检索历史 清除

目的:探讨环状RNA circ_0054633对儿童重症肺炎致急性肺损伤/急性呼吸窘迫综合征（ALI/ARDS）的早期诊断及预后预测价值。方法:采用回顾性病例对照研究方法，选择2022年7月1日至2024年2月29日天津市儿童医院收治的确诊重症肺炎患儿作为研究对象。通过电子病历系统查询及随访形式收集患儿临床资料，包括性别、年龄、入院24 h内肺损伤预测评分（LIPS）、小儿危重病例评分（PCIS）、血清circ_0054633和白细胞介素-6（IL-6）水平、动脉血气分析指标、氧合指数（PaO 2/FiO 2），以及28 d存活情况。根据重症肺炎是否进展为ALI/ARDS将患儿分为ALI/ARDS组和非ALI/ARDS组。比较各组重症肺炎患儿临床资料的差异；将具有统计学意义的指标纳入多因素Logistic回归分析，探讨重症肺炎患儿发生ALI/ARDS的危险因素；采用受试者工作特征曲线（ROC曲线）分析各危险因素对重症肺炎患儿发生ALI/ARDS的早期诊断价值。根据PaO 2/FiO 2水平将ALI/ARDS组患儿分为轻度组、中度组和重度组。比较不同病情严重程度各组ALI/ARDS患儿血清circ_0054633和IL-6水平的差异，以及不同28 d预后两组ALI/ARDS患儿血清circ_0054633和IL-6水平、PCIS评分、LIPS评分的差异，并分析各危险因素与circ_0054633的相关性。 结果:共纳入74例重症肺炎患儿，其中ALI/ARDS组34例，非ALI/ARDS组40例。ALI/ARDS组患儿中，轻度组9例，中度组15例，重度组10例；28 d死亡12例，存活22例。ALI/ARDS组患儿血清circ_0054633、IL-6水平及LIPS评分均明显高于非ALI/ARDS组，PCIS评分则明显低于非ALI/ARDS组，差异均有统计学意义。多因素Logistic回归分析显示，circ_0054633为重症肺炎患儿发生ALI/ARDS的独立危险因素〔优势比（ OR）＝3.853，95%可信区间（95% CI）为1.912～7.805， P＝0.017〕；ROC曲线进一步分析显示，circ_0054633预测重症肺炎患儿发生ALI/ARDS的ROC曲线下面积（AUC）为0.892，临界值为3.955，敏感度为79.4%，特异度为92.5%。随病情加重，ALI/ARDS组患儿的血清circ_0054633和IL-6水平均呈明显升高趋势；死亡组患儿的血清circ_0054633和IL-6水平均明显高于存活组，PCIS评分则明显低于存活组，差异均有统计学意义。Spearman相关性分析显示，ALI/ARDS患儿血清circ_0054633水平与28 d生存情况和IL-6水平均呈正相关（ r值分别为0.675和0.763，均 P<0.001），与PCIS评分呈负相关（ r＝-0.626， P<0.001），与LIPS评分无显著相关性（ r＝0.389， P＝0.023）。 结论:血清circ_0054633水平对重症肺炎患儿发生ALI/ARDS的早期诊断及预后预测价值均较高。

Objective:To explore the value of circ_0054633 in early diagnosis and prognosis prediction of acute lung injury/acute respiratory distress syndrome (ALI/ARDS) in children with severe pneumonia.Methods:A retrospective case-control study was conducted on children with diagnosed severe pneumonia admitted to Tianjin Children's Hospital from July 1, 2022, to February 29, 2024. The clinical data was collected by electronic medical record system and clinical follow-up, including gender, age, lung injury prediction score (LIPS), pediatric critical illness score (PCIS), serum circ_0054633, interleukin-6 (IL-6), the indicators of the arterial blood-gas analysis, oxygenation index (PaO 2/FiO 2) within 24 hours of admission and the survival status of 28 days. According to whether ALI/ARDS occurred, they were divided into the ALI/ARDS group and the non-ALI/ARDS group. The differences of clinical data between the two groups were compared, and multivariate Logistic regression was used to analyze the risk factors for ALI/ARDS in children with severe pneumonia. The receiver operator characteristic curve (ROC curve) will be used to explore the early diagnostic value of ALI/ARDS in children with severe pneumonia. The patients of ALI/ARDS were divided into mild group, moderate group and severe group according to the level of PaO 2/FiO 2. The levels of serum circ_0054633 and IL-6 in various severity ALI/ARDS were compared. The differences of serum circ_0054633, IL-6 levels, PCIS score and LIPS score were compared between the two groups of ALI/ARDS patients according to different prognoses in 28 days, as well as the correlation between various risk factors and circ_0054633. Results:A total 74 children with severe pneumonia were included, with 34 cases in the ALI/ARDS group and 40 cases in the non-ALI/ARDS group. In ALI/ARDS group, there were 9 cases in the mild group, 15 cases in the moderate group and 10 cases in the severe group; while 12 cases died and 22 cases survived after 28 days. The serum circ_0054633, IL-6 level and LIPS score were higher in the ALI/ARDS group than the non-ALI/ARDS group, while the PCIS score was lower, and the two groups had significant difference. Multivariate Logistic regression analysis showed that circ_0054633 was independent predictors of ALI/ARDS in children with severe pneumonia [odds ratio ( OR) = 3.853, 95% confidence interval (95% CI) was 1.912-7.805, P = 0.017]. ROC curve analysis showed that the cut-off values for circ_0054633 in the diagnosis of ALI/ARDS were 3.955, sensitivity was 79.4%, specificity was 92.5%, area under the ROC curve (AUC) was 0.892. The serum circ_0054633 and IL-6 levels were higher in the children who died in 28 days than the children who were survived, while the PCIS score was lower, and the two groups had significant difference. Spearman correlation analysis showed that the level of circ_0054633 in children with ALI/ARDS was positively correlated with 28-day mortality and IL-6 ( r value was 0.675, 0.763, respectively, all P < 0.001), but negatively correlated with PCIS score ( r = -0.626, P < 0.001), while no significant correlation with LIPS score ( r = 0.389, P = 0.023). Conclusion:The level of serum circ_0054633 has a better value in early diagnosis and prognosis prediction of ALI/ARDS caused in children with severe pneumonia.