| Objective To investigate differences in the serum expression levels of interleukin-6 (IL-6), interleukin-10 (IL-10), matrix metalloproteinase 9 (MMP9), and soluble myeloid trigger receptor-1 (sTREM-1) in infants with neonatal pneumonia (NP) of varying severity, and to assess their predictive value for treatment outcomes, thereby enabling the development of more precise treatment plans for these patients. Methods Prospectively, 136 children with NP who were admitted to Lianyungang Maternal and Child Health Hospital from January 2021 to December 2023 were selected as the research group, 113 newborns hospitalized for non-infectious diseases during the same period were selected as the control group. Patients were stratified by disease severity into the mild (n=85) and severe (n=51) groups. Based on therapeutic response after one week, the study group was further divided into the responders (n=114) and non-responders (n=22). Serum levels of IL-6, IL-10, MMP9, and sTREM-1 were compared across groups. Pearson’s correlation analysis was used to assess the correlation between serum IL-6, IL-10, MMP9, and sTREM-1 and the pneumonia index. Univariate analysis and multivariate logistic regression models were employed to identify factors influencing NP severity levels. Receiver operating characteristic (ROC) curves were used to evaluate the predictive performance of IL-6, IL-10, MMP9, and sTREM-1 levels for different disease severity and treatment outcomes. Results The levels of IL-6, IL-10, MMP9, and sTREM-1 in the study group were significantly higher than those in the control group (P < 0.05). Children in the severe group had significantly higher levels of IL-6, IL-10, MMP9, and sTREM-1 than those in the mild group (P < 0.05). After treatment, the levels of IL-6, IL-10, MMP9, and sTREM-1 decreased significantly in all children (P < 0.05), and were lower in the responsive group than in the non-responsive group (P < 0.05). The results of Pearson’s correlation analysis showed that serum IL-6, IL-10, MMP9, and sTREM-1 were positively correlated with the pneumonia index (r = 0.552、0.413、0.630、0.607，all P＜0.001). The results of the logistic regression analysis showed that levels of alkaline phosphatase, total serum protein, IL-6, IL-10, MMP9, and sTREM-1 were all significant predictors of disease severity in children with NP (P < 0.05). ROC analysis showed that the area under the curve (AUC) for the combined prediction of different disease severity levels in children with NP using IL-6, IL-10, MMP9, and sTREM-1 levels was 0.973, with a sensitivity of 88.24% and a specificity of 96.47%. The AUC for the combined prediction of these four markers was higher than that for IL-6 (Z = 3.853, P < 0.001), IL-10 (Z = 5.152, P < 0.001), MMP9 (Z = 3.827, P < 0.001), and sTREM-1 (Z = 3.746, P < 0.001) when used individually (P < 0.05). The AUC for the combined prediction of treatment response in NP patients using post-treatment serum IL-6, IL-10, MMP9, and sTREM-1 levels was 0.996, significantly higher than that of IL-6 alone (Z=4.809, P<0.001), IL-10 (Z=4.578, P<0.001), MMP9 (Z=4.367, P<0.001), and sTREM-1 (Z=4.071, P< 0.001) when used alone. Conclusion Changes in serum IL-6, IL-10, MMP9 and sTREM-1 levels are closely related to the different degrees of disease in children with NP, which are independent influencing factors leading to the different degrees of disease in children with NP. The combined testing of the above indexes has a high predictive efficacy of the therapeutic effects in children with NP. |
