ARDS儿童血清淀粉样蛋白A、降钙素原、乳酸脱氢酶水平及氧合指数与预后状况的相关性

目的 研究血清淀粉样蛋白A(serum amyloid A,SAA)、降钙素原(procallcitonin,PCT)、乳酸脱氢酶(lactate dehydrogenase,LDH)及氧合指数(fraction of inspiration oxygen/partial pressure of oxygen,FiO2/PO2)与急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)儿童预后的关系。 方法 选取保定市第一医院2018年1月-2021年6月收治的94例ARDS患儿纳为研究对象，所有患儿均接受机械通气、抗感染、营养支持等对症治疗，根据患儿治疗后28 d存活情况，将其分为存活组与死亡组。比较不同预后患儿血清SAA、PCT、LDH以及FiO2/PO2水平。COX风险比例回归分析影响ARDS患儿死亡的独立危险因素，绘制受试者工作特征曲线(receiver operating characteristic curve,ROC)，分析血清SAA、PCT、LDH以及FiO2/PO2水平在预测ARDS患儿死亡中的价值。 结果 死亡组ARDS患儿血清SAA、PCT、LDH浓度以及FiO2/PO2水平均高于存活组患儿，差异均具有统计学意义（P<0.05）。单因素分析提示，血清C反应蛋白(C-reactive protein,CRP)、SAA、PCT、LDH，FiO2/PO2及入院时急性生理与慢性健康评分系统Ⅱ(APACHEⅡ)均是影响ARDS患儿预后的相关因素（P<0.05）。多因素回归分析提示，血清SAA，FiO2/PO2及APACHEⅡ评分是影响ARDS患儿预后独立危险因素（P<0.05）。绘制ROC曲线发现，血清SAA、PCT、LDH以及FiO2/PO2单独应用在预测ARDS患儿预后中，以血清SAA的预测效能最高，其ROC曲线下的面积（Area Under Curve,AUC）=0.787，95%CI(0.661~0.914)，其次是FiO2/PO2，其AUC=0.775，95%CI(0.680~0.870)，而四个指标联合应用，可有效提高各指标单独应用时的效能，联合预测因子的AUC=0.937，95%CI(0.877~0.997)。 结论 血清SAA，FiO2/PO2与APACHEⅡ评分一同进入多因素回归模型，被证实是影响ARDS患儿预后独立危险因素，各指标联合应用在预测ARDS患儿预后中具有良好的应用效能。

Correlation of Serum Amyloid A, Procalcitonin and Lactate Dehydrogenase Levels with Oxygenation Index and Prognosis in Children with ARDS

Objective To discuss the correlation of serum amyloid A (SAA), procalcitonin (PCT) and lactate dehydrogenase (LDH) levels with oxygenation index [ratio of the partial pressure of arterial oxygen to the fraction of inspired oxygen (FiO2/PO2)] and prognosis in children with acute respiratory distress syndrome (ARDS). Methods Ninety-four children with ARDS in our hospital from January 2018 to June 2021 were enrolled, and all children received symptomatic treatment such as mechanical ventilation, anti-infection and nutritional support. Patients were classified into survival group and death group according to 28d short-term prognosis. Levels of SAA, PCT, LDH and FiO2/PO2 were compared between two groups. Cox proportional hazard regression analysis was used to screen the independent risk factors affecting death in children with ARDS, then receiver operating characteristic (ROC) curve was used to evaluate the value of serum SAA, PCT, LDH and FiO2/PO2 levels in predicting death in children with ARDS. Results Levels of SAA, PCT, LDH and FiO2/PO2 were abnormally elevated in death group compared with survival group, with statistical difference (P<0.05). Univariate analysis suggested that baseline serum C-reactive protein (CRP), SAA, PCT, LDH, FiO2/PO2 and Acute Physiology and Chronic Health Enquiry (APACHE II) scores were all factors affecting the prognosis of ARDS children (P<0.05). Multivariate regression analysis showed that baseline serum SAA, FiO2/PO2 and APACHE II scores were independent risk factors affecting the prognosis of children with ARDS (P<0.05). Among SAA, PCT, LDH and FiO2/PO2 in predicting the prognosis of children with ARDS, ROC curve denoted that SAA had the highest efficacy [AUC=0.787, 95%CI(0.661~0.914)], followed by FiO2/PO2 [AUC=0.775, 95%CI(0.680~0.870)], while the efficacy of the combined detection of SAA, PCT, LDH and FiO2/PO2 in predicting the prognosis of children with ARDS was better than that of the separate detection [AUC=0.937, 95%CI(0.877~0.997)]. Conclusion Multivariate regression model analysis reveals that SAA, FiO2/PO2 and APACHE II scores are confirmed to be independent risk factors affecting the prognosis of children with ARDS, and the combined detection of above indexes is of great clinical efficacy in predicting the prognosis of ARDS children.