目的：探究正五聚蛋白3（pentraxins3,PTX3）、降钙素原（procalcitonin,PCT）、D-二聚体在细菌性肺炎患儿的表达,分析其对预后的影响,为临床工作提供有利参考。方法：选取2021年10月—2023年4月我院收治的132例细菌性肺炎患儿为观察组,另以1∶1比例选取132例同期健康儿童为对照组;观察组分为轻症[临床肺部感染评分（clinical pulmonary infection score,CPIS）<6分,80例]、重症（CPIS≥6分,52例）。比较观察组轻症、重症病例PCT、PTX3、D-二聚体水平;观察组患儿均接受综合治疗方案,于治疗第1、2、3 d采集静脉血检测PCT、PTX3、D-二聚体水平,根据治疗7 d预后情况分为预后良好组（98例）、预后不良组（34例）,比较不同预后患儿不同时间PCT、PTX3、D-二聚体,并分析各指标对细菌性肺炎患儿预后的预测效能、一致性及临床效用。结果：观察组重症患儿PCT、PTX3、D-二聚体均高于轻症患儿;Pearson相关性分析,PCT、D-二聚体、PTX3与CPIS评分均呈正相关（r=0.611、0.648、0.714、0.672、0.631,P<0.05）;预后良好组治疗第1、2、3 d PCT、D-二聚体、PTX3水平均低于预后不良组;Logistic回归分析显示治疗第3 d PCT、PTX3、D-二聚体均为细菌性肺炎患儿预后的独立影响因素;治疗第3 d PCT、PTX3、D-二聚体联合预测细菌性肺炎患儿治疗7 d预后不良的AUC为0.901（95%CI：0.837~0.946）,大于各指标单独预测;校准曲线,显示PCT、PTX3、D-二聚体预测细菌性肺炎患儿预后不良风险与实际风险状况基本一致;决策曲线（decision curve analysis,DCA）显示PCT、PTX3、D-二聚体联合预测细菌性肺炎患儿预后不良具有良好临床效用。结论：细菌性肺炎患儿PCT、PTX3、D-二聚体与其病情存在紧密关系,对患儿预后也可有不同程度的影响,在预测患儿预后中的价值较高,有良好临床效用。
Abstract
Objective To explore the expression of pentraxin 3 (PTX3), procalcitonin (PCT), and D-dimer in children with bacterial pneumonia, and analyze their impact on prognosis based on the three factors, in order to provide a favorable reference for clinical work. Methods A total of 132 children with bacterial pneumonia admitted to our hospital from October 2021 to April 2023 were selected as the observation group, and another 132 healthy children were selected as the control group at a ratio of 1∶1. The observation group was divided into mild cases (clinical pulmonary infection score (CPIS)<6 scores, 80 cases) and severe cases (CPIS≥6 scores, 52 cases), and the levels of PCT, PTX3, and D-dimer were compared between the two groups; The observation group received a comprehensive treatment plan, and venous blood samples were collected on the first, second, and third days of treatment to measure the levels of PCT, PTX3, and D-dimer. Based on the prognosis at 7 days of treatment, the patients were divided into a good prognosis group (98 cases) and a poor prognosis group (34 cases). The PCT, PTX3, and D-dimer levels were compared between the different prognosis groups at different times, and the predictive efficacy, consistency, and clinical utility of each indicator for the prognosis of children with bacterial pneumonia were analyzed. Results The PCT, PTX3, and D-dimer levels in the observation group of severe children were higher than those in the observation group of mild children. Pearson correlation analysis showed that PCT, D-dimer, PTX3, and CPIS scores were positively correlated (r=0.611, 0.648, 0.714, 0.672, 0.631, P<0.05); the levels of PCT, D-dimer, and PTX3 in the good prognosis group were lower than those in the poor prognosis group on days 1, 2, and 3 of treatment (P<0.05). Logistic regression analysis showed that PCT, PTX3, and D-dimer on the third day of treatment were independent factors affecting the prognosis of children with bacterial pneumonia. On the third day of treatment, the AUC of PCT, PTX3, and D-dimer combined to predict poor prognosis in children with bacterial pneumonia after 7 days of treatment was 0.901 (95%CI: 0.837-0.946), which was greater than that of each indicator alone. The calibration curve shows that the predicted risk of poor prognosis and actual risk status of bacterial pneumonia in children with PCT, PTX3, and D-dimer are basically consistent; the DCA curve shows that the combination of PCT, PTX3, and D-dimer has good clinical utility in predicting poor prognosis in children with bacterial pneumonia. Conclusion There is a close relationship between PCT, PTX3, D-dimer and the condition of children with bacterial pneumonia, which can have varying degrees of impact on the prognosis of children. It has high value in predicting the prognosis of children and has good clinical utility.
关键词
细菌性肺炎 /
儿童 /
降钙素原 /
正五聚蛋白3 /
D-二聚体
Key words
bacterial pneumonia /
children /
procalcitonin /
pentraxin 3 /
D-dimer
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基金
2020年四川省医学（青年创新）科研课题项目“血D-二聚体等指标对儿童细菌性肺炎感染的临床研究”（S20F44）
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