摘要
目的探讨血清1,25二羟维生素D_(3)[1,25(OH)_(2)D_(3)]和嗜酸性粒细胞百分比(EOS%)联合急性生理与慢性健康评价评分表(APACHEⅡ)评估在小儿肺炎病情严重程度的价值。方法选取2019年10月—2023年12月秦皇岛市妇幼保健院收治的123例小儿肺炎患者作为观察组,根据病情严重程度再分为轻症组(79例)和重症组(44例)。同时选取60例该院同期体检健康儿童作为对照组。比较不同组别的血清1,25(OH)_(2)D_(3)、EOS%表达水平和APACHEⅡ评分,比较血清1,25(OH)_(2)D_(3)、EOS%、APACHEⅡ评分与肺功能指标[潮气量(VT)、呼吸频率(RR)、吸呼比(TI/TE)、呼气峰时长占总呼气时间百分比(TPTEF/TE)]的相关性。通过受试者工作特征(ROC)曲线评估1,25(OH)_(2)D_(3)、EOS%和APACHEⅡ评分的联合使用在评估疾病严重程度的有效性。结果观察组1,25(OH)_(2)D_(3)水平低于对照组(P<0.05),血清EOS%高于对照组(P<0.05)。重症组1,25(OH)_(2)D_(3)水平低于轻症组(P<0.05),EOS%和APACHEⅡ评分均高于轻症组(P<0.05)。重症组患儿VT、TI/TE及TPTEF/TE低于轻症组(P<0.05),RR高于轻症组(P<0.05)。Pearson相关性分析结果显示,1,25(OH)_(2)D_(3)水平与VT、TI/TE、TPTEF/TE均呈正相关(r=0.395、0.478、0.344,均P<0.05),与RR呈负相关(r=-0.236,P<0.05)。EOS%与VT、TI/TE、TPTEF/TE均呈负相关(r=-0.319、-0.290、-0.308,均P<0.05),与RR呈正相关(r=0.301,P<0.05)。APACHEⅡ评分与VT、TI/TE、TPTEF/TE呈负相关(r=-0.285、-0.503、-0.302,均P<0.05),与RR呈正相关(r=0.324,P<0.05)。ROC曲线分析结果显示,1,25(OH)_(2)D_(3)、EOS%和APACHEⅡ评分联合预测的曲线下面积最大,为0.993(95%CI:0.983,1.000);敏感性最高,为90.9%(95%CI:0.783,0.975);特异性最高,为100.0%(95%CI:0.954,1.000)。结论血清1,25(OH)_(2)D_(3)水平和EOS%联合APACHEⅡ评分与小儿肺炎的严重程度密切相关,3项指标联合检测可有效评估病情严重程度。
Objective To analyze the clinical value of serum 1,25-dihydroxyvitamin D_(3)[1,25(OH)2D_(3)]and eosinophil percentage(EOS%)combined with the Acute Physiology and Chronic Health Evaluation(APACHE)Ⅱscore in assessing the severity of pediatric pneumonia.Methods A total of 123 pediatric pneumonia patients admitted to Qinhuangdao Maternal and Child Health Hospital from October 2019 to December 2023 were enrolled and divided into the mild(n=79)and severe(n=44)groups based on disease severity.Additionally,60 healthy children undergoing routine health examinations in the hospital during the same period served as controls.Serum levels of 1,25(OH)2D_(3),EOS%,and APACHEⅡscores were compared among the groups,and their correlations with pulmonary function parameters[tidal volume(VT),respiratory rate(RR),inspiratory-to-expiratory ratio(TI/TE),and time to peak expiratory flow as a percentage of total expiratory time(TPTEF/TE)]were analyzed.The predictive efficacy of combining 1,25(OH)2D_(3),EOS%,and APACHEⅡscores for disease severity was evaluated using the receiver operating characteristic(ROC)curve analysis.Results Compared with the controls,the pneumonia patients exhibited significantly lower serum 1,25(OH)2D_(3)levels and higher EOS%(P<0.05).The severe group showed lower 1,25(OH)2D_(3)levels but higher EOS%and APACHEⅡscores than the mild group(P<0.05).The children in the severe group had reduced VT,TI/TE,and TPTEF/TE,along with elevated RR,compared with the mild group(P<0.05).Pearson correlation analysis indicated positive correlations between 1,25(OH)2D_(3)levels and VT,TI/TE,and TPTEF/TE(r=0.395,0.478 and 0.344,all P<0.05),but a negative correlation with RR(r=-0.236,P<0.05).EOS%was negatively correlated with VT,TI/TE,and TPTEF/TE(r=-0.319,-0.290 and-0.308,all P<0.05),and positively correlated with RR(r=0.301,P<0.05).APACHE Ⅱ scores were negatively correlated with VT,TI/TE,and TPTEF/TE(r=-0.285,-0.503 and-0.302,all P<0.05),and positively correlated with RR(r=0.324,P<0.05).ROC curve analysis showed that the combined prediction using 1,25(OH)_(2)D_(3),EOS%,and APACHE Ⅱ scores yielded the largest area under the curve 0.993(95%CI:0.983,1.000),with the highest sensitivity 90.9%(95%CI:0.783,0.975)and specificity 100.0%(95%CI:0.954,1.000).Conclusion Serum 1,25(OH)2D_(3),EOS%and the APACHEⅡscore are closely associated with the severity of pediatric pneumonia,and their combination could serve as effective biomarkers for clinical assessment.
作者
宋小宇
田大伟
张淑平
Song Xiao-yu;Tian Da-wei;Zhang Shu-ping(Department of Pediatrics,Qinhuangdao Maternal and Child Health Hospital,Qinhuangdao,Hebei 066000,China;First Department of Pediatrics,Qinhuangdao Maternal and Child Health Hospital,Qinhuangdao,Hebei 066000,China;Department of Oncology,Seventh People's Hospital of Hebei Province,Dingzhou,Hebei 073000,China)
出处
《中国现代医学杂志》
2025年第18期26-31,共6页
China Journal of Modern Medicine
基金
河北省卫生健康委员会科研基金项目(No:20231401)。
