Effect and predictive value of blood lactate level on neonatal respiratory distress syndrome complicated with bronchopulmonary dysplasia
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维普
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目的 探讨血乳酸水平对新生儿呼吸窘迫综合征(NRDS)并发支气管肺发育不良(BPD)的影响及预测价值.方法 选择2019年1月至2022年12月平顶山市第一人民医院收治的78例NRDS患儿为研究对象,依据是否并发BPD将患儿分为BPD组和非BPD组.采集患儿的一般临床资料,包括:胎龄、性别、出生体质量、1 min Apgar评分、5 min Apgar评分、胎膜早破情况.入院时,抽取患儿动脉血1 mL,使用JM1113-739853型血气分析仪检测血乳酸水平、动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)、pH值及氧合指数(OI);抽取患儿外周静脉血3 mL,应用酶联免疫吸附法检测血清中白细胞介素-6(IL-6)水平,双抗体夹心法检测血浆中 C-反应蛋白(CRP)和降钙素原(PCT)水平.比较2组患儿的一般资料和血乳酸水平、PaO2、PaCO2、pH值、OI及血清IL-6水平、血浆CRP、PCT水平,采用点二列相关性分析血乳酸水平与NRDS并发BPD的相关性,使用logistic回归分析NRDS并发BPD的影响因素,受试者操作特征曲线分析血乳酸水平对NRDS并发BPD的预测价值.结果 78例RDS患儿血乳酸水平为3.35～6.64(5.04±0.72)mmol·L-1;发生BPD的患儿16例,BPD发生率为20.51％(16/78).BPD组患儿出生体质量、OI显著低于非BPD组,血清IL-6、血浆CRP、血乳酸水平显著高于非BPD组(P＜0.05).2组患儿的胎龄、性别、1 min Apgar评分、5 min Apgar评分、胎膜早破、PaO2、PaCO2、pH值、PCT比较差异无统计学意义(P＞0.05).点二列相关性分析结果显示,血乳酸、血清IL-6、血浆CRP水平与NRDS发生BPD的风险呈正相关(r=0.502、0.475、0.507,P＜0.05),出生体质量、OI与NRDS发生BPD的风险呈负相关(r=-0.242、-0.403,P＜0.05).Logistic回归分析结果显示,血乳酸堆积、血清IL-6高表达、血浆CRP高表达、OI值降低是导致NRDS发生BPD风险增加的危险因素(P＜0.05).血乳酸预测NRDS患儿并发BPD的曲线下面积为0.865,95％置信区间为0.776～0.955;当血乳酸截断值为5.065 mmol·L-1时,预测NRDS患儿并发BPD的敏感度为0.938,特异度为0.501.结论 NRDS患儿血乳酸水平与BPD发生风险呈正相关,血乳酸堆积是NRDS并发BPD的危险因素,血乳酸水平对NRDS并发BPD有一定预测价值.
Objective To explore the effect and predictive value of blood lactate level on bronchopulmonary dysplasia(BPD)in newborns with neonatal respiratory distress syndrome(NRDS).Methods A total of 78 children with NRDS admitted to the First People's Hospital of Pingdingshan from January 2019 to December 2022 were selected as the research subjects.Based on whether they had BPD,the children were divided into a BPD group and a non-BPD group.The general clinical data of the children,including gestational age,gender,birth weight,1-minute Apgar score,5-minute Apgar score,and premature rupture of membranes,were collected.At admission,1 mL of arterial blood was extracted from the children,and the blood lactate level,arterial partial pressure of oxygen(PaO2),arterial partial pressure of carbon dioxide(PaCO2),pH value,and oxygenation index(OI)were measured using a JM1113-739853 blood gas analyzer;3 mL of peripheral venous blood was extracted from the children,and the level of interleukin-6(IL-6)in the serum was detected by enzyme-linked immunosorbent assay,while the levels of C-reactive protein(CRP)and procalcitonin(PCT)in the plasma were detected by double antibody sandwich method.The general information,blood lactate levels,PaO2,PaCO2,pH value,OI,serum IL-6 levels,plasma CRP and PCT levels of children were compared between the two groups.The correlation between blood lactate levels and NRDS complicated with BPD was determined by point-biserial correlation analysis,the influencing factors of NRDS complicated with BPD was analyzed by logistic regression,and the predictive value of blood lactate levels for NRDS complicated with BPD was analyzed by receiver operating characteristic curve.Results The blood lactate levels of 78 children with RDS ranged from 3.35 to 6.64(5.04±0.72)mmol·L-1.There were 16 children with BPD,with an incidence rate of 20.51％(16/78).The birth weight and OI of children in the BPD group were significantly lower than those in the non-BPD group,while the serum IL-6,plasma CRP,and blood lactate levels were significantly higher than those in the non-BPD group(P＜0.05).There was no statistically significant difference in gestational age,gender,1-minute Apgar score,5-minute Apgar score,premature rupture of membranes,PaO2,PaCO2,pH value,and PCT of children between the two groups(P＞0.05).The point-biserial correlation analysis showed that blood lactate,serum IL-6,and plasma CRP levels were positively correlated with the risk of BPD in children with NRDS(r=0.502,0.475,0.507;P＜0.05);while birth weight and OI were negatively correlated with the risk of BPD in children with NRDS(r=-0.242,-0.403;P＜0.05).Logistic regression analysis showed that blood lactate accumulation,high expression of serum IL-6,high expression of plasma CRP,and decreased OI were risk factors for BPD in children with NRDS(P＜0.05).The area under the curve for predicting BPD in children with NRDS based on blood lactate was 0.865,with a 95％confidence interval of 0.776 to 0.955;when the cut-off value of blood lactate was 5.065 mmol·L-1,the sensitivity and specificity of predicting BPD in children with NRDS were 0.938 and 0.501,respectively.Conclusion There is a positive correlation between blood lactate levels and the risk of BPD in children with NRDS.Blood lactate accumulation is a risk factor for NRDS complicated with BPD,and blood lactate level has a certain predictive value for NRDS complicated with BPD.
维普
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