目的 探讨血清降钙素原(PCT)、血管内皮生长因子(VEGF)、前肾上腺髓质素(pro-ADM)水平对新生儿重症监护病房(NICU)患儿发生呼吸机相关性肺炎(VAP)的预测价值。 方法 本研究为病例对照研究，采用非随机抽样的方法选取2018年3月至2021年3月宜昌市中心人民医院NICU收治的接受机械通气治疗的100例患儿为研究对象。根据住院期间是否合并VAP将患儿分为VAP组(30例)和非VAP组(70例)。比较2组患儿性别、胎龄、出生1 min Apgar评分、住院天数、出生日龄、机械通气天数、气管插管次数、有无重复吸痰和胃内容物误吸情况。比较2组患儿机械通气治疗前后血清PCT、VEGF、pro-ADM水平。应用受试者操作特征曲线分析血清PCT、VEGF、pro-ADM水平预测NICU患儿发生VAP的价值。多因素logistic回归分析NICU患儿发生VAP的危险因素。 结果 2组患儿性别、胎龄、出生日龄比较差异均无统计学意义(均P>0.05)。VAP组患儿出生1 min Apgar评分<7分者、住院天数≥7 d者、机械通气天数≥5 d者、气管插管次数≥2次者、有重复吸痰者、有胃内容物误吸者占比均高于非VAP组[60.00%(18/30)比38.57%(27/70)，70.00%(21/30)比41.43%(29/70)，63.33%(19/30)比35.71%(25/70)，73.33%(22/30)比32.86%(23/70)，66.67%(20/30)比37.14%(26/70)，76.67%(23/30)比40.00%(28/70)，均P<0.05]。VAP组患儿机械通气治疗前后血清PCT、VEGF、pro-ADM水平均高于非VAP组[治疗前PCT：(3.18±0.78) mmol/L比(2.17±0.59) mmol/L，治疗后PCT：(2.56±0.52)mmol/L比(2.15±0.45) mmol/L，治疗前VEGF：(89.64±16.29) ng/L比(68.97±13.59) ng/L，治疗后VEGF：(75.37±13.27) ng/L比(66.37±12.39) ng/L，治疗前pro-ADM：(37.61±10.39) μg/L比(25.61±9.67) μg/L，治疗后pro-ADM：(30.67±8.63) μg/L比(24.67±6.34) μg/L，均P<0.05]，VAP组患儿机械通气治疗后血清PCT、VEGF、pro-ADM水平均低于治疗前(均P<0.05)。受试者操作特征曲线显示，血清PCT、VEGF、pro-ADM水平预测NICU患儿发生VAP的曲线下面积分别为0.739(95%CI：0.614～0.864)、0.873(95%CI：0.785～0.962)、0.911(95%CI：0.835～0.987)。当PCT的最佳截断值为2.91 mmol/L时，敏感度为86.7%，特异度为56.7%；当VEGF的最佳截断值为82.86 ng/L时，敏感度为90.0%，特异度为76.7%；当pro-ADM的最佳截断值为31.28 μg/L时，敏感度为93.3%，特异度为31.3%。出生1 min Apgar评分<7分、住院天数≥7 d、机械通气天数≥5 d、气管插管次数≥2次、有重复吸痰、有胃内容物误吸、PCT≥2.91 mmol/L、VEGF≥82.86 ng/L、pro-ADM≥31.28 μg/L是NICU患儿发生VAP的独立危险因素。 结论 血清PCT、VEGF、pro-ADM水平对NICU患儿发生VAP均有一定预测价值，PCT、VEGF、pro-ADM升高是NICU患儿发生VAP的独立危险因素。 Objective To explore the predictive values of serum procalcitonin (PCT), vascular endothelial growth factor (VEGF), pro-adrenomedullin (pro-ADM) in children with ventilator-associated pneumonia (VAP) in neonatal intensive care unit (NICU). Methods It was a case-control study involving 100 children receiving mechanical ventilation treatment in NICU of Yichang Central People′s Hospital from March 2018 to March 2021 selected by non-random sampling method.They were divided into VAP group (30 cases) and non-VAP group (70 cases) according to the development of VAP during hospitalization or not.Gender, gestational age, Apgar score 1 min after birth, length of hospitalization, age of birth, length of mechanical ventilation, times for tracheal intubations, repeated sputum aspiration and aspiration of stomach contents were compared between the two groups.Serum PCT, VEGF and pro-ADM levels before and after mechanical ventilation were compared between the two groups.The value of serum PCT, VEGF and pro-ADM levels in predicting VAP in NICU children was analyzed by plotting the receiver operator characteristic (ROC) curves.Multivariate logistic regression analysis was performed to identify risk factors for VAP in NICU children. Results There were no significant differences in the gender, gestational age and age of birth between groups (all P>0.05).The proportion of children in VAP group with Apgar score 1 min after birth <7 points (60.00% [18/30]vs 38.57% [27/70]), hospitalization days ≥7 d (70.00% [21/30]vs 41.43% [29/70]), mechanical ventilation days ≥5 d (63.33% [19/30]vs 35.71% [25/70]), times for tracheal intubations ≥2 times (73.33% [22/30]vs 32.86% [23/70]), repeated sputum aspiration (66.67% [20/30]vs 37.14% [26/70]) and aspiration of stomach contents (76.67% [23/30]vs 40.00% [28/70]) was significantly higher than that of non-VAP group (all P<0.05).Serum PCT, VEGF and pro-ADM levels in VAP group before (PCT, [3.18±0.78] mmol/Lvs [2.17±0.59] mmol/L VEGF, [89.64±16.29] ng/Lvs [68.97±13.59] ng/L pro-ADM, [37.61±10.39] μg/Lvs [25.61±9.67] μg/L) and after mechanical ventilation (PCT, [2.56±0.52] mmol/L vs [2.15±0.45] mmol/L VEGF, [75.37±13.27] ng/Lvs [66.37±12.39] ng/L pro-ADM, [30.67±8.63] μg/Lvs [24.67±6.34] μg/L) were both significantly higher than those of non-VAP group (all P<0.05).The serum levels of PCT, VEGF and pro-ADM in VAP group after mechanical ventilation treatment were significantly lower than those before treatment (allP<0.05).ROC curves showed that the area under the curve (AUC) of serum PCT, VEGF and pro-ADM levels in predicting VAP in NICU children was 0.739 (95%CI: 0.614-0.864), 0.873 (95%CI: 0.785-0.962) and 0.911 (95%CI: 0.835-0.987), respectively.When the optimal cut-off value of PCT was 2.91 mmol/L, the sensitivity was 86.7% and the specificity was 56.7%.When the optimal cut-off value of VEGF was 82.86 ng/L, the sensitivity was 90.0% and the specificity was 76.7%.When the optimal cut-off value of pro-ADM was 31.28 μg/L, the sensitivity was 93.3% and the specificity was 31.3%.Apgar score 1 min after birth < 7 points, length of hospitalization ≥7 d, length of mechanical ventilation ≥5 d, times for tracheal intubations ≥2 times, repeated sputum aspiration, aspiration of stomach contents, PCT≥2.91 mmol/L, VEGF≥82.86 ng/L, and pro-ADM≥31.28 μg/L were independent risk factors for VAP in children with NICU. Conclusions Serum PCT, VEGF and pro-ADM have certain predictive value in VAP in NICU children.The increases in serum PCT, VEGF and pro-ADM are independent risk factors for the occurrence of VAP in NICU children.
Predictive values of serum PCT, VEGF and pro-ADM in children with ventilator-associated pneumonia in NICU
Objective To explore the predictive values of serum procalcitonin (PCT), vascular endothelial growth factor (VEGF), pro-adrenomedullin (pro-ADM) in children with ventilator-associated pneumonia (VAP) in neonatal intensive care unit (NICU). Methods It was a case-control study involving 100 children receiving mechanical ventilation treatment in NICU of Yichang Central People′s Hospital from March 2018 to March 2021 selected by non-random sampling method.They were divided into VAP group (30 cases) and non-VAP group (70 cases) according to the development of VAP during hospitalization or not.Gender, gestational age, Apgar score 1 min after birth, length of hospitalization, age of birth, length of mechanical ventilation, times for tracheal intubations, repeated sputum aspiration and aspiration of stomach contents were compared between the two groups.Serum PCT, VEGF and pro-ADM levels before and after mechanical ventilation were compared between the two groups.The value of serum PCT, VEGF and pro-ADM levels in predicting VAP in NICU children was analyzed by plotting the receiver operator characteristic (ROC) curves.Multivariate logistic regression analysis was performed to identify risk factors for VAP in NICU children. Results There were no significant differences in the gender, gestational age and age of birth between groups (all P>0.05).The proportion of children in VAP group with Apgar score 1 min after birth <7 points (60.00% [18/30]vs 38.57% [27/70]), hospitalization days ≥7 d (70.00% [21/30]vs 41.43% [29/70]), mechanical ventilation days ≥5 d (63.33% [19/30]vs 35.71% [25/70]), times for tracheal intubations ≥2 times (73.33% [22/30]vs 32.86% [23/70]), repeated sputum aspiration (66.67% [20/30]vs 37.14% [26/70]) and aspiration of stomach contents (76.67% [23/30]vs 40.00% [28/70]) was significantly higher than that of non-VAP group (all P<0.05).Serum PCT, VEGF and pro-ADM levels in VAP group before (PCT, [3.18±0.78] mmol/Lvs [2.17±0.59] mmol/L VEGF, [89.64±16.29] ng/Lvs [68.97±13.59] ng/L pro-ADM, [37.61±10.39] μg/Lvs [25.61±9.67] μg/L) and after mechanical ventilation (PCT, [2.56±0.52] mmol/L vs [2.15±0.45] mmol/L VEGF, [75.37±13.27] ng/Lvs [66.37±12.39] ng/L pro-ADM, [30.67±8.63] μg/Lvs [24.67±6.34] μg/L) were both significantly higher than those of non-VAP group (all P<0.05).The serum levels of PCT, VEGF and pro-ADM in VAP group after mechanical ventilation treatment were significantly lower than those before treatment (allP<0.05).ROC curves showed that the area under the curve (AUC) of serum PCT, VEGF and pro-ADM levels in predicting VAP in NICU children was 0.739 (95%CI: 0.614-0.864), 0.873 (95%CI: 0.785-0.962) and 0.911 (95%CI: 0.835-0.987), respectively.When the optimal cut-off value of PCT was 2.91 mmol/L, the sensitivity was 86.7% and the specificity was 56.7%.When the optimal cut-off value of VEGF was 82.86 ng/L, the sensitivity was 90.0% and the specificity was 76.7%.When the optimal cut-off value of pro-ADM was 31.28 μg/L, the sensitivity was 93.3% and the specificity was 31.3%.Apgar score 1 min after birth < 7 points, length of hospitalization ≥7 d, length of mechanical ventilation ≥5 d, times for tracheal intubations ≥2 times, repeated sputum aspiration, aspiration of stomach contents, PCT≥2.91 mmol/L, VEGF≥82.86 ng/L, and pro-ADM≥31.28 μg/L were independent risk factors for VAP in children with NICU. Conclusions Serum PCT, VEGF and pro-ADM have certain predictive value in VAP in NICU children.The increases in serum PCT, VEGF and pro-ADM are independent risk factors for the occurrence of VAP in NICU children.
Pneumonia, ventilator-associatedIntensive care units, neonatalProcalcitoninVascular endothelial growth factorsPro-adrenomedullin
万方数据
