25-(OH)D3水平均可作为临床监测小儿支原体肺炎的有效指标,同时对其病情评估也具有较高的指导价值,联合检测的诊断价值更高。

Objective To determine the diagnostic value of serum hydroxyvitamin D[(25-(OH)D3)]and serum amyloid A,(SAA)and galactagogue-3(Gal-3)in children with serum Mycoplasma pneumonia.Methods A total of 125 children with Mycoplasma pneumonia were recruited from May 2022 to May 2023 to join this study as the pneumonia group,and 120 healthy children admitted to the Second Affiliated Hospital of Nanyang Medical College for physical examination during the same period were included as the control group,and serum SAA,25-(OH)D3and Gal-3 levels were detected in both groups.The children in the pneumonia group were divided into the mild group(n=73)and the severe group(n=52)according to the severity of the disease,and the correlation between the above markers and the severity of the disease was analysed by Pearson correlation analysis,and the diagnostic efficacy of the serum factor levels was analysed by using the receiver operating curve(ROC).Results Serum SAA and Gal-3 levels were higher and 25-(OH)D3 levels were lower in the pneumonia group than those in the control group(all P<0.05).Children in the severe group had higher serum SAA and Gal-3 levels and higher 25-(OH)D3 levels than those in the mild group(all P<0.05).The serum SAA and Gal-3 levels of children with mycoplasma pneumonia were positively correlated with the severity of the disease(r=0.662,0.714,P<0.05);and negatively correlated with the serum 25-(OH)D3 level(r=-0.411,P<0.05).ROC curve analysis showed that the AUC of serum 25-(OH)D3,Gal-3 and SAA levels alone for the diagnosis of pediatric mycoplasma pneumonia were 0.647(0.520~0.774),0.750(0.638~0.862)and 0.845(0.756~0.933),respectively.The AUC of the combined test of the three serum indicators increased to 0.938(0.889~0.987),with a sensitivity and specificity of 96.88%and 77.56%,respectively.In assessing the severity of the disease,the AUCs of serum Gal-3,SAA and 25-(OH)D3 levels for the degree of inflammation of the disease were,in order,0.797(0.693~0.900),0.660(0.529~0.791)and 0.554(0.419~0.689),and that of the combined assay was 0.875(0.794~0.956).Conclusion Serum SAA,Gal-3 and 25-(OH)D3 levels can all be used as effective indicators for clinical monitoring of paediatric mycoplasma pneumonia,as well as a high guiding value for the assessment of its condition,and the diagnostic value of the combined test is even higher.