血清25羟维生素D、YKL-40检测在诊治儿童难治性支原体肺炎中的临床意义
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摘要
目的探究血清25羟维生素D[25(OH) D]及甲壳质酶蛋白40(YKL-40)水平检测在儿童难治性支原体肺炎早期诊断中的临床意义。方法选取2016年4月～2018年1月笔者医院收治的肺炎支原体肺炎(MPP)患儿107例为研究对象,其中普通支原体肺炎(OMPP)组67例,难治性支原体肺炎(RMPP)组40例,选取同期肺炎健康体检儿童55例作为对照组。采集各受试者静脉血,酶联免疫吸附(ELISA)法检测各患儿血清25(OH) D及YKL-40蛋白水平,并绘制ROC曲线分析二者在RMPP早期诊断中的预测价值。结果 MPP患儿血清25(OH) D水平明显低于对照组,YKL-40蛋白水平明显高于对照组,差异有统计学意义(P <0. 05)。血清25(OH) D、YKL-40水平诊断RMPP的ROC曲线下面积(AUC)分别为0. 732、0. 679。血清25(OH) D水平与MPP患儿肺部啰音、呼吸音低、胸腔积液、肺部坏死性炎症等发生率有关(P <0. 05);血清YKL-40水平与MPP患儿肺外并发症、肺部啰音、呼吸音低、胸腔积液、肺部坏死性炎症发生率有关(P <0. 05)。RMPP组肺炎患儿血清25(OH) D水平明显低于OMPP组(P <0. 05)、YKL-40蛋白水平显著高于OMPP组(P <0. 05)。血清25(OH) D、YKL-40对MPP患者诊断的AUC分别为0. 751、0. 797。结论 RMPP患儿血清25(OH) D水平显著降低,YKL-40显著升高,检测血清25(OH) D、YKL-40水平对RMPP早期诊断,具有一定临床应用价值。
Objective To explore the clinical significance of serum 25-hydroxy vitamin D [25( OH) D] and chitinase protein 40( YKL-40) levels detections in the early diagnosis of refractory mycoplasma pneumonia in children. Methods Totally 107 children with mycoplasma pneumoniae pneumonia( MPP) in our hospital from April 2016 to January 2018 were selected as the subjects,including 67 cases of common mycoplasma pneumonia( OMPP) and 40 cases of refractory mycoplasma pneumonia( RMPP),and 55 children with pneumonia in the same period were selected as the control group. Venous blood was collected from the subjects,enzyme linked immunosorbent assay( ELISA) was used to detect serum 25( OH) D and YKL-40 protein levels,the ROC curve was drawn to analyze the predictive values of the them in the early diagnosis of RMPP. Results The serum 25( OH) D level of children in the MPP group was significantly lower than that in the control group,the level of YKL-40 protein was significantly higher than that in the control group,the differences were statistically significant( P < 0. 05). The areas under the ROC curve( AUC) of serum 25( OH) D and YKL-40 levels in the diagnosis of RMPP was 0. 732 and 0. 679 respectively. The level of serum 25( OH) D was related to the incidence rates of lung rales,low respiratory sounds,pleural effusion and necrotizing inflammation in children with MPP( P < 0. 05). The level of serum YKL-40 was related to the incidence rates of extrapulmonary complications,pulmonary rales,low respiratory sounds,pleural effusion and necrotizing inflammation in children with MPP( P < 0. 05). The level of serum 25( OH) D of children in RMPP group was significantly lower than that in OMPP group( P < 0. 05),and YKL-40 protein level was significantly higher than that in OMPP group( P < 0. 05). The AUCs of serum 25( OH) D and YKL-40 levels in the diagnosis of MPP were 0. 751 and 0. 797 respectively. Conclusion The level of serum 25( OH) D decreased significantly in children with RMPP,YKL-40 increased significantly,the detections of serum 25( OH) D and YKL-40 levels have certain clinical values in early diagnosis of RMPP.
Objective To explore the clinical significance of serum 25-hydroxy vitamin D [25( OH) D] and chitinase protein 40( YKL-40) levels detections in the early diagnosis of refractory mycoplasma pneumonia in children. Methods Totally 107 children with mycoplasma pneumoniae pneumonia( MPP) in our hospital from April 2016 to January 2018 were selected as the subjects,including 67 cases of common mycoplasma pneumonia( OMPP) and 40 cases of refractory mycoplasma pneumonia( RMPP),and 55 children with pneumonia in the same period were selected as the control group. Venous blood was collected from the subjects,enzyme linked immunosorbent assay( ELISA) was used to detect serum 25( OH) D and YKL-40 protein levels,the ROC curve was drawn to analyze the predictive values of the them in the early diagnosis of RMPP. Results The serum 25( OH) D level of children in the MPP group was significantly lower than that in the control group,the level of YKL-40 protein was significantly higher than that in the control group,the differences were statistically significant( P < 0. 05). The areas under the ROC curve( AUC) of serum 25( OH) D and YKL-40 levels in the diagnosis of RMPP was 0. 732 and 0. 679 respectively. The level of serum 25( OH) D was related to the incidence rates of lung rales,low respiratory sounds,pleural effusion and necrotizing inflammation in children with MPP( P < 0. 05). The level of serum YKL-40 was related to the incidence rates of extrapulmonary complications,pulmonary rales,low respiratory sounds,pleural effusion and necrotizing inflammation in children with MPP( P < 0. 05). The level of serum 25( OH) D of children in RMPP group was significantly lower than that in OMPP group( P < 0. 05),and YKL-40 protein level was significantly higher than that in OMPP group( P < 0. 05). The AUCs of serum 25( OH) D and YKL-40 levels in the diagnosis of MPP were 0. 751 and 0. 797 respectively. Conclusion The level of serum 25( OH) D decreased significantly in children with RMPP,YKL-40 increased significantly,the detections of serum 25( OH) D and YKL-40 levels have certain clinical values in early diagnosis of RMPP.
引文
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8 Yan Y,Wei Y,Jiang W,et al.The clinical characteristics of corticosteroid-resistant refractory mycoplasma pneumoniae pneumonia in children[J].Sci Rep,2016,6(2):39929-39937
9 The Editors of the Lancet.Retraction-effect of vitamin and traceelement supplementation on immune responses and infection in elderly subjects[J].Lancet,2016,387(10017):417
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11邓永超,唐喜春,黄彩芝,等.25(OH)D在重症肺炎患儿中的水平及相关性研究[J].国际检验医学杂志,2017,38(2):221-223
12 Thuesen BH,Skaaby T,Husemoen LL,et al.The association of serum25(OH)D with atopy,asthma,and lung function in a prospective study of Danish adults[J].Clin Exp Allergy,2015,45(1):265-272
13 Rathored J,Sharma SK,Singh B,et al.Risk and outcome of multidrugresistant tuberculosis:vitamin D receptor polymorphisms and serum 25(OH)D[J].Int J Tuberc Lung Dis,2012,16(11):1522-1528
14 Harutyunyan M,Christiansen M,Johansen JS,et al.The inflammatory biomarker YKL-40 as a new prognostic marker for all-cause mortality in patients with heart failure[J].Immunobiology,2012,217(6):652-656
15贺元,廖明芳,曲乐丰.YKL-40在炎症性疾病中的作用及其信号通路研究进展[J].医学研究生学报,2016,29(8):883-888
16 Corradi M,Goldoni M,Alinovi R,et al.YKL-40 and mesothelin in the blood of patients with malignant mesothelioma,lung cancer and asbestosis[J].Anticancer Res,2013,33(12):5517-5524
17 Korthagen NM,van Moorsel CH,Zanen P,et al.Evaluation of circulating YKL-40 levels in idiopathic interstitial pneumonias[J].Lung,2014,192(6):975-980
18 Jae-Won O.The efficacy of glucocorticoid on macrolide resistant mycoplasma pneumonia in children[J].Allergy Asthma Immunol Res,2014,6(1):3-5
2 Gao J,Yue B,Haitao LI,et al.Epidemiology and clinical features of segmental/lobar pattern Mycoplasma pneumoniae pneumonia:A tenyear retrospective clinical study[J].Exp Ther Med,2015,10(6):2337-2344
3李刚,顾承东,张素巧,等.糖皮质激素对重症社区获得性肺炎合并脓毒性休克患者的治疗价值[J].中华危重病急救医学,2016,28(9):780-784
4 Chun RF,Liu PT,Modlin RL,et al.Impact of vitamin D on immune function:lessons learned from genome-wide analysis[J].Front Physiol,2014,5(5):151-162
5 Hellwig K,Kvartsberg H,Portelius E,et al.Neurogranin and YKL-40:independent markers of synaptic degeneration and neuroinflammation in Alzheimer's disease[J].Alzheimers Res Ther,2015,7(1):74-82
6胡亚美,江载芳.诸福棠实用儿科学(第7版)[M].北京:人民卫生出版社,2005:223-241
7刘金荣,赵顺英.儿科难治性疾病(2013)---难治性肺炎支原体肺炎判断与药物治疗[J].中国实用儿科杂志,2013,28(12):881-883
8 Yan Y,Wei Y,Jiang W,et al.The clinical characteristics of corticosteroid-resistant refractory mycoplasma pneumoniae pneumonia in children[J].Sci Rep,2016,6(2):39929-39937
9 The Editors of the Lancet.Retraction-effect of vitamin and traceelement supplementation on immune responses and infection in elderly subjects[J].Lancet,2016,387(10017):417
10 Christakos S,Dhawan P,Verstuyf A,et al.Vitamin D:metabolism,molecular mechanism of action,and pleiotropic effects[J].Physiol Rev,2016,96(1):365-408
11邓永超,唐喜春,黄彩芝,等.25(OH)D在重症肺炎患儿中的水平及相关性研究[J].国际检验医学杂志,2017,38(2):221-223
12 Thuesen BH,Skaaby T,Husemoen LL,et al.The association of serum25(OH)D with atopy,asthma,and lung function in a prospective study of Danish adults[J].Clin Exp Allergy,2015,45(1):265-272
13 Rathored J,Sharma SK,Singh B,et al.Risk and outcome of multidrugresistant tuberculosis:vitamin D receptor polymorphisms and serum 25(OH)D[J].Int J Tuberc Lung Dis,2012,16(11):1522-1528
14 Harutyunyan M,Christiansen M,Johansen JS,et al.The inflammatory biomarker YKL-40 as a new prognostic marker for all-cause mortality in patients with heart failure[J].Immunobiology,2012,217(6):652-656
15贺元,廖明芳,曲乐丰.YKL-40在炎症性疾病中的作用及其信号通路研究进展[J].医学研究生学报,2016,29(8):883-888
16 Corradi M,Goldoni M,Alinovi R,et al.YKL-40 and mesothelin in the blood of patients with malignant mesothelioma,lung cancer and asbestosis[J].Anticancer Res,2013,33(12):5517-5524
17 Korthagen NM,van Moorsel CH,Zanen P,et al.Evaluation of circulating YKL-40 levels in idiopathic interstitial pneumonias[J].Lung,2014,192(6):975-980
18 Jae-Won O.The efficacy of glucocorticoid on macrolide resistant mycoplasma pneumonia in children[J].Allergy Asthma Immunol Res,2014,6(1):3-5