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| 血清G-CSF sB7-H3 CysLTs联合对重症肺炎支原体肺炎患儿预后不良的预测价值 |
| The predictive value of combined serum G-CSF, sB7-H3 and CysLTs levels for poor prognosis in children with severe mycoplasma pneumoniae pneumonia |
| 投稿时间：2025-07-07 |
| DOI：10.3969/j.issn.1000-0399.2026.09.010 |
| 中文关键词: 重症肺炎支原体肺炎 粒细胞集落刺激因子 可溶性B7同源体3 半胱氨酰白三烯 |
| 英文关键词: Severe mycoplasma pneumoniae pneumonia Granulocyte colony-stimulating factor Soluble B7 homolog 3 Cysteine leukotrienes |
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| 中文摘要: |
| 目的 探讨血清粒细胞集落刺激因子（G-CSF）、可溶性B7同源体3（sB7-H3）、半胱氨酰白三烯（CysLTs）联合对重症肺炎支原体肺炎（SMPP）患儿预后不良的预测价值。方法 选取2021年11月至2023年11月平煤神马医疗集团总医院收治的108例SMPP患儿作为观察对象（SMPP组），根据危重程度分为非危重组（44例）、危重组（29例）和极危重组（35例）；根据预后情况分为预后良好组（67例）和预后不良组（41例）。另选取同期体检健康儿童105例作为对照组。利用酶联免疫吸附法测定血清G-CSF、sB7-H3、CysLTs表达水平。多因素logistic回归分析影响SMPP患儿预后不良的危险因素。受试者工作特征曲线分析血清G-CSF、sB7-H3、CysLTs对SMPP患儿预后不良的预测价值。决策曲线分析血清G-CSF、sB7-H3、CysLTs预测的临床净收益。结果 与对照组相比，SMPP组患儿血清G-CSF、sB7-H3、CysLTs表达水平较高（P<0.05）。极危重组、危重组血清G-CSF、sB7-H3、CysLTs水平高于非危重组（P<0.05）；极危重组血清G-CSF、sB7-H3、CysLTs水平高于危重组（P<0.05）。与预后良好组相比，预后不良组体温>39℃、极危重患儿比例，白细胞介素-6、肿瘤坏死因子-α、血小板计数、G-CSF、sB7-H3、CysLTs水平升高，第1秒用力呼气容积、第1秒用力呼气容积占用力肺活量比值降低（P<0.05）。血清G-CSF、sB7-H3、CysLTs是SMPP患儿预后不良的独立危险因素（P<0.05）。血清G-CSF、sB7-H3、CysLTs联合预测SMPP患儿预后不良的曲线下面积为0.932，高于单独指标(Z联合-G-CSF=2.179,Z联合-sB7-H3=2.132,Z联合-CysLTs=2.556,P=0.029、0.033、0.011)。高风险阈值在0.06～0.91时，血清G-CSF、sB7-H3、CysLTs联合预测模型的临床净获益率高于单一指标。结论 SMPP患儿血清G-CSF、sB7-H3、CysLTs升高，与危重程度、预后不良密切相关，且3者具有一定特异性，联合检测可提高预测效能和临床净获益。 |
| 英文摘要: |
| Objective To investigate the predictive value of the combination of serum granulocyte colony-stimulating factor（G-CSF）, soluble B7 homolog 3（sB7-H3）, and cysteine leukotrienes（CysLTs） for poor prognosis in children with severe mycoplasma pneumoniae pneumonia（SMPP）. Methods A total of 108 paediatric patients with SMPP admitted to the General Hospital of Pingmei Shenma Medical Group between November 2021 and November 2023 were selected as the study subjects（SMPP group）. According to severity, the patients were classified into the non-critical group（44 cases）, the critical group（29 cases） and the extremely critical group（35 cases）. According to the prognosis, the patients were divided into a group with a favourable prognosis（67 cases） and a group with an unfavourable prognosis（41 cases）. Additionally, 105 healthy children who underwent medical examinations during the same period were selected as the control group. An enzyme-linked immunosorbent assay was used to assess the expression levels of serum G-CSF, sB7-H3 and CysLTs. Multifactorial logistic regression was used to analyse adverse prognostic risk factors affecting children with SMPP. The receiver operating characteristic curve analysis was used to assess the predictive value of serum G-CSF, sB7-H3 and CysLTs for poor prognosis in children with SMPP. Results Compared with the control group, the SMPP group had higher expression levels of serum G-CSF, sB7-H3, and CysLTs（P<0.05）. The levels of serum G-CSF, sB7-H3, and CysLTs were higher in very critical recombination and critical recombination than in non-critical recombination（P<0.05）; the levels of serum G-CSF, sB7-H3, and CysLTs were higher in very critical recombination than in critical recombination（P<0.05）. Compared with the group with a favourable prognosis, the group with an unfavourable prognosis exhibited higher rates of body temperature >39℃ and critically ill children, as well as elevated levels of interleukin-6, tumour necrosis factor-α, platelet count, G-CSF, sB7-H3 and CysLTs, and reduced forced expiratory volume in one second and forced expiratory volume in one second/forced vital capacity ratio（P<0.05）. Serum G-CSF, sB7-H3, and CysLTs were independent risk factors for poor prognosis in children with SMPP（P<0.05）. The area under the curve for the combined prediction of poor prognosis in children with SMPP using serum G-CSF, sB7-H3 and CysLTs was 0.932, which was higher than that that of individual indicators(Zcombined-G-CSF=2.179, Zcombined-sB7-H3=2.132, Zcombined-CysLTs=2.556, P=0.029, 0.033, 0.011). At high-risk thresholds ranging from 0.06 to 0.91, the combined predictive model incorporating serum G-CSF, sB7-H3, and CysLTs demonstrated a higher clinical net benefit rate than any single marker. Conclusion The levels of G-CSF, sB7-H3 and CysLTs in the serum of children with SMPP are elevated, which are closely related to the severity of the condition and poor prognosis. Moreover, these three factors have certain specificity. The combined detection can improve the predictive efficiency and clinical net benefit. |
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