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| 重症肺炎患儿血清Periostin、SDF1水平变化及其与免疫功能和预后的关系 |
| Changes of serum Periostin and SDF-1 levels in children with severe pneumonia and their relationship with immune function and prognosis |
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| DOI：10.3969/j.issn.1007-8134.2023.03.09 |
| 中文关键词: 重症肺炎 骨膜蛋白 基质细胞衍生因子-1 免疫功能 预后 |
| 英文关键词: severe pneumonia periostin stromal cell-derived factor-1 immune function prognosis |
| 基金项目:保定市科技计划项目（17ZF031） |
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| 中文摘要: |
| 目的?探讨分析重症肺炎患儿血清骨膜蛋白（Periostin）、血清基质细胞衍生因子-1（stromal cell-derived factor-1, SDF-1）水平变化及其与免疫功能和预后的关系。方法? 选取本院2020年5月—2021年12月收治的108例重症肺炎儿童。采集患儿入院时、入院3 d、入院5 d时血清标本，检测血清Periostin、SDF1及T淋巴细胞亚群水平，采用急性生理和慢性健康状况评分II（acute physiology and chronic health evaluation Ⅱ, APACHEⅡ）评估患儿病情。根据入院后30 d患儿预后情况，将患儿分为预后良好组（68例）和预后不良组（40例）。采用Spearman相关性分析重症肺炎患儿血清Periostin、SDF-1水平与T淋巴细胞亚群和APACHEⅡ评分的关系，采用ROC曲线分析血清Periostin、SDF-1以及2者联合评估重症肺炎儿童的预后。结果?入院时、入院3 d、入院5 d时，预后不良组患儿血清Periostin、SDF-1水平及APACHEⅡ评分均高于预后良好组，而CD4+ T细胞占T淋巴细胞百分比（CD4+ T细胞比例）、CD8+ T细胞占T淋巴细胞百分比（CD8+ T细胞比例）及CD4+/CD8+水平均低于预后良好组（P均＜0.05）；2组不同时间和组间两两比较差异均具有统计学意义（P均＜0.05）；预后不良组APACHEⅡ评分逐渐升高，但差异无统计学意义（P＞0.05）。Spearman相关性分析结果显示，血清Periostin、SDF-1水平与CD4+ T细胞比例、CD8+ T细胞比例，CD4+/CD8+水平呈负相关（P均＜0.05）；血清Periostin、SDF-1水平与APACHEⅡ评分呈正相关（P均＜0.05）。ROC曲线结果显示，入院5 d时血清Periostin、SDF-1联合检测评估重症肺炎患儿预后的AUC为0.82（95%CI：0.814～0.859），敏感度与特异度分别为83.42%、70.13%。结论?重症肺炎患儿血清Periostin、SDF-1水平升高，可能与CD4+ T细胞、CD8+ T细胞水平下降有关，同时入院5 d时的表达水平对患儿预后评估具有一定潜在价值。 |
| 英文摘要: |
| Objective To explore and analyze the changes of serum Periostin and serum stromal cell-derived factor-1 (SDF-1) levels in children with severe pneumonia and their relationship with immune function and prognosis. Methods?One hundred and eight children with severe pneumonia admitted to our hospital from May 2020 to December 2021 were selected. According to the prognosis of 30 d after admission, the children were divided into a good prognosis group (68 cases) and a poor prognosis group (40 cases). Serum samples were collected at the time of admission, 3 d after admission and 5 d after admission, and serum Periostin, SDF-1 and T lymphocyte subsets were tested. Acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) was used to evaluate the condition of the children. Spearman was used to analyze the relationship between serum Periostin and SDF-1 levels and T lymphocyte subsets and APACHEⅡ scores in children with severe pneumonia. ROC curve was used to analyze the prognosis of children with severe pneumonia combined with serum Periostin, SDF-1 and 2 patients. Results?On admission, 3 d and 5 d, the levels of serum Periostin, SDF-1 and APACHEⅡ scores in the poor prognosis group were higher than those in the good prognosis group. The percentage of CD4+ T cells in T lymphocytes (proportion of CD4+ T cells), percentage of CD8+ T cells in T lymphocytes (proportion of CD8+ T cells) and CD4+/CD8+ levels were lower than those in good prognosis group (P＜ 0.05). There were statistically significant differences between the 2 groups at different time and between the 2 groups (P＜0.05). APACHEⅡ score of poor prognosis group was increased gradually, but the difference was not statistically significant (P＞0.05). Spearman correlation analysis showed that serum Periostin and SDF-1 levels were negatively correlated with the proportion of CD4+ T cells, the proportion of CD8+ T cells, and the level of CD4+/CD8+ (P＜0.05). Serum Periostin and SDF-1 levels were positively correlated with APACHEⅡ scores (P＜0.05). ROC curve results showed that the area under ROC curve for the combined test of sera Periostin and SDF-1 to evaluate the prognosis of children with severe pneumonia was 0.82 (95%CI: 0.814-0.859) at 5 d after admission, and the sensitivity and specificity were 83.42% and 70.13%, respectively. Conclusions?The levels of serum Periostin and SDF-1 increased in children with severe pneumonia, and may be related to the decrease of T cell levels of CD4+ and CD8+. In addition, the expression levels of both at 5 d after admission display potential value on prognosis assessment. |
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