Abstract:

Objective　To explore the relationship between level of leukocyte derived chemokine 2 (LECT2) and occurrence of necrotizing pneumonia in children with Streptococcus pneumoniae pneumonia and its clinical significance, in order to provide a reference for early diagnosis and treatment of Streptococcus pneumoniae pneumonia. Methods　The clinical data of 104 children with Streptococcus pneumoniae pneumonia admitted to Xi'an Gaoxin Hospital from January 2022 to January 2024 were retrospectively analyzed. According to the occurrence of necrotizing pneumonia, the children were divided into a necrotizing pneumonia group (49 cases) and a non-necrotizing pneumonia group (55 cases). In the necrotizing pneumonia group, there were 26 boys and 23 girls, aged (7.62±2.58) years. In the non-necrotizing pneumonia group, there were 27 boys and 28 girls, aged (7.18±2.03) years. The levels of LECT2, blood routine [C-reactive protein (CRP), lactate dehydrogenase (LDH), and procalcitonin (PCT)], and cytokines [tumor necrosis factor α (TNF-α) and γ interferon (IFN-γ)] were compared between the two groups. The relationship between LECT2 level and necrotizing pneumonia was analyzed, and the influencing factors of necrotizing pneumonia in children with Streptococcus pneumoniae pneumonia were analyzed. The prediction model for necrotizing pneumonia was established and its prediction efficiency was analyzed. χ² test and t test were used. Results　There were statistically significant differences between the two groups in terms of the duration of fever, hospital stay, pleural effusion, and pleural thickening (all P<0.05). The levels of LECT2, CRP, LDH, and PCT in the necrotizing pneumonia group were (28.36±4.46) mg/L, (91.47±7.48) mg/L, (462.27±61.44) U/L, and (0.25±0.10) µg/L, and those in the non-necrotizing pneumonia group were (26.07±5.17) mg/L, (77.65±7.59) mg/L, (346.85±48.93) U/L, and (0.11±0.04) µg/L, with statistically significant differences (t=2.404, 9.332, 10.649, and 9.564, all P<0.05). LECT2, CRP, LDH, and PCT were the influencing factors of secondary necrotizing pneumonia in children with Streptococcus pneumoniae pneumonia (all P<0.05). The area under the curve of LECT2 was 0.636 for predicting secondary necrotizing pneumonia in children with Streptococcus pneumoniae pneumonia, and the area under the curve of the combined detection of all indicators was 0.988, which was of higher diagnostic value. Conclusions　The level of LECT2 is closely related to the occurrence of necrotizing pneumonia in children with Streptococcus pneumoniae pneumonia, and its increase may elevate the risk of developing necrotizing pneumonia. Therefore, LECT2 can serve as a potential biomarker for predicting the development of necrotizing pneumonia in children with Streptococcus pneumoniae pneumonia, aiding clinicians in taking more targeted treatment measures at an early stage to improve the prognosis of affected children.

Key words:

Streptococcus pneumoniae pneumonia, Necrotizing pneumonia, Leukocyte derived chemokine 2, Early diagnosis, Children

摘要：

目的　本研究旨在探讨白细胞衍生趋化因子2（LECT2）水平与肺炎链球菌肺炎患儿发生坏死性肺炎的关系及其临床意义，为肺炎链球菌肺炎的早期诊断和治疗提供参考。方法　回顾性分析西安高新医院2022年1月至2024年1月收治的104例肺炎链球菌肺炎患儿的临床资料。根据是否发生坏死性肺炎，将患儿分为坏死性肺炎组（49例）和非坏死性肺炎组（55例）。坏死性肺炎组中男26例，女23例，年龄（7.62±2.58）岁；非坏死性肺炎组中男27例，女28例，年龄（7.18±2.03）岁。比较两组患儿的LECT2水平、血常规［C反应蛋白（CRP）、乳酸脱氢酶（LDH）、降钙素原（PCT）］以及细胞因子［肿瘤坏死因子α（TNF-α）和γ干扰素（IFN-γ）］水平。分析LECT2水平与坏死性肺炎的关系及肺炎链球菌肺炎患儿发生坏死性肺炎的影响因素。建立坏死性肺炎预测模型，并分析其预测效能。采用χ²检验、t检验。结果　两组患儿的发热时间、住院时间、有无胸腔积液、是否胸膜增厚比较，差异均有统计学意义（均P<0.05）。坏死性肺炎组患儿LECT2、CRP、LDH和PCT水平分别为（28.36±4.46）mg/L、（91.47±7.48）mg/L、（462.27±61.44）U/L、（0.25±0.10）µg/L，非坏死性肺炎组分别为（26.07±5.17）mg/L、（77.65±7.59）mg/L、（346.85±48.93）U/L、（0.11±0.04）µg/L，差异均有统计学意义（t=2.404、9.332、10.649、9.564，均P<0.05）。LECT2、CRP、LDH和PCT均是肺炎链球菌感染患儿继发坏死性肺炎的影响因素（均P<0.05）。预测肺炎链球菌感染患儿发生坏死性肺炎的各指标中，LECT2曲线下面积为0.636，各指标联合检测曲线下面积为0.988，联合检测具有更高的诊断价值。结论　LECT2水平与肺炎链球菌肺炎患儿发生坏死性肺炎密切相关，其水平的升高可能增加患儿发展为坏死性肺炎的风险。因此，LECT2可作为预测肺炎链球菌肺炎患儿发展为坏死性肺炎的潜在生物标志物，有助于临床医生在早期阶段采取更有针对性的治疗措施，从而改善患儿预后。

关键词:

肺炎链球菌肺炎, 坏死性肺炎, 白细胞衍生趋化因子2, 早期诊断, 儿童