探讨血清25羟基维生素D₃[25-（OH）D₃]、膜联蛋白（ANXA2）以及急性生理学和慢性健康状况评价Ⅱ（APACHE Ⅱ）评分与支气管肺炎患儿疾病严重程度及预后的关系。

选取徐州市中心医院儿童诊疗中心2023年1月至2024年1月收治的356例支气管肺炎患儿，根据疾病严重程度分为轻症组（175例）、中症组（101例）和重症组（80例），根据预后分为预后良好组（292例）和预后不良组（64例）。比较不同组别患儿血清25-（OH）D₃、ANXA2和APACHE Ⅱ评分，应用Spearman分析以上3个指标与支气管肺炎患儿疾病严重程度的相关性，多因素Logistic回归分析3个指标是否为支气管肺炎患儿预后不良的风险因素，并采用受试者工作特征（ROC）曲线分析3个指标单独及联合对支气管肺炎患儿预后不良的预测价值，以Hosmer-Lemeshow法对风险模型进行拟合优度检验。

入院时，重症组患儿血清25-（OH）D₃[（33.25±12.35）nmol/L]显著低于中症组和轻症组患儿[（54.63±13.16）nmol/L和68.98±15.27）nmol/L]，而ANXA2、APACHE Ⅱ评分[（4.81±1.25）μmol/L、（18.25±6.98）分]高于中症组[（4.07±0.89）μmol/L、（13.63±4.21）分]和轻症组患儿[（3.22±0.64）μmol/L、（8.74±2.32）分]，差异均有统计学意义（P均<0.001）。Spearman相关性分析显示，血清25-（OH）D₃与病情程度呈负相关（r_s=－0.626、P<0.001），ANXA2、APACHE Ⅱ评分与病情程度均呈正相关（r_s=0.434、0.490，P均<0.001）。预后不良组患儿血清25-（OH）D₃[（62.45±12.78）nmol/L]低于预后良好组[（93.16±18.93）nmol/L]，ANXA2及APACHE Ⅱ评分[（4.92±1.23）μmol/L、（12.36±3.84）分]显著高于预后良好组[（3.11±0.87）μmol/L、（5.63±1.28）分]，差异均有统计学意义（P均<0.001）。多因素Logistic回归分析表明，血清25-（OH）D₃（OR=0.955、95%CI：0.936～0.975、P<0.001）、ANXA2（OR=3.817、95%CI：2.535～5.748、P<0.001）和APACHE Ⅱ评分（OR=2.079、95%CI：1.523～2.839、P<0.001）均为支气管肺炎患儿预后的影响因素。ROC曲线分析显示，血清25-（OH）D₃、ANXA2和APACHE Ⅱ评分联合预测支气管肺炎患儿预后不良的AUC为0.895（95%CI：0.858～0.947），灵敏度和特异度分别为85.90%和80.80%。采用DeLong检验得出联合预测模型性能优于血清25-（OH）D₃、ANXA2或APACHE Ⅱ评分单独指标（Z=5.275、P<0.001，Z=4.211、P<0.001，Z=2.505、P=0.033）。Hosmer-Lemeshow检验χ²=10.347、P=0.242，表明预测效能较高。

血清25-（OH）D₃水平低，ANXA2和APACHE Ⅱ评分高与支气管肺炎患儿疾病程度及预后密切相关，关注以上指标水平变化对支气管肺炎患儿治疗有一定指导意义。

To investigate the relationship of serum 25-hydroxyvitamin D₃ [25-(OH) D₃], annexin A2 (ANXA2), acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) scores with disease severity and prognosis of children with bronchopneumonia.

Total of 356 children with bronchopneumonia in the Children’s Diagnosis and Treatment Center of Xuzhou Central Hospital from January 2023 to January 2024 were selected. According to the severity of the disease, the patients were divided into mild group (175 cases), moderate group (101 cases) and severe group (80 cases). After treatment, patients were categorized into good prognosis group (292 cases) and poor prognosis group (64 cases). The serum 25-(OH) D₃, ANXA2 and APACHE Ⅱ scores of patients in different groups were compared, and the correlations between the above three indicators and the disease severity of children with bronchopneumonia were analyzed by Spearman correlation analysis. Whether the above three indicators were risk factors for poor prognosis in children with bronchopneumonia were determined by multivariate Logistic analysis. The predictive value of the three indicators alone and combination for poor prognosis in children with bronchopneumonia were analyzed by receiver operating characteristic (ROC) curve. The goodness of fit of the risk model were tested by Hosmer-Lemeshow method.

At admission, the serum 25-(OH) D₃ of children in the severe group [(33.25±12.35) nmol/L] was significantly lower than those of children in moderate group and mild group [(54.63±13.16) nmol/L, (68.98±15.27) nmol/L]; However, the ANXA2 and APACHE Ⅱ scores [(4.81±1.25) μmol/L, (18.25±6.98) scores] were significantly higher than those of moderate condition group [(4.07±0.89) μmol/L and (13.63±4.21) scores] and mild condition group [(3.22±0.64) μmol/L and (8.74±2.32) scores], with significant differences (all P<0.001). Spearman correlation analysis showed that serum 25-(OH) D₃ was negatively correlated with the severity of the disease (r_s =-0.626, P<0.001), while ANXA2 and APACHE Ⅱ score were positively correlated with the severity of the disease (r_s=0.434, 0.490, both P<0.001). The serum 25-(OH) D₃ of children in poor prognosis group [(62.45±12.78) nmol/L] was lower than that of good prognosis group [(93.16±18.93) nmol/L]. The ANXA2 and APACHE Ⅱ scores [(4.92±1.23) μmol/L and (12.36±3.84) scores] were significantly higher than those of good prognosis group [(3.11±0.87) μmol/L and (5.63±1.28) scores], with significant differences (all P<0.001). Logistic multivariate regression analysis showed that serum 25-(OH) D₃ (OR=0.955, 95%CI: 0.936-0.975, P<0.001), ANXA2 (OR=3.817, 95%CI: 2.535-5.748, P<0.001) and APACHE Ⅱ score (OR=2.079, 95%CI: 1.523-2.839, P<0.001) were all the main influencing factor for the prognosis of children with bronchopneumonia. ROC curve analysis showed that the AUC of the combined prediction of poor prognosis in children with bronchopneumonia by serum 25-(OH) D₃, ANXA2 and APACHE Ⅱ score was 0.895 (95%CI: 0.858-0.947), and the sensitivity and specificity were 85.90% and 80.80%, respectively. Meanwhile, the DeLong test revealed that the performance of the combined prediction model was superior to that of individual indicator of serum 25-(OH) D₃, ANXA2 or APACHE Ⅱ score (Z=5.275, P<0.001; Z=4.211, P<0.001; Z=2.505, P=0.033). Hosmer-Lemeshow result showed a relative high predictive efficacy (χ²=10.347, P=0.242).

Low serum 25-(OH) D₃, high ANXA2 and high APACHE Ⅱ scores are closely related to the severity and prognosis of children with bronchoponia. It is of certain guiding significance to pay attention to the changes of the above indicators in the treatment of children with bronchopneumonia.