重症肺炎患儿血清PCT、hs-CRP、CER水平与心肌损害发生率的关系探讨

目的检测重症肺炎患儿血清降钙素原(PCT)、超敏C反应蛋白(hs-CRP)、铜蓝蛋白(CER)水平,并分析其与心肌损害发生率的关系。方法对医院2015年4月~2018年9月收治的212例重症肺炎患儿的资料进行回顾,检测其基线血清PCT、hs-CRP和CER水平。计算心肌损害发生率,对比心肌损害发生者和未发生者基线血清PCT、hs-CRP和CER水平。采用Logistic回归分析探讨上述血清因子与重症肺炎患儿心肌损害的关系,并绘制受试者工作特征曲线(ROC)探讨基线血清PCT、hs-CRP、CER水平及三者联合对心肌损害的预测效能。结果本组患儿心肌损害发生率为11.79%,发生时间为(7.15±2.08)d;心肌损害发生者基线血清PCT、hs-CRP和CER水平均高于未发生组(P<0.05);发生者年龄<3岁、并发呼吸衰竭、低蛋白血症、低氧血症、低钾血症、发病至入院时间>7d、发病至入院时间3~7d、基线PCT升高>50%、基线hs-CRP升高>50%、基线CER升高>50%构成比均高于未发生者(P<0.05),经Logistic回归分析证实均为心肌损害的危险因素;基线PCT、hs-CRP、CER水平预测心肌损害的Cut-off值分别为8.45pg/L、12.50mg/mL、402.47mg/L,三者联合预测心肌损害的灵敏度、特异度、AUC分别为92.00%、97.86%、0.896,均高于单独预测。结论重症肺炎患儿并心肌损害发生风险高,发生者基线PCT、hs-CRP、CER水平较高,年龄<3岁、并发呼吸衰竭等均是其危险因素,且基线PCT、hs-CRP、CER水平联合预测心肌损害的效能较高。

Relationship between serum PCT,hs-CRP,CER levels and the incidence of myocardial damage in children with severe pneumonia

Objective To detect the levels of serum procalcitonin(PCT),hypersensitive C-reactive protein(hs-CRP)and ceruloplasmin(CER)in children with severe pneumonia,and to analyze their relationship with the incidence of myocardial damage.Methods The data of 212 children with severe pneumonia admitted to our hospital from April 2015 to September 2018 were reviewed.The baseline serum PCT,hs-CRP and CER levels were measured.The incidence of myocardial damage was calculated and the baseline serum levels of PCT,hs-CRP and CER were compared between the patients with and without myocardial damage.Logistic regression analysis was used to explore the relationship between the above serum factors and myocardial damage in children with severe pneumonia.Subject operating characteristic curve(ROC)was drawn to explore the predictive effect of baseline serum PCT,hs-CRP,CER levels and their combination on myocardial damage.Results The incidence of myocardial damage in this group was 11.79%,and the occurrence time was(7.15±2.08)days.The baseline serum levels of PCT,hs-CRP and CER in patients with myocardial damage were higher than those in patients without myocardial damage(P<0.05).The risk factors of myocardial injury were age<3 years,respiratory failure,hypoproteinemia,hypoxemia,hypokalemia,onset to admission time>7 days,onset to admission time 3-7 days,baseline PCT>50%,baseline hs-CRP>50%,baseline CER>50%(P<0.05).Logistic regression analysis confirmed that all of them were risk factors for myocardial damage.The cut-off values of baseline PCT,hs-CRP and CER for predicting myocardial damage were 8.45 pg/L,12.50 mg/mL and 402.47 mg/L,respectively.The sensitivity,specificity and AUC of the three combined predictors were 92.00%,97.86%and 0.896,respectively,which were higher than those of the single predictors.Conclusion Children with severe pneumonia have a high risk of myocardial damage.The baseline levels of PCT,hs-CRP and CER are higher in those with severe pneumonia.Age<3 years old,respiratory failure and so on are the risk factors.The baseline levels of PCT,hs-CRP and CER are more effective in predicting myocardial damage.