摘要
目的:基于限制性立方样条(RCS)分析血清C1q/肿瘤坏死因子相关蛋白4(CTRP4)、纤溶酶原激活物抑制因子1(PAI-1)水平与早产儿急性呼吸窘迫综合征(ARDS)预后的相关性及其临床意义。方法:选取ARDS早产儿230例,根据28 d预后情况分为预后不良组(61例)和预后良好组(169例)。比较两组一般资料及血清CTRP4、PAI-1水平,Logistic回归分析ARDS早产儿预后不良的影响因素,RCS分析血清CTRP4、PAI-1与ARDS早产儿预后不良的剂量-反应关系,受试者工作特征(ROC)曲线分析血清CTRP4、PAI-1预测ARDS早产儿预后不良的价值。根据预后不良的常规影响因素构建常规Logistic回归模型,并根据常规影响因素及血清CTRP4、PAI-1构建新Logistic回归模型,比较两种模型的预测价值。结果:预后不良组胸部X线表现为Ⅲ-Ⅳ级占比、机械通气时间以及血清CTRP4、PAI-1水平高于预后良好组,出生体重和新生儿危重症评分(NCIS)低于预后良好组(均P<0.05)。胸部X线表现为Ⅲ-Ⅳ级、机械通气时间以及血清CTRP4、PAI-1为ARDS早产儿预后不良的独立危险因素,出生体重和NCIS为独立保护因素(均P<0.05)。血清CTRP4、PAI-1与ARDS早产儿预后不良风险存在正相关的剂量-反应关系(均P<0.05)。血清CTRP4、PAI-1预测ARDS早产儿预后不良的曲线下面积(AUC)分别为0.747、0.758(均P<0.05)。常规Logistic回归模型、新Logistic回归模型预测ARDS早产儿预后不良的AUC分别为0.856、0.938(均P<0.05)。与常规Logistic回归模型比较,新Logistic回归模型预测预后不良的AUC明显增大,净重新分类指数(NRI)和综合判别改善指数(IDI)均>0(均P<0.05)。结论:血清CTRP4、PAI-1水平与ARDS早产儿预后不良风险存在正相关的剂量-反应关系,且具有预测预后不良风险的价值。
Objective:To analyze the correlation between serum C1q/tumor necrosis factor-related protein 4(CTRP4),plasminogen activator inhibitor-1(PAI-1),and the prognosis of acute respiratory distress syndrome(ARDS)in premature infants based on restricted cubic spline(RCS)analysis and their clinical significance.Methods:A total of 230 premature infants with ARDS were selected and divided into apoor prognosis group(n=61)and good prognosis group(n=169)based on their 28-day prognosis.The general data and serum CTRP4 and PAI-1 levels of the two groups were compared.Logistic regression was used to analyze the influencing factors of poor prognosis of premature infants with ARDS.RCS was used to analyze the dose-response relationship between serum CTRP4,PAI-1 and poor prognosis of premature infants with ARDS.ROC curve was used to analyze the value of serum CTRP4 and PAI-1 in predicting the poor prognosis of preterm infants with ARDS.The conventional Logistic regression model was constructed according to the conventional influencing factors of poor prognosis,and the new Logistic regression model was constructed according to the conventional influencing factors and serum CTRP4 and PAI-1,and the predictive value of the two models was compared.Results:The proportion of gradeⅢ-Ⅳchest X-ray findings,the duration of mechanical ventilation,and the levels of serum CTRP4 and PAI-1 in the poor prognosis group were higher than those in the good prognosis group,while the birth weight and Neonatal Critical Illness Score(NCIS)were lower than those in the good prognosis group(all P<0.05).The gradeⅢ-Ⅳchest X-ray findings,duration of mechanical ventilation,serum CTRP4 and PAI-1 were independent risk factors for poor prognosis in premature infants with ARDS,while birth weight and NCIS were independent protective factors(all P<0.05).There was a positive dose-response relationship between serum CTRP4,PAI-1 and the risk of poor prognosis in premature infants with ARDS(all P<0.05).The AUC of serum CTRP4 and PAI-1 for predicting poor prognosis in premature infants with ARDS were 0.747 and 0.758,respectively(all P<0.05).The AUC of the conventional Logistic model and the new Logistic model for predicting poor prognosis in premature infants with ARDS were 0.856 and 0.938,respectively(all P<0.05).Compared with the conventional Logistic model,the AUC of the new Logistic model for predicting poor prognosis increased significantly,and both the Net Reclassification Index(NRI)and Integrated Discrimination Improvement(IDI)were greater than 0(all P<0.05).Conclusion:There is a positive dose-response relationship between serum CTRP4,PAI-1 levels and the risk of poor prognosis in premature infants with ARDS,and they have the value in predicting the risk of poor prognosis.
作者
林加娟
黄向荣
崔铭玲
张园园
孙瑞
LIN Jiajuan;HUANG Xiangrong;CUI Mingling;ZHANG Yuanyuan;SUN Rui(Department of Neonatology,Suzhou Municipal Hospital,Suzhou 215000,China;Department of Neonatology,Xi’an Central Hospital,Xi’an 710004,China)
出处
《陕西医学杂志》
2025年第9期1213-1218,共6页
Shaanxi Medical Journal
基金
江苏省优势学科建设工程项目(YSHL2101-131)。
