Abstract: Objective　To analyze the relationships between serum apolipoprotein AI (ApoAI), high-density lipoprotein cholesterol (HDL-C), and serum amyloid A (SAA) and the severity of meningococcal sepsis in children. Methods　The general data of 90 children with meningococcal sepsis admitted to Children's Hospital Affiliated to Zhengzhou University from September 2019 to October 2021 were analyzed. The 90 children with meningococcal sepsis were divided into a meningococcal sepsis group (52 cases), a severe meningococcal sepsis group (30 cases), and a meningococcal septic shock group (8 cases) according to the guidelines issued by the American College of Chest Physicians and the Society of Critical Care Medicine. The children's general information [gender, age, course of disease, and body mass index (BMI)] were collected, and the children's serum ApoAI, HDL-C, and SAA levels were detected. Logistic regression analysis method was used to analyze the factors affecting the severity of meningococcal sepsis in children, and a risk assessment model was established. The receiver operating characteristic curve (ROC) was used to evaluate the diagnostic performance of the model. χ² test and F test were used. Results　There were 31 males and 21 females in the meningococcal sepsis group, with an age of (6.11±0.91) years old; there were 18 males and 12 females in the severe meningococcal sepsis group, with an age of (5.97±0.89) years old; there were 5 males and 3 females in the meningococcal septic shock group, with an age of (6.27±0.94) years old. There were no statistically significant differences in the gender, age, course of disease, and BMI among the three groups (all P>0.05). There were statistically significant differences in the serum ApoAI, HDL-C, and SAA levels among the three groups (all P<0.05), and compared with those in the meningococcal sepsis group and the severe meningococcal sepsis group, the meningococcal septic shock group had the lowest serum ApoAI and HDL-C levels, and the highest SAA level (all P<0.05). Multivariate logistic regression analysis showed that serum ApoAI (OR=0.156, P<0.001), HDL-C (OR=0.231, P=0.007), and SAA (OR=1.047, P=0.002) were the independent factors affecting the severity of meningococcal sepsis in children. ROC analysis results showed that the AUC value of the combined detection of the above three indicators was the highest, which was 0.957, and the sensitivity and specificity were 94.73% and 71.05%. Conclusion　Serum ApoAI, HDL-C, and SAA levels are closely related to the severity of meningococcal sepsis in children. The more severe the meningococcal sepsis in children, the lower the serum ApoAI and HDL-C levels, and the higher the SAA level. At the same time, the combined detection of serum ApoAI, HDL-C, and SAA has high clinical value in evaluating the severity of meningococcal sepsis in children.

Key words: Meningococcal sepsis, Serum amyloid A, Apolipoprotein AI, High-density lipoprotein cholesterol

摘要： 目的　分析血清载脂蛋白AI（ApoAI）、高密度脂蛋白胆固醇（HDL-C）及血清淀粉样蛋白A（SAA）与脑膜炎球菌败血症患儿严重程度的关系。方法　回顾性分析2019年9月至2021年10月郑州大学附属儿童医院收治的90例脑膜炎球菌败血症患儿的一般资料。按照美国胸科医师协会/危重病医学会颁布的指南将90例脑膜炎球菌败血症患儿按照病情严重程度分为脑膜炎球菌败血症组（52例）、严重脑膜炎球菌败血症组（30例）和脑膜炎球菌败血症休克组（8例），收集患儿的一般资料［性别、年龄、病程、体质量指数（BMI）］，并对患儿的血清ApoAI、HDL-C、SAA水平进行检测，通过多因素logistic回归分析方法分析影响脑膜炎球菌败血症患儿病情严重程度的因素，建立风险评估模型，经受试者工作特征曲线（ROC）评估模型诊断效能。使用χ²检验、F检验。结果　脑膜炎球菌败血症组男31例，女21例，年龄（6.11±0.91）岁；严重脑膜炎球菌败血症组男18例，女12例，年龄（5.97±0.89）岁；脑膜炎球菌败血症休克组男5例，女3例，年龄（6.27±0.94）岁。3组患儿在性别、年龄、病程、BMI方面比较差异均无统计学意义（均P>0.05）。3组患儿在血清ApoAI、HDL-C、SAA水平比较差异均有统计学意义（P<0.05），且与脑膜炎球菌败血症组和严重脑膜炎球菌败血症组相比较，脑膜炎球菌败血症休克组的血清ApoAI、HDL-C水平最低，SAA水平最高（均P<0.05）。经logistic回归模型多因素分析，血清ApoAI（OR=0.156，P<0.001）、HDL-C（OR=0.231，P=0.007）、SAA（OR=1.047，P=0.002）是脑膜炎球菌败血症患儿病情严重程度的独立影响因素。ROC分析结果表明，上述3种指标联合检测的曲线下面积（AUC）值最高，为0.957，灵敏度、特异度分别为94.73%、71.05%。结论　血清ApoAI、HDL-C、SAA水平和脑膜炎球菌败血症患儿病情严重程度有密切关联，脑膜炎球菌败血症患儿病情越严重，其血清ApoAI、HDL-C水平则越低，SAA水平越高。同时血清ApoAI、HDL-C、SAA联合检测的方式在评估脑膜炎球菌败血症患儿病情严重程度方面具有较高的临床价值。

关键词: 脑膜炎球菌败血症, 血清淀粉样蛋白A, 载脂蛋白AI, 高密度脂蛋白