肠道菌群、血清HMGB1与急性呼吸窘迫综合征患儿免疫功能、病情程度的关系及预后预警作用OA

Objective To investigate the correlation of intestinal flora and serum high mobility group box 1 protein(HMGB1)with the disease severity and immune function of pediatric patients with acute respiratory distress syndrome(ARDS),and to analyze its prognostic warning effect.Methods A total of 134 children with ARDS admitted from October 2022 to October 2023 were selected as the ARDS group,and 70 healthy children undergoing physical examination during the same period were selected as the control group.The levels of intestinal flora and serum HMGB1 were compared between the two groups.The intestinal flora,serum HMGB1 and immune function indexes(CD3+,CD4+,CD4+/CD8+,IgA,IgG,IgM)of children with ARDS of different severity were compared.The correlation between intestinal flora,serum HMGB1 and disease severity,immune function indicators in children with ARDS was analyzed.The prognostic value of intestinal flora and serum HMGB1 in children with ARDS was analyzed,and the early warning effect was analyzed by relative risk(RR).Results The number of Escherichia coli and serum HMGB1 level in ARDS group were higher than those in control group,while the number of Lactobacillus,Bifidobacterium,Eubacterium and Peptococcus were lower than those in control group(P<0.05).The number of Escherichia coli and serum HMGB1 level in ARDS children in severe subgroup were higher than those in moderate subgroup and mild subgroup,while the number of Lactobacillus,Bifidobacterium,Eubacterium,Digestive cocci and immune function indexes were lower than those in moderate subgroup and mild subgroup(P<0.05).The levels of Escherichia coli and serum HMGB1 in children with ARDS were positively correlated with the severity of the disease,and negatively correlated with the immune function indexes(P<0.05).Lactobacillus,Bifidobacterium,Eubacterium and Peptococci were negatively correlated with the severity of the disease,and positively correlated with each immune function index(P<0.05).The area under the receiver operating characteristic(ROC)curve of the above intestinal flora combined with serum HMGB1 in evaluating the prognosis of children with ARDS was 0.928(95％CI:0.871,0.966),with the sensitivity of 80.77％,and the specificity of 87.96％(P<0.05).The risk of poor prognosis in children with high levels of Escherichia coli,Lactobacillus,Bifidobacterium,Eubacterium,Digestive cocci,and serum HMGB1 was 4.643,0.212,0.196,0.156,0.176,and 5.552 times that of children with low levels(P<0.05).Conclusion The abnormalities of intestinal flora and serum HMGB1 in children with ARDS are closely related to the severity of ARDS and the status of immune function.The combination of the two has certain evaluation value for the prognosis of ARDS,which is conducive to identifying the risk of poor prognosis in children.