重症肺炎合并ARDS患儿血清纤维胶凝蛋白-3、白三烯B4、髓系分化因子88水平及其对生存结局的预测价值OA

Objective To investigate the serum levels of Ficolin-3,leukotriene B4(LTB4)and myeloid dif-ferentiation factor 88(MyD88)in children with severe pneumonia complicated with acute respiratory distress syndrome(ARDS)and their predictive value for survival outcome.Methods A total of 120 children with se-vere pneumonia complicated with ARDS admitted to the hospital from March 2020 to September 2022 were prospectively selected as the case group,120 children with severe pneumonia without ARDS were selected as the case control group,and 120 healthy children without pulmonary inflammation who underwent physical ex-amination in the hospital during the same period were selected as the healthy control group.Enzyme-linked immunosorbent Assay was applied to detect serum levels of Ficolin-3,LTB4 and MyD88.The baseline data of patients with severe pneumonia complicated with ARDS were collected.The children with severe pneumonia complicated with ARDS were followed up for 30 d from the day of admission,and they were divided into death group and survival group according to the follow-up results.Multivariate Logistic regression was applied to analyze the factors affecting the death of children with severe pneumonia complicated with ARDS.The receiver operating characteristic(ROC)curve was drawn to analyze the predictive value of serum Ficolin-3,LTB4 and MyD88 for the death of children with severe pneumonia complicated with ARDS.Results The serum levels of Ficolin-3,LTB4 and MyD88 in the case group were higher than those in the case control group and the healthy control group,and the serum levels of Ficolin-3,LTB4 and MyD88 in the case control group were higher than those in the healthy control group,and the differences were statistically significant(P<0.05).There were 52 cases in the death group and 68 cases in the survival group.There were significant differences in sepsis-related organ failure assessment score,oxygenation index,ARDS grade,as well as serum Ficolin-3,LTB4 and MyD88 levels,between the death group and the survival group(P<0.05).ROC curve analysis results showed that the areas under the curves(AUCs)of serum Ficolin-3,LTB4 and MyD88 alone and in combination of the three indicators to predict the death of children with severe pneumonia and ARDS were 0.754,0.781,0.775 and 0.881 respectively,and the AUC of the combined prediction of the three indicators was significantly larger than that of serum Ficolin-3(Z=2.703,P=0.007),LTB4(Z=2.138,P=0.033)and MyD88(Z=2.624,P=0.009)alone.Multivariate Logistic regression analysis results showed that moderate to severe ARDS and increased serum levels of Ficolin-3,LTB4 and MyD88 were risk factors for death in children with severe pneu-monia complicated with ARDS(P<0.05),while increased oxygenation index was a protective factor for death in children with severe pneumonia complicated with ARDS(P<0.05).Conclusion The serum levels of Fico-lin-3,LTB4 and MyD88 in children with severe pneumonia and ARDS are increased,and the combination of the three indicators has a higher value in predicting the survival outcome of children with severe pneumonia and ARDS.