【摘要】 目的 评估降钙素原(PCT)联合C反应蛋白(CRP)、肿瘤坏死因子α(TNF-α)对儿童腺病毒肺炎(AP)发展为闭塞性细支气管炎(BO)的预测价值。方法 选择2017年6月至2020年6月首都儿科研究所附属儿童医院呼吸科收治的100例AP儿童为研究组，同期选取本院健康体检正常儿童100例为对照组。根据AP儿童出院半年后是否发生BO将AP儿童分为BO组38例和非BO组62例。Logistic回归分析影响AP儿童发展为BO的有关因素；ROC曲线及曲线下面积(AUC)分析血清PCT联合CRP、TNF-α对儿童AP发展为BO的预测价值。结果 与对照组比较，研究组血清PCT、CRP、TNF-α水平均升高，差异有统计学意义(t值分别为24.642、13.742、32.982,P<0.05);与非BO组比较，BO组患儿住院时间、发热持续时间、谷草转氨酶(AST)、乳酸脱氢酶(LDH)、PCT、CRP、TNF-α水平及呼吸衰竭、呼吸困难、有创机械通气、免疫球蛋白使用比例升高，白蛋白(ALB)水平降低，差异有统计学意义(χ~2/t值介于2.292～19.148之间，P<0.05);Logistic回归分析结果表明血清PCT、CRP、TNF-α高水平是儿童AP发展为BO的危险因素，其OR值及95%CI分别为2.237(1.354～3.695)、1.982(1.355～2.899)、1.876(1.236～2.848),P<0.05;ROC曲线分析结果表明，血清PCT、CRP、TNF-α水平诊断儿童AP发展为BO的AUC分别为0.798、0.825、0.670,三者联合评估的AUC为0.898,敏感度为86.5%,特异性为82.3%。结论 PCT联合CRP、TNF-α对儿童AP发展为BO具有较高的诊断价值，可能为临床上儿童AP发展为BO的预测提供理论依据。更多还原

【Abstract】 Objective To evaluate the predictive value of procalcitonin(PCT) combined with C-reactive protein(CRP) and tumor necrosis factor α(TNF-α) in the development of adenovirus pneumonia(AP) into bronchiolitis obliterans(BO) in children. Methods 100 children with AP admitted to the respiratory department of the Children′s Hospital Affiliated to Capital Institute of Pediatrics from June 2017 to June 2020 were selected as the study group, and 100 children with normal physical examination in the hospital during the same period were selected as the control group. According to the incidence of BO 6 months after being discharged from the hospital, AP children were divided into the BO group with 38 cases and the non-BO group with 62 cases. Logistic regression was used to analyze the related factors affecting the development of AP into BO in children. Receiver operating characteristic(ROC) curve and area under curve(AUC) was used to analyze the predictive value of serum PCT combined with CRP and TNF-α in the development of AP into BO in children. Results Compared with the control group, the levels of serum PCT, CRP and TNF-α in the study group increased, and the differences were statistically significant(t values were 24.642, 13.742 and 32.982, respectively, P<0.05). Compared with the non-BO group, the hospital stay, duration of fever, levers of aspartate aminotransferase(AST), lactate dehydrogenase(LDH), PCT, CRP, and TNF-α, the incidence of respiratory failure, dyspnea, and invasive mechanical ventilation, the proportion of immunoglobulin use increased, and the albumin(ALB) level decreased in the BO group(χ~2/t value between 2.292-19.148, P<0.05). The Logistic regression analysis showed that the high levels of serum PCT, CRP and TNF-α were the risk factors for the development of AP into BO in children, and their OR values and 95% CI were 2.237(1.354-3.695), 1.982(1.355-2.899) and 1.876(1.236-2.848), respectively, P<0.05. The ROC curve analysis showed that the AUC of serum PCT, CRP and TNF-α in diagnosing the development of AP into BO in children were 0.798, 0.825 and 0.670, respectively. The AUC of the combined evaluation was 0.898, with a sensitivity of 86.5% and a specificity of 82.3%. Conclusion PCT combined with CRP and TNF-α have a high diagnostic value for the development of AP into BO in children, and may provide a theoretical basis for the clinical prediction of the development of AP into BO in children.更多还原