摘要
目的探讨不同病情严重程度急性呼吸窘迫综合征患儿血清自分泌运动因子(ATX)、CD5抗原样蛋白(CD5L)、成纤维细胞生长因子21(FGF21)水平的变化及其与预后的关系。方法选取2019年4月至2020年4月期间华北理工大学附属唐山市妇幼保健院收治的125例急性呼吸窘迫综合征患儿为研究对象,依据氧合指数(OI)将其分为轻度组(n=55)、中度组(n=38)、重度组(n=32),依据患儿住院28d的临床结局将其分为生存组(n=102)与死亡组(n=23)。比较不同病情严重程度及预后患儿血清ATX、CD5L、FGF21水平的变化情况,采用多因素Logistic回归分析急性呼吸窘迫综合征患儿住院28d死亡的影响因素,以受试者工作特征(ROC)曲线分析血清ATX、CD5L、FGF21水平对患儿死亡的预测价值。结果重度组的血清ATX水平较中度组和轻度组均有所升高,血清CD5L和FGF21水平均有所降低(F值分别为55.865、14.275、27.470,P<0.05)。死亡组血清ATX水平高于生存组(t=5.430,P<0.05),血清CD5L和FGF21水平均低于生存组(t值分别为3.058、6.888,P<0.05)。死亡组与生存组的机械通气时间、小儿危重病例评分(PCIS)、OI比较差异均有统计学意义(t值分别为6.233、5.153、14.505,P<0.05)。多因素Logistic回归分析显示,OI升高[OR=1.203,95%CI:1.017~1.772]、机械通气时间延长[OR=2.055,95%CI:1.575~5.537]、血清ATX水平升高[OR=1.514,95%CI:1.118~2.051]均是急性呼吸窘迫综合征患儿死亡的危险因素(P<0.05),而血清CD5L水平升高[OR=0.704,95%CI:0.530~0.935]、血清FGF21水平升高[OR=0.837,95%CI:0.273~0.970]均是急性呼吸窘迫综合征患儿死亡的保护因素(P<0.05)。血清ATX、CD5L和FGF21水平单独及联合检测预测急性呼吸窘迫综合征患儿死亡的曲线下面积(AUC)分别为0.781、0.726、0.734、0.856,灵敏度分别为82.60%、69.57%、78.26%、87.96%,特异度分别为74.51%、71.57%、68.63%、82.35%,其中联合检测预测效能更高。结论血清ATX、CD5L、FGF21水�
Objective To investigate the changes in serum autocrine motility factor(ATX),CD5 antigen-like protein(CD5L),and fibroblast growth factor 21(FGF21)levels in children with acute respiratory distress syndrome of different disease severity and their relationship with prognosis.Methods 125 children with acute respiratory distress syndrome admitted to Tangshan Maternal and Child Healthcare Hospital affiliated to North China University of Science and Technology between April 2019 and April 2020 were selected for the study,and were divided into mild(n=55),moderate(n=38),and severe(n=32)groups based on the oxygenation index(OI).They were divided into survival group(n=102)and death group(n=23)according to the clinical outcome of 28 days in hospital.To compare the changes of serum ATX,CD5L and FGF21 levels in children with different disease severity and prognosis.Multivariate logistic regression analysis was used to analyse the factors influencing the death of children with acute respiratory distress syndrome who were hospitalised for 28d,The receiver operating characteristic(ROC)curve was used to analyse the predictive value of serum ATX,CD5L,and FGF21 levels on the death of children.Results Serum ATX levels were higher in the severe group than in the moderate and mild groups,and serum CD5L and FGF21 levels were lower(F=55.865,14.275,and 27.470,respectively,all P<0.05).Serum ATX levels were higher in the death group than in the survival group(t=5.430,P<0.05),and serum CD5L and FGF21 levels were lower than in the survival group(t=3.058 and 6.888,respectively,all P<0.05).The differences in mechanical ventilation time,PCIS score,and OI were statistically significant when comparing the death group with the survival group(t=6.233,5.153,and 14.505,respectively,all P<0.05).Multifactorial logistic regression analysis showed that elevated OI(OR=1.203,95%CI:1,017-1.772),prolonged duration of mechanical ventilation(OR=2.055,95%CI:1.575-5.537),and elevated serum ATX levels(OR=1.514,95%CI;1.118-2.051)were the most important factors in
作者
张慧玉
黄光举
李娟
ZHANG Huiyu;HUANG Guangju;LI Juan(Department of Pediatrics,Tangshan Maternal and Child Health Hospital Af filiated to North China University of Science and Technology,Hebei Tangshan 063000,China)
出处
《中国妇幼健康研究》
2023年第11期26-31,共6页
Chinese Journal of Woman and Child Health Research
基金
河北省2019年度医学科学研究课题计划(编号20191538)。
