外周血cf-DNA/NETs水平与重症肺炎患儿转归不良的关系分析-东南大学学报医学版

外周血cf-DNA/NETs水平与重症肺炎患儿转归不良的关系分析

单位：1. 郑州大学附属儿童医院检验科/郑州市儿童感染与免疫重点实验室, 河南郑州 450018;
2. 郑州市疾病预防控制中心理化所, 河南郑州 450018

分类号：R725.6

出版年·卷·期（页码）：2025·44·第一期（66-72）

摘要：

目的:分析外周血游离脱氧核糖核酸(cf-DNA)/中性粒细胞胞外诱捕网(NETs)水平与重症肺炎患儿转归不良的关系。方法:选取2021年1月至2023年12月本院122例重症肺炎患儿和122例健康体检儿童,分别作为疾病组和对照组,均检测外周血cf-DNA/NETs水平并对比。按照重症肺炎患儿病情转归情况分为转归良好和转归不良。比较转归良好和转归不良患儿临床资料,采用Logistic回归法分析重症肺炎患儿转归不良的影响因素,计算比值比(OR)、95%置信区间(95%CI)。采用Pearson相关系数评估重症肺炎患儿外周血cf-DNA/NETs与转归不良的相关性。结果:疾病组外周血cf-DNA/NETs水平为250.00~715.00 ng·mL^-1,平均(452.66±80.44)ng·mL^-1;对照组外周血cf-DNA/NETs水平为50.00~110.00 ng·mL^-1,平均(78.96±14.65)ng·mL^-1。疾病组外周血cf-DNA/NETs水平高于对照组(P＜0.05)。疾病组中,病情转归不良37例(30.33%),转归良好85例(69.67%)。与转归良好患儿比较,转归不良患儿病变累及≥2个肺叶占比、机械通气占比、白细胞计数(WBC)、C-反应蛋白(CRP)、降钙素原(PCT)、cf-DNA/NETs及临床肺部感染评分(CPIS)升高(P＜0.05),白蛋白(Alb)、CD4⁺/CD8⁺降低(P＜0.05);机械通气(OR=1.642,95%CI: 1.238~2.178)、CRP(OR=1.815,95%CI: 1.329~2.478)、cf-DNA/NETs(OR=2.059,95%CI: 1.380~3.070)及CPIS评分(OR=1.883, 95%CI: 1.285~2.760)是重症肺炎患儿转归不良的危险因素(P＜0.05), Alb(OR=0.576,95%CI: 0.407~0.815)、CD4⁺/CD8⁺(OR=0.531,95%CI:0.369~0.765)是重症肺炎患儿转归不良的保护因素(P＜0.05);Pearson相关性分析显示,重症肺炎患儿外周血cf-DNA/NETs水平与转归不良发生呈正相关(P＜0.05)。结论:重症肺炎患儿外周血cf-DNA/NETs水平升高;重症肺炎患儿转归不良的危险因素包括机械通气、CRP、cf-DNA/NETs及CPIS评分,保护因素包括Alb、CD4⁺/CD8⁺;重症肺炎患儿外周血cf-DNA/NETs水平与转归不良发生呈正相关。

Objective: To analyze the relationship between cf-DNA/NETs levels in peripheral blood and poor outcomes in children with severe pneumonia. Methods:From January 2021 to December 2023, 122 children with severe pneumonia and 122 healthy children with physical examination in our hospital were selected into a disease group and a control group, respectively. The levels of cf-DNA/NETs in peripheral blood were measured and compared in both groups. According to the outcomes of children with severe pneumonia, the outcomes was divided into good and bad. The clinical data of children with good outcomes and poor outcomes were compared. The influencing factors of poor outcomes were analyzed by Logistic regression method, and the odds ratio(OR) and 95% confidence interval(95%CI) were calculated. Pearson correlation coefficient was used to evaluate the correlation between cf-DNA/NETs in peripheral blood of children with severe pneumonia and poor outcomes. Results:The levels of cf-DNA/NETs in peripheral blood of the disease group ranged from 250.00 to 715.00 ng·mL^-1, with an average of(452.66±80.44) ng·mL^-1. The levels of cf-DNA/NETs in peripheral blood of the control group ranged from 50.00 to 110.00 ng·mL^-1, with an average of(78.96±14.65) ng·mL^-1. The level of cf-DNA/NETs in peripheral blood of disease group was higher than that of control group(P<0.05). In the disease group, 37 cases(30.33%) had poor outcomes and 85 cases(69.67%) had good outcomes. Compared with the children with good outcomes, the lesions of the children with poor outcomes involved proportion of the lesion involved ≥2 lung lobes, proportion of mechanical ventilation, white blood cell count(WBC), C-reactive protein(CRP), procalcitonin(PCT), cf-DNA/NETs and clinical pulmonary infection score(CPIS) were increased (P<0.05), albumin(Alb) and CD4⁺/CD8⁺ were decreased (P<0.05). Mechanical ventilation(OR=1.642, 95%CI:1.238-2.178), CRP(OR=1.815, 95%CI: 1.329-2.478), cf-DNA/NETs(OR=2.059, 95%CI: 1.380-3.070) and CPIS score(OR=1.883, 95%CI: 1.285-2.760) were the risk factors for poor outcomes in children with severe pneumonia(P<0.05), Alb(OR=0.576, 95%CI: 0.407-0.815), CD4⁺/CD8⁺(OR=0.531, 95%CI: 0.369-0.765) were the protective factors for poor outcomes in children with severe pneumonia(P<0.05). Pearson correlation analysis showed that the level of cf-DNA/NETs in peripheral blood of children with severe pneumonia was positively correlated with the occurrence of poor outcomes(P<0.05). Conclusion:The level of cf-DNA/NETs in peripheral blood of children with severe pneumonia is increased. The risk factors for poor outcomes in children with severe pneumonia include mechanical ventilation, CRP, cf-DNA/NETs and CPIS scores, and the protective factors included Alb, CD4⁺/CD8⁺. The level of cf-DNA/NETs in peripheral blood of children with severe pneumonia is positively correlated with poor outcomes.

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