摘要
目的探讨急性呼吸窘迫综合征(ARDS)患儿血清红细胞转化特异性转录因子样基因1(ELK1)、Runt相关转录因子1(RUNX1)水平与病情严重程度及预后的关系。方法选取2021年1月至2023年1月该院收治的205例ARDS患儿作为ARDS组,另选取同期在该院体检的112例健康儿童作为对照组。根据病情严重程度将ARDS患儿分为轻度ARDS组(53例)、中度ARDS组(83例)、重度ARDS组(69例)。根据入院后28 d内是否发生死亡,将ARDS患儿分为预后不良组和预后良好组。采用酶联免疫吸附试验检测血清ELK1、RUNX1水平。采用Spearman相关分析ARDS患儿血清ELK1、RUNX1水平与病情严重程度的相关性。采用多因素Logistic回归分析ARDS患儿预后不良的影响因素。绘制受试者工作特征(ROC)曲线分析血清ELK1、RUNX1对ARDS患儿预后不良的预测价值。结果ARDS组血清ELK1水平高于对照组,RUNX1水平低于对照组,差异均有统计学意义(P<0.05)。重度ARDS组血清ELK1水平高于轻度ARDS组、中度ARDS组,且中度ARDS组高于轻度ARDS组,差异均有统计学意义(P<0.05)。重度ARDS组血清RUNX1水平低于轻度ARDS组、中度ARDS组,且中度ARDS组低于轻度ARDS组,差异均有统计学意义(P<0.05)。Spearman相关分析结果显示,ARDS患儿血清ELK1水平与病情严重程度呈正相关(r_(s)=0.797,P<0.001),血清RUNX1水平与病情严重程度呈负相关(r_(s)=-0.783,P<0.001)。预后不良组呼气末正压、ELK1水平高于预后良好组,氧合指数、清蛋白、RUNX1水平低于预后良好组,差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,氧合指数、清蛋白和RUNX1水平升高是ARDS患儿预后不良的保护因素(P<0.05),血清ELK1水平升高是ARDS患儿预后不良的危险因素(P<0.05)。ROC曲线分析结果显示,血清ELK1、RUNX1联合预测ARDS患儿预后不良的曲线下面积(AUC)为0.875,大于血清ELK1、RUNX1单独预测的AUC(Z=3.215、3.376,P=0.001、0.001)。结论ARDS患儿血清ELK1水平升高,RUNX1水平降低,二者水平与病情严重程度和预后有关,血清ELK1、RUNX1联合检测对ARDS患儿预后不良有较高的预测价值。
Objective To investigate the relationship between the levels of serum erythroblast transformation-specific transcription factor-like gene 1(ELK1)and Runt-related transcription factor 1(RUNX1)in children with acute respiratory distress syndrome(ARDS)and the severity of the disease and prognosis.Methods A total of 205 children with ARDS admitted to the hospital from January 2021 to January 2023 were selected as the ARDS group,and 112 healthy children who underwent physical examination at the the hospital during the same period were selected as the control group.The children with ARDS were divided into mild ARDS group(53 cases),moderate ARDS group(83 cases)and severe ARDS group(69 cases)according to the severity of the disease.The children with ARDS were divided into poor prognosis group and good prognosis group according to whether death occurred within 28 d after admission.Serum ELK1 and RUNX1 levels were detected by enzyme-linked immunosorbent assay.Spearman correlation analysis was used to analyze the correlation between serum ELK1 and RUNX1 levels and the severity of the disease in children with ARDS.Multivariable Logistic regression analysis was used to analyze the influencing factors of poor prognosis in children with ARDS.The receiver operating characteristic(ROC)curve was drawn to analyze the predictive value of serum ELK1 and RUNX1 for poor prognosis in children with ARDS.Results The serum ELK1 level in the ARDS group was higher than that in the control group,and the serum RUNX1 level in the ARDS group was lower than that in the control group,and the differences were statistically significant(P<0.05).The serum ELK1 level in the severe ARDS group was higher than that in the mild ARDS group and the moderate ARDS group,and that in the moderate ARDS group was higher than that in the mild ARDS group,and the differences were statistically significant(P<0.05).The serum RUNX1 level in the severe ARDS group was lower than that in the mild ARDS group and the moderate ARDS group,and that in the moderate ARDS group was lower than that in the mild ARDS group,and the differences were statistically significant(P<0.05).Spearman correlation analysis showed that the serum ELK1 level in children with ARDS was positively correlated with the severity of the disease(r_(s)=0.797,P<0.001),and the serum RUNX1 level was negatively correlated with the severity of the disease(r_(s)=-0.783,P<0.001).The end-expiratory positive pressure and serum ELK1 level in the poor prognosis group were higher than those in the good prognosis group,and the oxygenation index,albumin,RUNX1 level were lower than those in the good prognosis group,and the differences were statistically significant(P<0.05).Multivariable Logistic regression analysis showed that the elevated oxygenation index,albumin,and RUNX1 level were protective factors for poor prognosis in children with ARDS(P<0.05),and the elevated serum ELK1 level was a risk factor for poor prognosis in children with ARDS(P<0.05).The ROC curve analysis showed that the area under the curve(AUC)of serum ELK1 and RUNX1 combined for predicting poor prognosis in children with ARDS was 0.875,which was larger than the AUC of serum ELK1 and RUNX1 alone(Z=3.215,3.376,P=0.001,0.001).Conclusion The serum ELK1 level is elevated and the serum RUNX1 level is decreased in children with ARDS,and the levels of both are related to the severity of the disease and prognosis.The combined detection of serum ELK1 and RUNX1 has a high predictive value for poor prognosis in children with ARDS.
作者
张迎旭
赵媛媛
张孝兴
ZHANG Yingxu;ZHAO Yuanyuan;ZHANG Xiaoxing(Department of Emergency Intensive Care,Baoji Maternal and Child Health Hospital,Baoji,Shaanxi 721000,China;Department of Laboratory Medicine,Baoji Maternal and Child Health Hospital,Baoji,Shaanxi 721000,China)
出处
《检验医学与临床》
2026年第3期296-302,共7页
Laboratory Medicine and Clinic
基金
陕西省卫生健康科研项目(2020E008)。
关键词
急性呼吸窘迫综合征
红细胞转化特异性转录因子样基因1
Runt相关转录因子1
病情严重程度
预后
acute respiratory distress syndrome
erythroblast transformation-specific transcription factor-like gene 1
Runt-related transcription factor 1
severity of the disease
prognosis
