血清生存素、4-羟基壬烯醛、高半胱氨酸蛋白61对儿童社区获得性肺炎诊断和病情评估的价值分析

doi:10.19871/j.cnki.xfcrbzz.2025.05.002

摘要/Abstract

摘要： 目的探讨血清生存素（survivin）、4-羟基壬烯醛（4-hydroxynonenal,4-HNE）、高半胱氨酸蛋白61（cysteine-rich 61,CYR61）联合检测对儿童社区获得性肺炎（community acquired pneumonia,CAP）诊断和病情评估的临床意义。方法前瞻性选取2021年9月至2023年9月期间于武汉市中医医院就诊的132例CAP患儿为研究组,根据其病情严重程度将其分为轻症组（92例）和重症组（40例）,另选取同期健康儿童74例作为对照组。采用ELISA法测定各组血清survivin、4-HNE、CYR61水平;Pearson法分析血清survivin、4-HNE、CYR61水平与临床相关血清指标之间的相关性;多因素Logistic回归分析重症CAP发生的影响因素;绘制受试者操作特征曲线（receiver operating characteristic curve,ROC曲线）分析血清survivin、4-HNE、CYR61水平对CAP及重症CAP的诊断价值。结果研究组患儿血清4-HNE、CYR61水平显著高于对照组,血清survivin水平显著低于对照组（P<0.05）。血清survivin、4-HNE、CYR61水平单独及联合诊断CAP的曲线下面积（area under the curve,AUC）分别为0.780、0.809、0.858及0.944,三者联合检测优于单项诊断。与轻症组相比,重症组白细胞计数（white blood cell count,WBC）、降钙素原（procalcitonin,PCT）、C反应蛋白（C reactive protein,CRP）、白介素细胞-6（interleukin-6,IL-6）、肿瘤坏死因子-α（tumor necrosis factor-α,TNF-α）、4-HNE、CYR61水平显著升高,血清survivin水平显著降低（P<0.05）。WBC、PCT、CRP、IL-6、TNF-α均与血清survivin水平呈负相关（P< 0.05）,均与4-HNE、CYR61水平呈正相关（均P<0.05）。血清CRP、4-HNE、CYR61水平升高及survivin水平降低为重症CAP发生的危险因素（P<0.05）。血清survivin、4-HNE、CYR61水平单独及联合诊断重症CAP的AUC分别为0.864、0.753、0.782及0.941,且三者联合诊断价值高于单项诊断。结论血清survivin、4-HNE、CYR61联合检测在儿童CAP的诊断及病情严重程度分层中均表现出较高价值,提示其具有作为CAP早期预警标志物的潜力。

关键词: 生存素, 4-羟基壬烯醛, 高半胱氨酸蛋白61, 社区获得性肺炎, 诊断, 病情评估

Abstract: Objective To investigate the clinical significance of combined detection of serum survivin, 4-hydroxynonenal (4-HNE), and cysteine-rich 61 (CYR61) in the diagnosis and condition assessment of childhood community-acquired pneumonia (CAP). Method A total of 132 CAP children admitted to our hospital between September 2021 and September 2023 were prospectively selected as the study group. According to the severity of their condition, they were divided into a mild group (n=92) and a severe group (n=40). Another 74 healthy children during the same period were selected as the control group. Serum levels of survivin, 4-HNE, and CYR61 in each group were measured using ELISA. Pearson correlation analysis was used to analyze the correlation between serum survivin, 4-HNE, CYR61 levels and clinically relevant serum indicators. Multivariate logistic regression was applied to identify the influencing factors of severe CAP. Receiver operating characteristic (ROC) curve was constructed to evaluate the diagnostic value of serum survivin, 4-HNE, and CYR61 levels for CAP and severe CAP. Result The serum levels of 4-HNE and CYR61 in the study group were significantly higher than those in the control group, while the survivin level was significantly lower than that in the control group (P<0.05). The area under the curve (AUC) of serum survivin, 4-HNE, CYR61 alone and in combination for diagnosing CAP were 0.780, 0.809, 0.858, and 0.944, respectively. The combined detection of the three markers showed higher diagnostic accuracy than any single marker. Compared with the mild group, the levels of white blood cell (WBC) count, procalcitonin (PCT), C reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor-α(TNF-α), 4-HNE, and CYR61 in the severe group were significantly higher, while the survivin level was significantly lower (P<0.05). WBC, PCT, CRP, IL-6, and TNF-α were all negatively correlated with serum survivin level (P<0.05), and positively correlated with 4-HNE and CYR61 levels (all P<0.05). Elevated serum CRP, 4-HNE, CYR61 levels and decreased survivin level were risk factors for severe CAP (P<0.05). The AUC of serum survivin, 4-HNE, CYR61 alone and in combination for diagnosing severe CAP were 0.864, 0.753, 0.782, and 0.941, respectively. The combined detection demonstrated greater diagnostic value than single-marker detection. Conclusion Combined detection of serum survivin, 4-HNE, and CYR61 has high value in diagnosis and condition assessment of childhood CAP, with certain clinical significance.

Key words: Survivin, 4-hydroxynonanal, Cysteine-rich 61, Community acquired pneumonia, Diagnosis, Disease assessment

中图分类号:

郑婷, 李小玲, 徐玉琪, 蔡建新. 血清生存素、4-羟基壬烯醛、高半胱氨酸蛋白61对儿童社区获得性肺炎诊断和病情评估的价值分析[J]. 新发传染病电子杂志, 2025, 10(5): 6-11.

Zheng Ting, Li Xiaoling, Xu Yuqi, Cai Jianxin. The value analysis of serum survivin, 4-hydroxynonenal, and homocysteine protein 61 for the diagnosis and disease assessment of community-acquired pneumonia in children[J]. Electronic Journal of Emerging Infectious Diseases, 2025, 10(5): 6-11.

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