儿童难治性支原体肺炎血清载脂蛋白C1和YKL-40水平变化及临床意义
Journal of Chinese Practical Diagnosis and Therapy(2020)
Abstract
目的 探讨血清载脂蛋白C1 (apolipoprotein C1,APOC1)、YKL-40在儿童难治性肺炎支原体肺炎(mycoplasma pneumoniae pneumonia,MPP)中的表达水平及临床意义.方法 89例MPP患儿依据病情分为普通性MPP组53例和难治性MPP组36例,体检健康儿童40例为对照组.采用ELISA法检测血清APOC1、YKL-40水平,采用肺功能仪测定用力肺活量占预计值百分比(forced vital capacity of the predicted value,FVC% pred)、第1秒用力呼气容积占预计值百分比(forced expiratory volume in one second of the predicted value,FEV1% pred)、第1秒用力呼气容积/用力肺活量(forced expiratory volume in one second/forced vital capacity,FEV1/FVC);采用Pearson积矩相关分析普通性MPP、难治性MPP患儿血清APOC1、YKL40与肺功能指标的相关性;绘制ROC曲线,评估APOC1、YKL-40单独及二者联合检测预测MPP患儿发生难治性MPP的效能.结果 难治性MPP组血清APOC1[(16.31±1.22) mg/L]和YKL-40[(38.02±2.37) mmol/L]水平高于普通性MPP组[(9.86±1.63) mg/L、(23.17±1.85) mmol/L]和对照组[(5.24±1.35)mg/L、(12.68±2.09) mmol/L],普通性MPP组高于对照组(P<0.05);难治性MPP组FVC% pred[(69.14±7.49)%]、FEV1 %pred[(56.22±6.90)%]、FEV1/FVC (0.75±0.06)水平低于普通性MPP组[(78.95±7.24)%、(67.61±6.78)%、0.82±0.09]和对照组[(90.47±8.16)%、(89.08±6.24)%、0.93±0.07],普通性MPP组低于对照组(P<0.05).普通性MPP、难治性MPP患儿血清APOC1、YKL40水平与肺功能指标FVC% pred、FEV1% pred、FEV1/FVC均呈不同程度负相关(P<0.05).APOC1、YKL-40单独检测预测MPP患儿难治性MPP的AUC为0.892、0.900,灵敏度为79.25%、83.02%,特异度为83.33%、86.11%,准确率为80.90%、84.27%;APOC1联合YKL-40检测预测MPP患儿发生难治性MPP的AUC为0.948,灵敏度为92.45%,特异度为94.44%,准确率为93.26%.结论 血清APOC1、YKL-40异常升高参与了难治性MPP的发病过程,且与肺功能密切相关,早期二者联合检测可作为预测MPP患儿发生难治性MPP的重要指标.
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