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中华实验和临床感染病杂志(电子版) ›› 2021, Vol. 15 ›› Issue (05) : 323 -329. doi: 10.3877/cma.j.issn.1674-1358.2021.05.006

论著

肺炎支原体肺炎患儿血清淀粉样蛋白A和人软骨糖蛋白-39水平监测及其预测价值
陈洋1, 崔湘君1,†(), 李敏1, 孙迎军1   
  1. 1. 221000　徐州市，徐州市中心医院儿科
  • 收稿日期:2020-11-08 出版日期:2021-10-15
  • 通信作者: 崔湘君

Monitoring of serum amyloid A and human cartilage glycoprotein-39 levels of children with mycoplasma pneumoniae pneumonia and the prognostic value

Yang Chen1, Xiangjun Cui1,†(), Min Li1, Yingjun Sun1   

  1. 1. Department of Pediatrics, Xuzhou Central Hospital, Xuzhou 221009, China
  • Received:2020-11-08 Published:2021-10-15
  • Corresponding author: Xiangjun Cui
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引用本文：

陈洋, 崔湘君, 李敏, 孙迎军. 肺炎支原体肺炎患儿血清淀粉样蛋白A和人软骨糖蛋白-39水平监测及其预测价值[J/OL]. 中华实验和临床感染病杂志(电子版), 2021, 15(05): 323-329.

Yang Chen, Xiangjun Cui, Min Li, Yingjun Sun. Monitoring of serum amyloid A and human cartilage glycoprotein-39 levels of children with mycoplasma pneumoniae pneumonia and the prognostic value[J/OL]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2021, 15(05): 323-329.

目的

探讨肺炎支原体肺炎（MPP）患儿血清淀粉样蛋白A（SAA）和人软骨糖蛋白-39（HC-gp39）水平及其对预后的预测价值。

方法

对徐州市中心医院2018年10月至2019年12月收治的86例MPP患儿（研究组）与同期于本院进行体检的79例健康儿童（对照组）的临床资料进行回顾性分析。比较研究组患儿入院时与对照组儿童体检时、研究组重症与轻症患儿血清SAA和HC-gp39水平。分析研究组患儿预后不良发生率，比较预后不良与预后良好患儿入院时、治疗后3 d和治疗后1周的血清SAA和HC-gp39水平及变化率。采用Logistic回归分析MPP患儿预后不良的影响因素；采用受试者工作特征（ROC）曲线下面积（AUC）分析血清SAA和HC-gp39水平对MPP患儿预后不良的预测价值。

结果

研究组患儿血清SAA和HC-gp39水平均高于对照组（t = 49.374、P < 0.001，t = 49.374、P < 0.001）。研究组重症患儿占比为45.35%（39/86），重症患儿血清SAA和HC-gp39水平均高于轻症患儿（t = 13.411、P < 0.001，t = 10.426，P < 0.001），差异均有统计学意义。研究组患儿预后不良发生率为6.98%（6/86）；入院时、治疗后3 d和治疗后1周，预后不良患儿血清SAA和HC-gp39水平均逐渐升高，预后良好患儿则均逐渐降低；预后不良和预后良好患儿治疗后1周较入院时血清SAA变化率分别为（57.10 ± 6.59）%和（-77.12 ± 9.87）%，血清HC-gp39变化率分别为（58.63 ± 7.79）%和（-29.09 ± 4.18）%，差异均有统计学意义（SAA：t = 4.873、P < 0.001；HC-gp39：t = 15.588、P < 0.001）。MPP患儿预后不良者重症率、SAA变化率和HC-gp39变化率均显著高于预后良好者[100.00% vs. 41.25%：χ2 = 7.773、P = 0.005，（52.49 ± 6.59）% vs.（-77.12 ± 9.87）%：t = 4.873、P < 0.001，（58.63 ± 7.79）% vs.（-29.09 ± 4.18）%：t = 15.588、P < 0.001]，且重症（OR = 6.386、P = 0.003）、SAA变化率（OR = 7.892、P < 0.001）和HC-gp39变化率（OR = 8.654、P = 0.001）均为MPP患儿预后不良的危险因素；SAA变化率和HC-gp39变化率单独预测预后不良的最佳截断点分别为45.07%和41.19%，灵敏度分别为83.33%和66.67%，特异度分别为82.15%和87.65%，AUC分别为0.817、0.765；SAA变化率联合HC-gp39变化率预测预后不良的灵敏度、特异度和AUC分别为66.67%、97.50%和0.906，SAA变化率、HC-gp39变化率联合预测预后不良的特异度、AUC均高于单独指标预测（特异度：χ2 = 11.123、P = 0.001，χ2 = 4.783、P = 0.029；AUC：Z = 3.012、P = 0.031，Z = 4.258、P = 0.014）。

结论

MPP患儿血清SAA、HC-gp39水平高于健康儿童，重症、预后不良MPP患儿SAA变化率、HC-gp39变化率均更高，且二者是预后不良的危险因素，二者变化率联合应用可预测MPP的预后。

关键词: 肺炎支原体肺炎, 血清淀粉样蛋白A, 人软骨糖蛋白-39, 预后
Objective

To investigate the levels of serum amyloid A (SAA) and human cartilage glycoprotein-39 (HC-gp39) of children with mycoplasma pneumoniae pneumonia (MPP), and to explore their prognostic value.

Methods

The clinical data of 86 children with MPP admitted to Xuzhou Central Hospital from October 2018 to December 2019 (study group) and 79 healthy children who underwent physical examination during the same period (control group) were reviewed, retrospectively. The levels of SAA and HC-gp39 between cases in study group and control group, severe cases and mild cases in study group were compared, respectively. The incidence of poor prognosis of cases in study group was analyzed, serum SAA, HC-gp39 levels and change rates of poor prognosis cases and good prognosis cases were compared at admission, 3 days after treatment and 1 week after treatment, respectively. The influencing factors of poor prognosis of children with MPP were analyzed by Logistic regression analysis. The predictive value of serum SAA and HC-gp39 on the prognosis of MPP were evalued by area under curve (AUC) of receiver operating characteristic (ROC).

Results

The levels of serum SAA and HC-gp39 of cases in study group were higher than those of control group (t = 49.374, P < 0.001; t = 49.374, P < 0.001). Among study group, 45.35% (39/86) children were severe cases. The levels of serum SAA and HC-gp39 of severe cases were higher than those of mild cases, with significant differences (t =13.411, P < 0.001; t = 10.426, P < 0.001). The incidence of poor prognosis in study group was 6.98% (6/86). The levels of serum SAA and HC-gp39 of poor prognosis cases increased gradually, which decreased gradually in cases with good prognosis. Compared with the indexes at admission, the change rates of serum SAA and HC-gp39 of poor prognosis cases and good prognosis cases 1 week after treatment were [(57.10 ± 6.59)% vs. (-77.12 ± 9.87)%] and [(58.63 ± 7.79)% vs. (-29.09 ± 4.18)%], with significant differences (SAA: t = 4.873, P < 0.001, HC-gp39: t = 15.588, P < 0.001). Severity rate, SAA and HC-gp39 change rates of cases with poor prognosis were significantly higher than those with good prognosis [100.00% vs. 41.25%: χ2 = 7.773, P = 0.005; (52.49 ± 6.59)% vs. (-77.12 ± 9.87)%: t = 4.873, P < 0.001; (58.63 ± 7.79) vs. (-29.09 ± 4.18): t = 15.588, P < 0.001], and severity (OR = 6.386, P = 0.003), SAA change rate (OR = 7.892, P < 0.001) and HC-gp39 change rate (OR = 8.654, P = 0.001) were all risk factors for poor prognosis. The best cut-off points of SAA and HC-gp39 change rates in predicting poor prognosis alone were 45.07% and 41.19%, the sensitivity were 83.33% and 66.67%, and the specificity were 82.15% and 87.65%, and the AUC were 0.817 and 0.765, respectively. The sensitivity, specificity and AUC of SAA combined with HC-gp39 change rates in predicting poor prognosis were 66.67%, 97.50% and 0.906, respectively, the specificity and AUC of SAA combined with HC-gp39 change rates for prediction were higher than individual index (specificity: χ2 = 11.123, P = 0.001; χ2 = 4.783, P = 0.029; AUC: Z = 3.012, P = 0.031; Z = 4.258, P = 0.014).

Conclusions

The serum levels of SAA and HC-gp39 of MPP children were higher than those of healthy children. The SAA change rate and HC-gp39 change rate were higher in children with severe MPP and poor prognosis, which were both risk factors for poor prognosis, and the combination of SAA and HC-gp39 change rates could predict the prognosis of MPP.

Key words: Mycoplasma pneumoniae pneumonia, Serum amyloid A, Human cartilage glycoprotein-39, Prognosis
表1 研究组与对照组儿童一般资料
组别 例数 性别[例（%）] 年龄（±s，岁） 病程（±s，d）
男性 女性
研究组 86 39（45.35） 47（54.65） 8.01 ± 1.23 2.34 ± 0.34
对照组 79 35（44.30） 44（55.70） 7.85 ± 1.27 —
统计量   χ2 = 0.018a t = 0.822 —
P值   0.893 0.412 —
表2 研究组与对照组血清SAA和HC-gp39水平（±s）
组别 例数 SAA（mg/L） HC-gp39（ng/ml）
研究组 86 109.24 ± 18.75 40.91 ± 7.12
对照组 79 4.95 ± 0.89 24.84 ± 4.37
t值   49.374 17.289
P值   < 0.001 < 0.001
表3 研究组重症与轻症患儿入院时血清SAA和HC-gp39水平（±s）
组别 例数 SAA（mg/L） HC-gp39（ng/ml）
重症患儿 39 139.41 ± 23.88 48.74 ± 7.75
轻症患儿 47 84.19 ± 13.74 34.41 ± 4.89
t值   13.411 10.426
P值   < 0.001 < 0.001
表4 研究组预后不良与预后良好患儿不同时间点血清SAA和HC-gp39水平（±s）
指标 预后不良（6例） 预后良好（80例） t值 P值
SAA（mg/L）        
  入院时 111.73 ± 17.61 66.03 ± 11.25 9.208 < 0.001
  治疗后3 d 146.18 ± 21.39 40.28 ± 5.47 33.621 < 0.001
  治疗后1周 175.53 ± 22.01 15.11 ± 2.73 63.302 < 0.001
  aF值 45.671 20.089    
  aP值 < 0.001 < 0.001    
HC-gp39（ng/ml）        
  入院时 49.51 ± 8.07 40.63 ± 7.29 2.859 < 0.001
  治疗后3 d 66.18 ± 10.19 33.42 ± 5.11 13.960 < 0.001
  治疗后1周 78.54 ± 10.35 28.81 ± 4.17 24.643 < 0.001
  bF值 34.087 15.982    
  bP值 < 0.001 < 0.001    
表5 MPP患儿预后良好和预后不良的影响因素
影响因素 预后不良（6例） 预后良好（80例） 统计量 P值
性别[例（%）]     χ2 = 0.035a 0.851
  男 3（50.00） 36（45.00）    
  女 3（50.00） 44（55.00）    
年龄（±s，岁） 7.95 ± 1.21 8.01 ± 1.25 t = 0.114 0.910
发热[例（%）]     χ2 = 1.829a 0.176
  是 6（100.00） 61（76.25）    
  否 0（0.00） 19（23.75）    
病程（±s，d） 2.51 ± 0.37 2.33 ± 0.33 t = 1.279 0.204
重症[例（%）]     χ2 = 7.773a 0.005
  是 6（100.00） 33（41.25）    
  否 0（0.00） 47（58.75）    
SAA变化率（±s，%） 52.49 ± 6.59 -77.12 ± 9.87 t = 4.873 < 0.001
HC-gp39变化率（±s，%） 58.63 ± 7.79 -29.09 ± 4.18 t = 15.588 < 0.001
表6 MPP患儿预后不良影响因素的Logistic回归分析
影响因素 β值 SE值 Wald χ2值 P值 OR值 95%CI值
重症 1.854 0.689 7.241 0.003 6.386 5.887~6.905
SAA变化率 2.066 0.546 14.318 < 0.001 7.892 7.156~8.110
HC-gp39变化率 1.968 0.669 8.654 0.001 7.158 7.021~7.438
表7 血清SAA变化率和HC-gp39变化率预测MPP患儿预后不良的AUC、灵敏度及特异度
指标 最佳截断点（%） 灵敏度（%） 特异度（%） AUC P值 95%CI
SAA变化率 45.07 83.33（5/6） 81.25（65/80） 0.817 < 0.001 0.719~0.892
HC-gp39变化率 41.19 66.67（4/6） 87.65（71/80） 0.765 < 0.001 0.723~0.874
联合检测 — 66.67（4/6） 97.50（78/80） 0.906 < 0.001 0.824~0.958
图1 SAA变化率、HC-gp3变化率及联合评估MPP患儿预后不良的ROC曲线
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