肺炎支原体肺炎儿童血清SP-D、sB7-H3浓度变化及其与疾病严重程度的相关性研究-东南大学学报医学版

肺炎支原体肺炎儿童血清SP-D、sB7-H3浓度变化及其与疾病严重程度的相关性研究

单位：1. 邯郸市第二医院儿科, 河北邯郸 056001;
2. 邯郸市中心医院儿科, 河北邯郸 056001

分类号：R725.6;R563.15

出版年·卷·期（页码）：2021·40·第三期（305-311）

摘要：

目的：观察肺炎支原体肺炎（MPP）儿童血清肺表面活性物质相关蛋白D （SP-D）、可溶性B7-H3（sB7-H3）的浓度变化，并分析二者与疾病严重程度的相关性。方法：选取邯郸市第二医院2018年7月至2020年7月收治的MPP患儿104例作为MPP组，选取同期体检的健康体检儿童90例作为对照组。比较两组血清SP-D、sB7-H3浓度。根据重症MPP诊断标准评估MPP患儿的疾病严重程度，并分成轻症组（n=56）和重症组（n=48）。比较两组血清SP-D、sB7-H3浓度，分析重症MPP发生的影响因素，绘制受试者工作特征（ROC）曲线分析二者评估MPP严重程度的ROC曲线下面积（AUC），观察二者与临床肺部感染评分（CPIS）的相关性。结果：MPP组血清SP-D、sB7-H3浓度较对照组明显增高（P<0.05）。Logistic多因素回归模型分析提示，血清CRP （OR=3.611，95% CI为1.504~8.670）、SP-D （OR=3.069，95% CI为1.296~7.268）、sB7-H3（OR=3.625，95% CI为1.594~8.244）浓度及CPIS （OR=4.095，95% CI为1.948~8.608）是重症MPP发生的影响因素（P<0.05）。血清SP-D、sB7-H3浓度单独与二者并联评估重症MPP的AUC分别为0.759（95% CI为0.666~0.852，敏感度为66.70%，特异度为67.90%）、0.780（95% CI为0.690~0.869，敏感度为68.80%，特异度为69.60%）、0.884（95% CI为0.812~0.956，敏感度为87.50%，特异度为89.30%）。血清SP-D、sB7-H3浓度与CPIS评分呈正相关（r值分别为0.620、0.662，均P<0.05）。结论：MPP患儿的血清SP-D、sB7-H3浓度明显增高，且二者与疾病严重度呈正相关，临床有望通过测定二者在血清中的表达水平对MPP患儿病情进展进行评估。

Objective: To observe the changes in serum pulmonary surfactant associated protein D (SP-D) and soluble B7-H3 (sB7-H3) concentrations in children with Mycoplasma pneumoniae pneumonia (MPP), and analyze the correlation between the two and the severity of the disease. Methods: A total of 104 children with MPP admitted to Handan Second Hospital from July 2018 to July 2020 were selected as the MPP group, and 90 healthy children who received physical examination in the hospital during the same period were selected as the control group. The serum SP-D and sB7-H3 concentrations were compared between the two groups. According to the diagnostic criteria of severe MPP, the disease severity of children with MPP was assessed, and they were divided into mild group (n=56) and severe group (n=48). The serum concentrations of SP-D and sB7-H3 were compared between the two groups, the influencing factors of severe MPP were analyzed, the receiver operating characteristic (ROC) curve was drawn, the area under curve (AUC) of the severity of MPP was evaluated, and the correlation between them and clinical pulmonary infection score (CPIS) was observed. Results: Serum SP-D and sB7-H3 concentrations in the MPP group were significantly higher than those in the control group (P<0.05). Logistic multivariate regression model analysis showed that serum CRP (OR=3.611, 95%CI: 1.504-8.670), SP-D (OR=3.069, 95%CI: 1.296-7.268), sB7-H3 (OR=3.625, 95%CI: 1.594-8.244) concentrations and CPIS score (OR=4.095, 95%CI: 1.948-8.608) were the influencing factors of the occurrence of severe MPP (P<0.05). Serum SP-D and sB7-H3 concentrations alone and the combination of the two to assess the AUC of severe MPP were 0.759 (95% CI: 0.666-0.852, sensitivity = 66.70%, specificity = 67.90%), 0.780 (95% CI: 0.690-0.869, sensitivity=68.80%, specificity=69.60%), 0.884 (95%CI: 0.812-0.956, sensitivity=87.50%, specificity=89.30%). serum SP-D and sB7-H3 concentrations were positively correlated with CPIS (r=0.620, 0.662, P<0.05). Conclusion: The concentrations of serum SP-D and sB7-H3 in children with MPP are significantly increased, and both of them are positively correlated with the severity of the disease. It is clinically hopeful that by measuring the expression levels of the two in the serum to evaluate the progress of the disease in children with MPP.

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