血清ACE2、sICAM-1水平对重症肺炎患儿并发心肌损害的预测价值

Predictive value of serum ACE2 and sICAM-1 levels for myocardial damage in children with severe pneumonia

导出

摘要目的探讨血清血管紧张素转化酶2(ACE2)、可溶性细胞间黏附分子1(sICAM-1)水平对重症肺炎患儿并发心肌损害的预测价值。方法前瞻性选取2021年7月至2024年6月郑州大学第一附属医院收治的230例重症肺炎患儿纳入研究,根据患儿入院7 d内是否并发心肌损害分组,其中47例发生心肌损害(心肌损害组),183例未发生心肌损害(无心肌损害组)。比较两组患儿的血清ACE2、sICAM-1水平、儿童早期预警(PEWS)评分、心肌损害标志物[肌酸激酶同工酶MB(CK-MB)、超敏肌钙蛋白T(hs-cTnT)],采用Pearson分析血清ACE2、sICAM-1与PEWS评分、心肌损害标志物的相关性,采用多因素Logistic回归分析重症肺炎患儿并发心肌损害的影响因素,采用受试者工作特征(ROC)曲线、曲线下面积(AUC)评估血清各指标对重症肺炎患儿并发心肌损害的预测效能,相对危险度(RR)分析血清各指标对重症肺炎患儿并发心肌损害的预警作用。结果心肌损害组患儿的血清ACE2水平为(8.13±0.97)ng/mL,明显低于无心肌损害组的(12.51±1.83)ng/mL,血清sICAM-1水平为(392.47±112.63)μg/L,高于无心肌损害组的(248.68±83.51)μg/L,差异均有统计学意义(P<0.05);心肌损害组患儿的PEWS评分(5.87±0.84)分,明显高于无心肌损害组的(5.23±0.80)分,血清hs-cTnT为(1.84±0.58)μg/L,明显高于无心肌损害组的(0.16±0.04)μg/L,CK-MB水平为(68.32±7.13)U/L,明显高于无心肌损害组的(33.16±4.57)U/L,差异均有统计学意义(P<0.05);Pearson分析结果显示,PEWS评分、血清hs-cTnT、CK-MB水平与血清ACE2水平均呈负相关(P<0.05),与血清sICAM-1水平呈正相关(P<0.05);多因素Logistic回归分析显示,血清ACE2、sICAM-1是重症肺炎患儿并发心肌损害的影响因素(P<0.05);ROC曲线结果显示,血清ACE2、sICAM-1联合预测重症肺炎患儿并发心肌损害的AUC为0.885(95%CI:0.837~0.924),高于血清指标单独预测的AUC(P<0.05);Cut-off值分为高水平、低水平,血清ACE2低水平、血清sICAM-1高水平的重症肺炎患儿并发心肌损害风险较高(P<0.05)。结论重症肺炎患儿血清ACE2、sICAM-1水平与心肌损伤、病情程度存在一定关系,血清ACE2、sICAM-1水平评估重症肺炎患儿并发心肌损害具有较高的预测价值。 Objective To explore the predictive value of serum angiotensin-converting enzyme 2(ACE2)and soluble intercellular adhesion molecule-1(sICAM-1)levels for myocardial damage in children with severe pneumonia.Methods A total of 230 pediatric patients with severe pneumonia admitted to the First Affiliated Hospital of Zhengzhou University from July 2021 to June 2024 were prospectively selected.According to whether myocardial damage occurred within 7 days of admission,patients were grouped a myocardial damage group(n=47)and a non-myocardial damage group(n=183).The levels of serum ACE2 and sICAM-1,pediatric early warning score(PEWS),and myocardial damage markers(creatine kinase isoenzyme MB[CK-MB]and high-sensitivity cardiac troponin T[hs-cTnT])were compared between the two groups.Pearson correlation analysis was used to examine the correlation of serum ACE2 and sICAM-1 with PEWS score and myocardial damage markers.Multivariate logistic regression analysis was conducted to investigate factors influencing on the development of myocardial damage.Receiver operating characteristic(ROC)curves and area under the curve(AUC)were employed to evaluate the predictive performance of each serum indicator,and relative risk(RR)analysis examined their early-warning utility.Results Serum ACE2 levels in the myocardial damage group were(8.13±0.97)ng/mL,significantly lower than(12.51±1.83)ng/mL in the non-myocardial damage group(P<0.05).Serum sICAM-1 levels were(392.47±112.63)μg/L,significantly higher than(248.68±83.51)μg/L in the non-myocardial damage group(P<0.05).The myocardial damage group also showed higher EWS,hs-cTnT,and CK-MB than the non-myocardial damage group(all P<0.05):EWS,(5.87±0.84)vs(5.23±0.80);hs-cTnT,(1.84±0.58)μg/L vs(0.16±0.04)μg/L;and CK-MB,(68.32±7.13)U/L vs(33.16±4.57)U/L.Pearson analysis indicated that PEWS score,serum hs-cTnT,and CK-MB levels were negatively correlated with serum ACE2 levels but positively correlated with serum sICAM-1 levels(all P<0.05).Multivariate logistic regression analysis revealed that serum ACE2 and sICAM-1 were independent factors influencing myocardial damage(P<0.05).The AUC for the combined prediction of myocardial damage by serum ACE2 and sICAM-1 was serum ACE2 and sICAM-1 was 0.885(95%CI:0.837-0.924),significantly higher than that of either marker alone(P<0.05).Using cut-off values to define high and low levels,children with low serum ACE2 or high serum sICAM-1 had a significantly higher risk of developing myocardial damage in severe pneumonia(P<0.05).Conclusion In children with severe pneumonia,serum ACE2 and sICAM-1 levels closely associated with myocardial damage and severity of the disease.Assessing these biomarkers provides a high predictive value for myocardial damage in children with severe pneumonia.

作者范晓蕾马威霍玉峰 FAN Xiao-lei;MA Wei;HUO Yu-feng(Pediatric Intensive Care Unit,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,Henan,CHINA)

机构地区郑州大学第一附属医院儿童重症监护病区

出处《海南医学》 2025年第11期1628-1632,共5页 Hainan Medical Journal

基金河南省医学科技攻关计划联合共建项目(编号:LHGJ20200232)。

关键词重症肺炎心肌损伤血管紧张素转化酶2 可溶性细胞间黏附分子1 儿童早期预警评分相关性预测价值 Severe pneumonia Myocardial damage Angiotensin-converting enzyme 2 Soluble intercellular adhesion molecule 1 Early warning score for children Correlation Predictive value

分类号 R725.6 [医药卫生—儿科]