血清TNFSF14、HO-1、APC对儿童重症肺炎预后的影响及预测效能分析OA
Effects of serum TNFSF14,HO-1 and APC on the prognosis of severe pneumonia in children and their predictive efficacy
目的 探讨血清肿瘤坏死因子超家族成员14(TNFSF14)、血红素加氧酶-1(HO-1)、活化蛋白C(APC)对重症肺炎患儿预后的影响及对预后的预测价值.方法 选取2023年1月—2025年1月收治的144例重症肺炎患儿进行前瞻性研究,均采取常规对症治疗.根据治疗预后情况分为良好组104例和不良组40例.统计并比较两组一般资料及入院时血清TNFSF14、HO-1、APC,采用多因素Logistic回归分析血清TNFSF14、HO-1、APC对重症肺炎患儿预后的影响,采用限制性立方样条模型(RCS)分析血清TNFSF14、HO-1、APC与重症肺炎患儿预后的关系,绘制受试者工作特征曲线分析血清TNFSF14、HO-1、APC对重症肺炎患儿预后的预测价值.结果 不良组氧分压、氧分压/吸入氧浓度、血清APC水平低于良好组,二氧化碳分压、呼气末正压通气、血清TNFSF14、HO-1水平高于良好组(P＜0.01).血清TNFSF14、HO-1、APC是重症肺炎患儿预后不良的影响因素(P＜0.01).血清TNFSF14、HO-1与重症肺炎患儿预后不良呈非线性正相关,APC水平与重症肺炎患儿预后不良呈非线性负相关(P＜0.01).当APC水平＜32.00 pmol/L时,患儿预后不良风险不受APC水平影响;APC水平＞32.00 pmol/L时,患儿预后不良风险随着APC水平升高而降低.血清TNFSF14、HO-1、APC水平联合预测重症肺炎患儿预后的曲线下面积(0.909)高于TNFSF14(0.785)、HO-1(0.746)、APC(0.776)单独预测(P＜0.01).结论 血清TNFSF14、HO-1、APC水平异常可能导致重症肺炎患儿预后不良,各指标联合检测可为临床预测预后提供参考.
Objective To investigate the effects of serum tumor necrosis factor superfamily member 14(TNFSF14),heme oxygenase-1(HO-1)and activated protein C(APC)on the prognosis of children with severe pneumonia,as well as their predictive value for the prognosis.Methods A prospective study was conducted on 144 children with severe pneumonia admitted from January 2023 to January 2025,all of whom were treated with conventional symptomatic treatment.According to the prognosis of treatment,they were divided into good group(n=104)and poor group(n=40).The general data and serum TNFSF14,HO-1 and APC were compared between the two groups.Multivariate logistic regression analysis was used to analyze the effect of serum TNFSF14,HO-1 and APC on the prognosis of children with severe pneumonia.The restrictive cubic spline model(RCS)was used to analyze the relationship between serum TNFSF14,HO-1 and APC and the prognosis of children with severe pneumonia.The receiver operating characteristic(ROC)curve was drawn to analyze the predictive value of serum TNFSF14,HO-1 and APC on the prognosis of children with severe pneumonia.Results The oxygen partial pressure,oxygen partial pressure/inhaled oxygen concentration and serum APC level in the poor group were lower than those in the good group,and the carbon dioxide partial pressure,positive end-expiratory pressure ventilation,serum TNFSF14 and HO-1 levels were higher than those in the good group(P＜0.01).Serum TNFSF14,HO-1 and APC were the influencing factors of poor prognosis in children with severe pneumonia(P＜0.01).Serum TNFSF14 and HO-1 were non-linearly positively correlated with poor prognosis in children with severe pneumonia,and APC level was non-linearly negatively correlated with poor prognosis in children with severe pneumonia(P＜0.01).When APC level was＜32.00 pmol/L,the risk of poor prognosis was not affected by APC level;when APC was＞32.00 pmol/L,the risk of poor prognosis decreased with the increase of APC level.The area under the ROC curve(0.909)of combined serum TNFSF14,HO-1 and APC levels in predicting the prognosis of children with severe pneumonia was higher than that of TNFSF14(0.785),HO-1(0.746)and APC(0.776)alone(P＜0.01).Conclusion Abnormal levels of serum TNFSF14,HO-1 and APC may lead to poor prognosis in children with severe pneumonia.The combined detection of each index can provide reference for clinical prediction of prognosis.
刘静;程阔菊;张旭铭;张中翠;李欣颖
达州市中西医结合医院儿科,四川达州 635000达州市中西医结合医院药学科,四川达州 635000达州市中西医结合医院儿科,四川达州 635000达州市中西医结合医院儿科,四川达州 635000达州市中西医结合医院儿科,四川达州 635000
重症肺炎儿童肿瘤坏死因子超家族成员14血红素加氧酶-1活化蛋白C限制性立方样条模型预后
severe pneumoniachildrentumor necrosis factor superfamily member 14heme oxygenase-1activated protein Crestricted cubic spline modelprognosis
《临床误诊误治》 2026 (8)
73-79,7
2023年四川省中医药管理局面上项目(2023MS275)
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