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动态监测经皮血气分析指标和炎性指标对新生儿呼吸窘迫综合征并发支气管肺发育不良的预测价值

Predictive value of dynamic monitoring of transcutaneous blood gas analysis and inflammatory indicators for bronchopulmonary dysplasia in neonatal respiratory distress syndrome

    摘要
  • 摘要:
    目的 探讨动态监测经皮氧分压ptc(O2)、经皮二氧化碳分压ptc(CO2)与血清淀粉样蛋白A(SAA)、白细胞介素-6(IL-6)水平对新生儿呼吸窘迫综合征(NRDS)患儿并发支气管肺发育不良(BPD)的预测价值。
    方法 选取240例NRDS患儿作为研究对象，根据是否并发BPD分为BPD组108例和非BPD组132例。比较2组患儿出生后第1、7、14天时ptc(O2)、ptc(CO2)、SAA、IL-6水平，采用Spearman相关分析法探讨各指标间的相关性及其与病情程度的相关性，采用相对危险度(RR)和95%置信区间(CI)评价各指标对NRDS患儿并发BPD的影响，采用受试者工作特征(ROC)曲线、决策曲线分析各指标预测BPD的效能及临床净获益。
    结果 出生后第1天, 2组患儿ptc(O2)、ptc(CO2)和血清SAA、IL-6水平比较，差异均无统计学意义(P>0.05); 出生后第7、14天, BPD组ptc(O2)低于非BPD组, ptc(CO2)和血清SAA、IL-6水平高于非BPD组，差异有统计学意义(P < 0.05)。相关性分析结果显示，患儿BPD程度与出生后第7天时ptc(O2)呈负相关(r=-0.724, P < 0.05), 与出生后第7天时ptc(CO2)、SAA、IL-6呈正相关(r=0.635、0.830、0.715, P < 0.05); 患儿肺功能障碍程度与出生后第7天时ptc(O2)呈负相关(r=-0.719, P < 0.05), 与出生后第7天时ptc(CO2)、SAA、IL-6呈正相关(r=0.673、0.756、0.696, P < 0.05); 出生后第7天时, BPD患儿ptc(O2)分别与SAA、IL-6呈负相关(r=-0.605、-0.623, P < 0.05), ptc(CO2)分别与SAA、IL-6呈正相关(r=0.618、0.650, P < 0.05)。ROC曲线显示，出生后第7天ptc(O2)、ptc(CO2)、SAA、IL-6联合预测NRDS并发BPD的效能优于四者单独预测，曲线下面积为0.938(95%CI: 0.899~0.965)。ptc(CO2)、SAA、IL-6高表达者并发BPD的风险是低表达者的2.256、1.668、1.667倍, ptc(O2)高表达者并发BPD的风险是低表达者的0.568倍。决策曲线分析结果显示，当阈值在0.2~0.9时，出生后第7天时ptc(O2)、ptc(CO2)、SAA、IL-6联合模型预测NRDS患儿合并BPD的净获益率优于四者单独预测。
    结论 ptc(O2)、ptc(CO2)、SAA、IL-6均与NRDS并发BPD患儿病情严重程度密切相关，四者联合检测有助于提高对NRDS并发BPD的预测效能及净获益率。

     

    Abstract:
    Objective To investigate the predictive value of dynamic monitoring of transcutaneous oxygen partial pressure ptc(O2), transcutaneous carbon dioxide partial pressure ptc(CO2), serum amyloid A (SAA), and interleukin-6 (IL-6) levels in predicting bronchopulmonary dysplasia (BPD) in neonates with neonatal respiratory distress syndrome (NRDS).
    Methods A total of 240 NRDS patients were selected as the research subjects and divided into BPD group (108 cases) and non-BPD group (132 cases) based on whether BPD occurred. The levels of ptc(O2), ptc(CO2), SAA, and IL-6 were compared between the two groups on the 1st, 7th, and 14th day after birth. Spearman correlation analysis was used to explore the correlation between each indicator and the degree of illness. The relative risk (RR) and 95% confidence interval (CI) were used to evaluate the impact of each indicator on BPD in NRDS patients. Receiver operating characteristic (ROC) curves and decision curve analysis were used to evaluate the predictive efficacy and clinical net benefit of each indicator for BPD.
    Results On the 1st day after birth, there were no statistically significant differences in ptc(O2), ptc(CO2), serum SAA, and IL-6 levels between the two groups (P>0.05). On the 7th and 14th day after birth, the ptc(O2) in the BPD group was lower than that in the non-BPD group, while the ptc(CO2) and serum SAA, IL-6 levels were higher than those in the non-BPD group (P < 0.05). Correlation analysis results showed that the degree of BPD in children was negatively correlated with ptc(O2) on the 7th day after birth (r=-0.724, P < 0.05), and positively correlated with ptc(CO2), SAA, and IL-6 on the 7th day after birth (r=0.635, 0.830, 0.715, P < 0.05). The degree of pulmonary dysfunction in children was negatively correlated with ptc(O2) on the 7th day after birth (r=-0.719, P < 0.05), and positively correlated with ptc(CO2), SAA, and IL-6 on the 7th day after birth (r=0.673, 0.756, 0.696, P < 0.05). On the 7th day after birth, the ptc(O2) of BPD patients was negatively correlated with SAA and IL-6 (r=-0.605, -0.623, P < 0.05), while ptc(CO2) was positively correlated with SAA and IL-6 (r=0.618, 0.650, P < 0.05). ROC curve showed that the combined prediction of ptc(O2), ptc(CO2), SAA, and IL-6 on the 7th day after birth for NRDS complicated with BPD was better than the individual prediction of the four indicators, with an area under the curve of 0.938 (95%CI, 0.899 to 0.965). The risk of BPD in high-expression of ptc(CO2), SAA, and IL-6 was 2.256, 1.668, and 1.667 times higher than that in low-expression, respectively. The risk of BPD in high-expression of ptc(O2) was 0.568 times higher than that in low-expression. The decision curve analysis showed that when the threshold value was within the range of 0.2 to 0.9, the combined model of ptc(O2), ptc(CO2), SAA, and IL-6 was superior to the individual prediction in predicting the net benefit rate of BPD in NRDS patients on the 7th day after birth.
    Conclusion The severity of NRDS complicated with BPD is closely related to ptc(O2), ptc(CO2), SAA, and IL-6, and the combined detection of the four indicators can help improve the predictive efficacy and net benefit rate of NRDS complicated with BPD.

     

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