| 303 | 10 | 207 |
| 下载次数 | 被引频次 | 阅读次数 |
为探究血清C反应蛋白（C-reactiveprotein,CRP）、免疫球蛋白A(Immunoglobulin A,IgA)以及血管内皮生长因子（vascular endothelial growth factor,VEGF）在儿童重症腺病毒肺炎（Severe adenoviral pneumonia,SAP）早期诊断中的价值，本研究选取2020年2月-2023年5月新疆阿勒泰地区人民医院儿科收治的98例腺病毒肺炎患儿，按病情分为重症腺病毒肺炎组（33例）和普通腺病毒肺炎组（65例），于患儿入院1d内采集外周静脉血，检测其血清相关指标水平值，并比较2组相关指标的水平差异。结果发现，重症腺病毒肺炎组患儿年龄较普通腺病毒肺炎组更小（P<0.05），合并肺炎支原体感染率、血清炎症指标TNF-α、IFN-γ、IL-6、CRP、MIP-1α以及TGF-β1、VEGF水平值明显较普通腺病毒肺炎组更高（P<0.05），血清IgA水平值低于普通腺病毒肺炎组（P<0.05）；多因素Logistic回归分析确认年龄、肺炎支原体感染、高CRP、VEGF、IFN-γ、TGF-β1及低IgA为SAP危险因素。Pearson相关性分析显示，血清IgA水平表达与SAP呈负相关，CRP、VEGF与水平表达SAP均呈正相关；ROC曲线分析表明，联合检测对SAP的诊断效能高于各指标单独检测（P<0.05）。本研究结果表明，血清CRP、VEGF及IgA参与了儿童SAP的发生，联合检测能够进一步提高其诊断效能。
Abstract：To explore the value of serum C-reactive protein(CRP), immunoglobulin A(IgA) and vascular endothelial growth factor(VEGF) in the early diagnosis of severe adenovirus pneumonia(SAP) in children, 98children with adenovirus pneumonia admitted to the Department of Pediatrics of Xinjiang Altay Regional People's Hospital from February 2020 to May 2023 were selected. The patients were divided into severe adenovirus pneumonia group(33 cases) and common adenovirus pneumonia group(65 cases). Peripheral venous blood was collected within 1 day after admission, and the levels of serum related indicators were detected, and the differences between the two groups were compared. The results showed that the age of children in the severe adenovirus pneumonia group was younger than that in the common adenovirus pneumonia group(P< 0.05), and the infection rate of mycoplasma pneumoniae, serum inflammation indexes TNF-α, IFN-γ, IL-6, CRP, MIP-1α, TGF-β1 and VEGF levels were significantly higher than those in the common adenovirus pneumonia group(P< 0.05). Serum IgA level was lower than that of common adenovirus pneumonia group(P< 0.05). Multivariate Logistic regression analysis confirmed age, mycoplasma pneumoniae infection, high CRP, VEGF, IFN-γ, TGF-β1 and low IgA as risk factors for SAP. Pearson correlation analysis showed that serum IgA expression was negatively correlated with SAP, CRP and VEGF were positively correlated with SAP expression. ROC curve analysis showed that the diagnostic efficiency of combined detection on SAP was higher than that of individual detection(P< 0.05). The results of this study indicate that serum CRP, VEGF and IgA are involved in the occurrence of SAP in children, and the combined detection can further improve its diagnostic efficiency.
[1] Rueda ZV, Aguilar Y, Maya MA, et al. Etiology and the challenge of diagnostic testing of communityacquired pneumonia in children and adolescents[J].BMC Pediatr, 2022, 22(1):169. DOI:10. 1186/s12887-022-03235-z.
[2] Zhang D, Chen Y, Shi T, et al. Severe pneumonia caused by human adenovirus type 55 in children[J].Front Pediatr, 2022, 10:1002052. DOI:10. 3389/fped. 2022. 1002052.
[3]黄浩，陈瑜，马丽娅，等.儿童重症腺病毒肺炎的临床特征及高危因素分析[J].中华儿科杂志，2021, 59(1):14-19. DOI:10. 3760/cma. j. cn112140-20200704-00687.
[4]刘爱良，黄英，杨洋，等.儿童重症腺病毒肺炎213例临床特征分析[J].临床儿科杂志，2013, 31(8):726-729. DOI:10. 3969/j. issn. 1000-3606. 2013. 08. 007.
[5]黄冰，王雪琳，黎历，等.儿童腺病毒肺炎进展为重症的危险因素[J].山东医药，2023, 63(30):65-68.DOI:10. 3969/j. issn. 1002-266X. 2023. 30. 015.
[6]范江花，罗海燕，张新萍，等.重症腺病毒肺炎患儿临床特征和免疫指标分析[J].儿科药学杂志，2021, 27(10):5-9. DOI:10. 13407/j. cnki. jpp. 1672-108X. 2021. 10. 002.
[7] Josuttis D, Schwedler C, Heymann G, et al. Vascular endothelial growth factor as potential biomarker for COVID-19 severity[J]. J Intensive Care Med, 2023, 38(12):1165-1173. DOI:10. 1177/08850666231186787.
[8]中华人民共和国国家卫生健康委员会国家中医药管理局.儿童腺病毒肺炎诊疗规范（2019年版）[J].中华临床感染病杂志，2019(3):161-166. DOI:10. 3760/cma. j. issn. 1674-2397. 2019. 03. 001.
[9]中华医学会儿科学分会呼吸学组，《中华儿科杂志》编辑委员会.儿童社区获得性肺炎管理指南（2013修订）（下）[J].中华儿科杂志，2013, 51(11):856-862.DOI:10. 3760/cma. j. issn. 0578-1310. 2013. 11. 012.
[10]中华医学会儿科学分会临床检验学组.儿童肺炎支原体呼吸道感染实验室诊断中国专家共识[J].中华检验医学杂志，2019, 42(7):507-513. DOI:10. 3760/cma. j. issn. 1009-9158. 2019. 07. 005.
[11]Shieh WJ. Human adenovirus infections in pediatric population-An update on clinico-pathologic correlation[J]. Biomed J, 2022, 45(1):38-49. DOI:10. 1016/j.bj. 2021. 08. 009.
[12]Zhang R, Wang H, Tian S, et al. Adenovirus viremia may predict adenovirus pneumonia severity in immunocompetent children[J]. BMC Infect Dis, 2021,21(1):213. DOI:10. 1186/s12879-021-05903-4.
[13]Hong Y, Wang Q, Song Y, et al. Factors associated with severe adenovirus pneumonia in children:a retrospective study from Guangzhou, China(2017-2019)[J]. Med Sci Monit, 2023, 29:e939578. DOI:10. 12659/msm. 939578.
[14]杨丽君，林茹，叶莉芬，等.体外膜肺氧合治疗重症腺病毒肺炎致呼吸衰竭的临床特征及管理经验[J].中华急诊医学杂志，2020, 29(10):1360-1363. DOI:10. 3760/cma. j. issn. 1671-0282. 2020. 10. 018.
[15]蒲开彬，黄英，舒畅，等.静脉用丙种球蛋白辅助治疗儿童重症腺病毒肺炎回顾性分析[J].临床儿科杂志，2014, 32(5):449-452. DOI:10. 3969/j. issn. 1000-3606. 2014. 05. 013.
[16]Chen X, Lv J, Qin L, et al. Severe adenovirus pneumonia requiring extracorporeal membrane oxygenation support in immunocompetent children[J].Front Pediatr, 2020, 8:162. DOI:10. 3389/fped. 2020. 00162.
[17]Wei J, Wu S, Jin X, et al. Association of Mycoplasma pneumoniae coinfection with adenovirus pneumonia severity in children[J]. Allergol Immunopathol(Madr), 2022, 50(1):31-36. DOI:10. 15586/aei.v50i1. 476.
[18]Zhong H, Dong X. Analysis of clinical characteristics and risk factors of severe adenovirus pneumonia in children[J]. Front Pediatr, 2021, 9:566797. DOI:10. 3389/fped. 2021. 566797.
[19]张金仿，王刚，高琰，等.腺病毒肺炎患儿血清MIP-1α和外周血SOCS-1 mRNA、SOCS-3 mRNA的变化及意义[J].临床和实验医学杂志，2020, 19(15):1582-1585. DOI:10. 3969/j. issn. 1671-4695. 2020. 15. 004.
[20]Yang DY, Lu BT, Shi TT, et al. Total and doublestranded DNA-specific immunoglobulin E in bronchoalveolar lavage fluid of children with human adenovirus pneumonia[J]. J Infect Chemother, 2020,26(9):986-991. DOI:10. 1016/j. jiac. 2020. 04. 024.
[21]杨婷，饶花平，罗力妍，等.重组人干扰素-α1b吸入联合免疫球蛋白对重症腺病毒肺炎患儿细胞免疫功能的影响[J].疑难病杂志，2021, 20(7):676-679, 684.DOI:10. 3969/j. issn. 1671-6450. 2021. 07. 007.
[22]张学会，韩晶晶，张玉岩，等. VEGF、RDW与重症肺炎支原体肺炎患儿心肌损害的相关性及诊断价值分析[J].中国医师杂志，2024, 26(3):418-422. DOI:10. 3760/cma. j. cn431274-20230506-00636.
[23]涂小波，舒畅，邓芳，等.儿童重症肺炎继发噬血细胞性淋巴组织细胞增生症临床特征分析[J].临床儿科杂志，2022, 40(11):858-863. DOI:10. 12372/jcp. 2022. 21e0784.
基本信息:
DOI：10.13242/j.cnki.bingduxuebao.004585
中图分类号:R725.6
引用信息:
[1]薄蔚,甘强,马金莲.血清CRP、IgA及VEGF对儿童重症腺病毒肺炎的诊断价值研究[J].病毒学报,2024,40(05):1093-1098.DOI:10.13242/j.cnki.bingduxuebao.004585.
2024-09-04
2024-09-04
2024-09-04