中性粒细胞明胶酶相关脂质运载蛋白在重症肺炎合并脓毒症患儿中的表达及临床价值

目的探讨中性粒细胞明胶酶相关脂质运载蛋白(NGAL)在重症肺炎合并脓毒症患儿中的表达及临床价值。方法选取该院106例重症肺炎合并脓毒症患儿,根据严重程度分为脓毒症组、严重脓毒症组和脓毒症休克组,根据出院时转归分为预后良好组和预后不良组,根据是否合并肾功能障碍分为肾功能障碍组和无肾功能障碍组。分析患儿的NGAL、降钙素原(PCT)、白细胞介素-6(IL-6)、C-反应蛋白(CRP)及小儿危重病例评分(PCIS),采用Spearman秩相关及受试者工作特征曲线(ROC曲线)对各指标进行分析与评价。结果肾功能障碍组NGAL水平明显高于无肾功能障碍组,两组比较差异有统计学意义(P<0.05);NGAL、CRP、PCT、IL-6水平和PCIS在脓毒症组、严重脓毒症组和脓毒症休克组中的差异均有统计学意义(均P<0.05),其中NGAL、PCT、IL-6水平在3组中依次升高,PCIS在3组中依次降低,组间两两比较差异均有统计学意义(均P<0.05);与预后良好组比较,预后不良组的NGAL、CRP、PCT、IL-6水平明显升高,PCIS明显降低,差异均有统计学意义(均P<0.05);Spearman相关分析显示NGAL与CRP、PCT、IL-6呈正相关,与PCIS呈负相关(均P<0.05);NGAL用于预测预后不良的曲线下面积(AUC)为0.915,仅次于PCIS的0.949。结论NGAL在重症肺炎合并脓毒症患儿病情严重程度及预后预测中可能具有一定的临床价值。

Expression and clinical value of neutrophil gelatinase-associated lipocalin in children with severe pneumonia complicated by sepsis

Objective To investigate the expression and clinical value of neutrophil gelatinase-associated lipocalin(NGAL)in children with severe pneumonia complicated by sepsis.Methods A total of 106 children with severe pneumonia and sepsis in this hospital were selected and divided into sepsis group,severe sepsis group and septic shock group according to their severity.They were divided into good prognosis group and poor prognosis according to the outcome at discharge,and divided into renal dysfunction group and non-renal dysfunction group according to whether they had renal dysfunction.The children’s NGAL,proealcitonin(PCT),interleukin-6(IL-6),C-reactive protein(CRP),and pediatric critical case score(PCIS) were analyzed.Spearman rank correlation and receiver operating characteristic curve(ROC curve) were used to analyse and evaluate each index.Results The level of NGAL in the renal dysfunction group was significantly higher than that in the non renal dysfunction group(P<0.05);the differences of NGAL,CRP,PCT,IL-6 and PCIS in the sepsis group,the severe sepsis group and the sepsis shock group were statistically significant(P <0.05),anong which the levels of NGAL,PCT and IL-6 in the three groups increased in turn,PCIS in the three groups decreased in turn,there were statistically significant differences between the two groups(P<0.05);compared with the group with good prognosis,the levels of NGAL,CRP,PCT,IL-6 in the group with poor prognosis were significantly higher and PCIS was significantly lower(P <0.05);Spearman correlation analysis showed that NGAL was positively correlated with CRP,PCT,IL-6 and negatively correlated with PCIS(P<0.05);NGAL was used to predict the area under the curve(AUC) for poor prognosis was 0.915,next to 0.949 of PCIS.Conclusion NGAL may have clinical value in predicting the severity and prognosis of children with severe pneumonia complicated by sepsis.