| 徐 丹,潘冬宁,骆亚丽,苏 聃,于 欣.不同病情手足口病患儿血清肿瘤坏死因子-α、C-反应蛋白、降钙素原的变化及其对预后不良的预测价值研究[J].,2023,(8):1457-1462 |
| 不同病情手足口病患儿血清肿瘤坏死因子-α、C-反应蛋白、降钙素原的变化及其对预后不良的预测价值研究 |
| Changes of Serum Tumor Necrosis Factor-α, C-Reactive Protein and Procalcitonin in Children with Hand Foot and Mouth Disease of Different Conditions and Their Predictive Value Study for Poor Prognosis |
| 投稿时间：2022-10-19 修订日期：2022-11-13 |
| DOI：10.13241/j.cnki.pmb.2023.08.011 |
| 中文关键词: 手足口病 肿瘤坏死因子-α C-反应蛋白 降钙素原 病情分级 预后 预测价值 |
| 英文关键词: Hand foot and mouth disease Tumor necrosis factor-α C-reactive protein Procalcitonin Disease grading Prognosis Predictive value |
| 基金项目:江苏省自然科学基金项目（BK202000146） |
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| 中文摘要: |
| 摘要 目的：探讨不同病情手足口病（HFMD）患儿血清肿瘤坏死因子-α（TNF-α）、C-反应蛋白（CRP）、降钙素原（PCT）的变化，并分析三者联合检测对预后不良的预测价值。方法：选取2019年1月～2022年1月我院儿科收治的117例HFMD患儿（HFMD组），根据不同病情分为普通组32例、重症组45例、危重症组40例，根据治疗后预后情况分为预后不良组32例和预后良好组85例，另选取同期50例体检健康儿童作为对照组。收集HFMD患儿基本资料，检测所有研究对象血清TNF-α、CRP、PCT水平。采用多因素Logistic回归分析HFMD患儿预后不良的影响因素，受试者工作特征（ROC）曲线分析血清TNF-α、CRP、PCT水平对HFMD患儿预后不良的预测价值。结果：HFMD组血清TNF-α、CRP、PCT水平高于对照组（P均＜0.05）。普通组、重症组、危重症组血清TNF-α、CRP、PCT水平依次升高（P均＜0.05）。单因素分析结果显示：预后不良组发热≥39℃、发热持续时间≥3 d比例和病情分级为危重症、中性粒细胞比例、TNF-α、CRP、PCT水平高于预后良好组，淋巴细胞比例、心输出量、氧合指数低于预后良好组（P均＜0.05）。多因素Logistic回归分析显示，发热持续时间≥3 d、病情分级为危重症和TNF-α、CRP、PCT升高为HFMD患儿预后不良的独立危险因素，心输出量和氧合指数增加为独立保护因素（P均＜0.05）。ROC曲线分析显示，血清TNF-α、CRP、PCT单独与联合预测HFMD患儿预后不良的曲线下面积分别为0.769、0.793、0.799、0.947，血清TNF-α、CRP、PCT联合预测的曲线下面积大于各指标单独预测。结论：血清TNF-α、CRP、PCT水平升高与HFMD患儿病情加重和预后不良有关，联合检测血清TNF-α、CRP、PCT水平对HFMD患儿预后不良的预测价值较高。 |
| 英文摘要: |
| ABSTRACT Objective: To investigate the changes of serum tumor necrosis factor-α (TNF-α), C-reactive protein (CRP) and procalcitonin (PCT) in children with different hand foot and mouth disease (HFMD) of different conditions, and to analyze the predictive value of the combination of the three detection for poor prognosis. Methods: 117 children with HFMD (HFMD group) who were admitted to the pediatric department of our hospital from January 2019 to January 2022 were selected, and they were divided into 32 cases in the general group, 45 cases in the severe group and 40 cases in the critical group according to different conditions, and they were divided into 32 cases in the poor prognosis group and 85 cases in the good prognosis group according to the prognosis after treatment, and another 50 healthy children were selected as the control group. The basic data of children with HFMD were collected, and serum TNF-α, CRP and PCT levels were measured in all study subjects. Multivariate Logistic regression was used to analyze the influencing factors of poor prognosis in children with HFMD, and receiver operating characteristic (ROC) curve was used to analyze the predictive value of serum TNF-α, CRP and PCT levels on poor prognosis in children with HFMD. Results: The serum TNF-α, CRP and PCT levels in the HFMD group were higher than those in the control group (all P<0.05). The serum TNF-α, CRP and PCT levels in the general group, severe group and critical group were increased successively (all P<0.05). The results of univariate analysis showed that the proportion of fever≥39℃, fever duration≥3 d, disease grading as critical disease, proportion of neutrophil, TNF-α, CRP and PCT levels in the poor prognosis group were higher than those in the good prognosis group, while the proportion of lymphocytes, cardiac output and oxygenation index were lower than those in the good prognosis group (all P<0.05). Multivariate Logistic regression analysis showed that fever duration≥3 d, disease grading as critical and increased TNF-α, CRP and PCT were independent risk factors for poor prognosis in children with HFMD, while increased cardiac output and oxygenation index were independent protective factors (all P<0.05). ROC curve analysis showed that the area under curve of serum TNF-α, CRP and PCT alone and combined to predict poor prognosis in children with HFMD were 0.769, 0.793, 0.799 and 0.947, respectively. The area under curve of serum TNF-α, CRP and PCT combined to predict poor prognosis was greater than that of each index alone. Conclusion: The increase serum TNF-α, CRP and PCT levels are associated with the exacerbation of the disease and poor prognosis in children with HFMD. The combined detection of serum TNF-α, CRP and PCT levels has a high predictive value for poor prognosis in children with HFMD. |
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