摘要
Abstract
Objective To investigate the relationship between serum levels of soluble Fas ligand(sFasL)and mid-regional proadrenomedullin(MR-proADM)and disease progression and prognosis in children with severe pneumonia.Methods A total of 112 children with severe pneumonia who were admitted to Shanghai Ninth People's Hospital of Shanghai JiaoTong University School of Medicine from September 2020 to September 2023 were enrolled as the study subjects,and they were divided into severe group(n=72)and critical group(n=40)according to the progression of their disease.In addition,64 healthy children were selected as the control group.After 30 days of treatment,the children were divided into survival group(n=89)and death group(n=23)according to their survival.Enzyme-linked immunosorbent assay was used to detect serum levels of sFasL and MR-proADM.Spearman correlation analysis analyzed the correlation between sFasL,MR-proADM levels and pneumonia severity index scores.Multivariate logistic regression analysis was performed to analyze the influencing factors of the prognosis of death in children with severe pneumonia.The receiver operating characteristic(ROC)curve evaluated the predictive value of serum sFasL and MR-proADM levels in children with severe pneumonia.Results Serum sFasL and MR-proADM levels of children in the control,severe,and critically ill groups were sequentially increased,and the difference was statistically significant(F-values were 234.738 and 181.025,respectively,P＜0.05).Compared with the survival group,the serum sFasL and MR-proADM levels in the death group were obviously higher,and the difference was statistically significant(t-values were 7.895 and 7.294,respectively,P＜0.05).The results of Spearman correlation analysis showed that the level of sFasL was positively correlated with the scores of sequential organ failure(SOFA),CURB-65 and pneumonia severity index(PSI)(r-values were 0.467,0.482,0.546,respectively,P＜0.001),the MR-proADM level was positively correlated with SOFA,CURB-65,and PSI scores(r-values were 0.623,0.541,0.578,respectively,P＜0.001).Logistic regression analysis showed that elevated levels of procalcitoninogen(PCT),C-reactive protein(CRP),sFasL and MR-proADM were all risk factors for death in children with severe pneumonia(OR values were 1.722,1.648,1.931 and 1.873,respectively,P＜0.05).The results of ROC curve showed that the area under the curve(AUC)of serum sFasL and MR-proADM levels in predicting prognostic death of children alone and in combination were 0.830,0.800 and 0.935,respectively,and the combined predictive value of the two was higher(Z-values were 2.088 and 2.066,respectively,P＜0.05).Conclusion Serum sFasL and MR-proADM levels were closely related to the progression of severe pneumonia,and the value of joint prediction of prognosis in children with severe pneumonia was higher.关键词
可溶性Fas配体/中区肾上腺髓质素/重症肺炎患儿/病情进展/预后转归Key words
soluble Fas ligand/mid-regional proadrenomedullin/children with severe pneumonia/disease progression/prognostic outcome分类
医药卫生
