儿童重症肺炎血清炎性因子及RNA异常表达与肺损伤和治疗结局的相关性

张贵英; 胡阳; 黄波; 高红亮; 朱孟沙

doi:10.16766/j.cnki.issn.1674-4152.002972

儿童重症肺炎血清炎性因子及RNA异常表达与肺损伤和治疗结局的相关性

doi: 10.16766/j.cnki.issn.1674-4152.002972

河北省儿童医院重症医学二科，河北石家庄 050031

基金项目:

河北省卫健委医学科学研究课题项目 20190848

详细信息

通讯作者:
朱孟沙，E-mail：zms19811982@126.com

中图分类号: R563.1 R446
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出版历程
- 收稿日期: 2022-11-28

Correlation between abnormal expression of serum inflammatory factors and RNA in children with severe pneumonia and lung injury and treatment outcomes

Second Department of Intensive Medicine, Hebei Children ' s Hospital, Shijiazhuang, Hebei 050031, China

摘要

摘要: 目的探究重症肺炎儿童血清炎性因子及RNA的异常表达及对患儿肺部及治疗的影响。方法选择2020年8月—2022年8月河北省儿童医院收治的158例肺炎患儿作为研究对象，其中重症肺炎72例，普通肺炎86例，另选取同期该院体检健康儿童80例作为对照组。分析比较各组RNA水平、LPS评分、血清炎症因子水平，并分析血清降钙素原(procalcitonin，PCT)、RNA水平对肺及不良结局的预测价值。结果重症组、普通组、对照组miRNA-221、miRNA-24水平依次升高，LPS评分依次降低，血清PCT、PGRN、CRP水平依次降低(均P＜0.05)。重症组治疗结局中存活患儿血清PCT水平低于死亡患儿，miRNA-221、miRNA-24水平高于死亡患儿(均P＜0.05)。据Pearson相关性分析，重症组患儿肺损伤及治疗结局与血清PCT与呈正相关关系，与miRNA-221、miRNA-24水平呈负相关关系(P﹤0.05)。Logistic回归分析显示，高水平的血清PCT、低水平的miRNA-221与miRNA-24为重症肺炎儿童发生肺损伤及治疗不良结局的独立危险因素(均P﹤0.05)。ROC曲线分析显示，血清PCT、miRNA-221、miRNA-24水平对疾病不良结局发生风险的特异性、敏感性分别为0.802、0.807、0.814；0.845、0.850、0.858，有较高的预测价值(AUC＞0.70)。结论儿童重症肺炎血清PCT和miRNA-221、miRNA-24异常表达与患儿发生肺损伤和治疗不良结局密切相关，是其独立危险因素，并对其有良好的预测价值。
- 重症肺炎 /
- 血清PCT /
- miRNA-221 /
- miRNA-24 /
- 肺损伤 /
- 治疗结局
Abstract: Objective To investigate the abnormal expression of serum inflammatory factors and RNA in children with severe pneumonia, and explore its effect on the lungs and treatment of children. Methods A total of 158 children with pneumonia admitted to Hebei Children ' s Hospital from August 2020 to August 2022 were selected as the study subjects, including 72 cases of severe pneumonia (severe group) and 86 cases of common pneumonia (general group). In addition, 80 healthy children who underwent physical examination in the hospital during the same period were selected as the control group. RNA levels, LPS scores, and serum inflammatory factor levels in each group were analyzed and compared, and the predictive value of serum procalcitonin (PCT) and RNA levels on lung and adverse outcomes was analyzed. Results The levels of miRNA-221 and miRNA-24 in the severe group, general group, and control group increased in turn, the LPS score decreased in turn, and the serum levels of PCT, PGRN, and CRP decreased in turn (all P < 0.05). In the treatment outcome of the severe group, the serum PCT level of the surviving children was lower than that of the dead children, while the levels of miRNA-221 and miRNA-24 were higher than those of the dead children (all P < 0.05). According to Pearson correlation analysis, there was a positive correlation between lung injury and treatment outcome in children with severe illness and serum PCT, but a negative correlation between them and levels of miRNA-221 and miRNA-24 (P < 0.05). Logistic regression analysis showed that high levels of serum PCT, low levels of miRNA-221 and miRNA-24 were independent risk factors for lung injury and adverse treatment outcomes in children with severe pneumonia (all P < 0.05). ROC curve analysis showed that the level of this factor had specificity for the risk of adverse disease outcomes, with sensitivities of 0.802, 0.807, 0.814 and 0.845, 0.850, 0.858, respectively, which had high predictive value (AUC>0.70). Conclusion The abnormal expression of serum PCT, miRNA-221 and miRNA-24 in children with severe pneumonia is closely related to the occurrence of lung injury and adverse treatment outcomes, and is an independent risk factor and has good predictive value.
- Severe pneumonia /
- Serum PCT /
- MiRNA-221 /
- MiRNA-24 /
- Lung injury /
- Treatment outcome
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图 1 重症肺炎组患儿血清PCT、miRNA-221、miRNA-24水平对患儿肺损伤及治疗不良结局的ROC曲线

Figure 1. Children with severe pneumonia group serum PCT, micrornas-221, micrornas-24 levels for the treatment of children with lung injury and adverse outcomes of ROC curve

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表 1 3组儿童一般资料的比较

Table 1. Comparison of general data of three groups of children

组别	例数	性别(男/女，例)	年龄(x±s，岁)	体重(x±s，kg)	身高(x±s，cm)
重症肺炎组	72	38/34	7.14±2.39	26.25±3.92	120.07±3.78
普通肺炎组	86	46/40	6.95±2.06	25.96±3.67	119.85±3.56
对照组	80	42/38	7.33±2.42	26.04±3.89	119.67±3.69
χ²值		0.017	0.572	0.118	3.034
P值		0.991	0.565	0.889	0.225

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表 2 3组儿童miRNA-221、miRNA-24水平比较(x ±s)

Table 2. Comparison of miRNA-221 and miRNA-24 levels in three groups(x ±s)

组别	例数	miRNA-221	miRNA-24
重症肺炎组	72	0.69±0.06^ab	0.79±0.13^ab
普通肺炎组	86	0.81±0.12^a	0.92±0.16^a
对照组	80	1.11±0.31	1.06±0.21
F值		93.848	47.457
P值		＜0.001	＜0.001
注：与对照组比较，^aP＜0.05；与普通肺炎组比较，^bP＜0.05。

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表 3 3组儿童LPS评分比较(x ±s，分)

Table 3. Comparison of LPS scores in three groups(x ±s, points)

组别	例数	LPS评分
重症肺炎组	72	9.14±2.18^ab
普通肺炎组	86	7.23±1.95^a
对照组	80	5.94±1.87
F值		49.018
P值		＜0.001
注：与对照组比较，^aP＜0.05；与普通肺炎组比较，^bP＜0.05。

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表 4 3组儿童血清PCT、PGRN、CRP水平比较(x ±s)

Table 4. Comparison of serum PCT, PGRN and CRP levels among three groups(x ±s)

组别	例数	PCT(μg/L)	PGRN(μg/L)	CRP(mg/L)
重症肺炎组	72	2.92±0.81^ab	33.26±7.18^ab	22.04±8.69^ab
普通肺炎组	86	1.63±0.57^a	29.12±5.94^a	15.43±5.61^a
对照组	80	0.47±0.14	27.65±4.59	6.17±1.95
F值		352.840	17.929	136.860
P值		＜0.001	＜0.001	＜0.001
注：与对照组比较，^aP＜0.05；与普通肺炎组比较，^bP＜0.05。

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表 5 不同治疗结局重症肺炎组患儿血清PCT、miRNA-221、miRNA-24水平比较(x ±s)

Table 5. Comparison of serum PCT, mirna-221 and mirna-24 levels in the treatment outcome of children in severe pneumonia group(x ±s)

组别	例数	PCT(μg/L)	miRNA-221	miRNA-24
存活组	64	2.71±0.76	0.63±0.07	0.76±0.11
死亡组	8	4.27±0.93	0.52±0.05	0.61±0.08
t值		5.342	4.297	3.725
P值		＜0.001	＜0.001	＜0.001

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表 6 重症肺炎组患儿血清PCT、miRNA-221、miRNA-24水平与患儿肺损伤及治疗结局相关性分析

Table 6. Correlation analysis of serum PCT, miRNA-221 and miRNA-24 levels with lung injury and treatment outcome in children with severe pneumonia group

指标	肺损伤		治疗结局
指标	r值	P值	r值	P值
PCT	0.381	0.001	0.426	＜0.001
miRNA-221	-0.563	＜0.001	-0.298	0.011
miRNA-24	-0.309	0.008	-0.472	＜0.001

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表 7 重症肺炎患儿对肺损伤及治疗不良结局的多因素logistic回归分析

Table 7. Multivariate Logistic regression analysis of lung injury and adverse treatment outcomes in children with severe pneumonia

变量	B	SE	Wald χ²	P值	OR值	95%CI
PCT	1.128	0.436	6.693	0.010	3.089	1.314~7.261
miRNA-221	1.096	0.314	12.183	＜0.001	2.992	1.617~5.537
miRNA24	0.865	0.271	10.188	0.001	2.375	1.396~4.040

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表 8 重症肺炎组患儿血清PCT、miRNA-221、miRNA-24水平对预测患儿肺损伤及治疗不良结局的预测价值

Table 8. Predictive value of serum levels of PCT, miRNA-221 and miRNA-24 in predicting lung injury and adverse treatment outcomes in children with severe pneumonia

变量	AUC	95% CI	SE	P值	特异度	敏感度
PCT	0.833	0.703~0.963	0.066	＜0.001	0.802	0.845
miRNA-221	0.838	0.711~0.966	0.065	＜0.001	0.807	0.850
miRNA-24	0.846	0.722~0.970	0.063	＜0.001	0.814	0.858

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