Abstract:

Objective　To explore the correlations between high mobility group box 1 (HMGB1), procalcitonin (PCT), and transforming growth factor β1 (TGF-β1) levels with the severity and prognosis of neonatal severe pneumonia. Methods　A total of 90 neonates with severe pneumonia diagnosed and treated in the Department of Neonatology, Xianyang Central Hospital from September 2020 to December 2023 were selected as the study subjects, and were divided into a good prognosis group (64 cases) and a poor prognosis group (26 cases) according to the condition within 30 days of follow-up. Serum HMGB1, PCT, and TGF-β1 levels, Pediatric Critical Illness Score (PCIS), and Acute Physiology and Chronic Health Evaluation Ⅱ (APACHEⅡ) score were compared between the two groups on the day of admission (D0) and 1 day after admission (D1), 3 days after admission (D3), 5 days after admission (D5), and 7 days after admission (D7), and the ratio of D7/D1 was calculated (represented as the ratio value). The correlations between the changes of serum indexes and the condition and the influence on prognosis were analyzed. Independent sample t test, χ² test, and Pearson correlation analysis were used. Results　In the poor prognosis group, there were 13 boys and 13 girls, with a gestational age of (37.58±1.13) weeks, aged (11.43±1.47) days. In the good prognosis group, there were 33 boys and 31 girls, with a gestational age of (38.64±1.06) weeks, aged (10.95±1.59) days. The levels of serum HMGB1, PCT, and TGF-β1 and APACHEⅡ score in the poor prognosis group were higher than those in the good prognosis group from D0 to D7, and the PCIS was lower than that in the good prognosis group (all P<0.05). The ratio values of serum HMGB1, PCT, and TGF-β1 were negatively correlated with the PCIS ratio value, and positively correlated with the APACHEⅡ ratio value (all P<0.05). Logistic regression analysis showed that HMGB1-ratio, PCT-ratio, TGF-β1-ratio, PCIS-ratio, and APACHEⅡ-ratio were all influencing factors for poor prognosis in neonates with severe pneumonia (all P<0.05). The areas under the curves of serum HMGB1-ratio, PCT-ratio, and TGF-β1-ratio in predicting poor prognosis in neonates with severe pneumonia were 0.823, 0.820, and 0.923, respectively, and the area under the curve of the combined prediction of the three was 0.977. Conclusions　The levels of HMGB1, PCT, and TGF-β1 in neonatal severe pneumonia are closely related to the severity of the disease and prognosis. The levels of these indicators are higher in the children with poor prognosis, and the ratio values of these indicators can effectively predict the prognosis. The combined prediction of the three indicators has a higher accuracy, which helps to evaluate the condition and prognosis.

Key words:

High mobility group box 1, Procalcitonin, Transforming growth factor β1, Neonates, Severe pneumonia

摘要：

目的　探讨高迁移率族蛋白B1（high mobility group box 1，HMGB1）、降钙素原（procalcitonin，PCT）、转化生长因子β1（transforming growth factor β1，TGF-β1）水平与新生儿重症肺炎病情相关性及对预后的影响。方法　选取2020年9月至2023年12月在咸阳市中心医院新生儿科诊治的重症肺炎新生儿90例为研究对象，根据随访30 d内的情况分为预后良好组（64例）与预后不良组（26例）。比较两组入院当天（D0）、入院1 d（D1）、入院3 d（D3）、入院5 d（D5）、入院7 d（D7）血清HMGB1、PCT、TGF-β1水平及小儿危重病例评分（Pediatric Critical Illness Score，PCIS）、急性生理与慢性健康评估Ⅱ（Acute Physiology and Chronic Health Evaluation Ⅱ，APACHEⅡ）评分，并计算D7/D1的比值（以ratio表示），分析各血清指标水平变化与病情的相关性和对预后的影响。采用独立样本t检验、χ²检验、Pearson相关性分析。结果　预后不良组男13例，女13例，胎龄（37.58±1.13）周，日龄（11.43±1.47）d；预后良好组男33例，女31例，胎龄（38.64±1.06）周，日龄（10.95±1.59）d。预后不良组D0～D7血清HMGB1、PCT、TGF-β1水平及APACHEⅡ评分高于预后良好组，PCIS低于预后良好组（均P<0.05）。血清HMGB1-ratio、PCT-ratio、TGF-β1-ratio与PCIS-ratio呈负相关，与APACHEⅡ-ratio呈正相关（均P<0.05）。logistic回归分析显示，HMGB1-ratio、PCT-ratio、TGF-β1-ratio、PCIS-ratio、APACHEⅡ-ratio均为重症肺炎新生儿预后不良的影响因素（均P<0.05）。血清HMGB1-ratio、PCT-ratio、TGF-β1-ratio预测重症肺炎新生儿预后不良的曲线下面积分别为0.823、0.820、0.923，三者联合预测的曲线下面积为0.977。结论　新生儿重症肺炎中HMGB1、PCT、TGF-β1水平与病情严重度和预后密切相关。预后不良患儿这些指标水平较高，这些指标的比值可有效预测疾病预后，三者联合预测准确度更高，有助于评估病情和预后。

关键词:

高迁移率族蛋白B1, 降钙素原, 转化生长因子β1, 新生儿, 重症肺炎