The clinical value of pentraxin3 in community-acquired pneumonia of children / 中国小儿急救医学

ABSTRACT

Objective To investigate the clinical value of pentraxins 3 ( PTX3) in children's com-munity-acquired pneumonia ( CAP ). Methods We collected 122 inpatients diagnosed with CAP from Department of Respiratory Medicine and Intensive Care Unit ( ICU) of Hunan Children's Hospital from March 2016 to January 2017,whose ages were between 28 days and 18 years old. We collected 20 healthy subjects as control group. According to the severity of illness,122 inpatients were divided into mild group and severe group. According to respiratory failure or not,122 inpatients were divided into the respiratory failure group and the non-respiratory failure group. According to the optimal thresholds of PTX3 in the study on respir-atory failure,122 inpatients were divided into group A (≤165. 30 ng/ml) and group B (>165. 30 ng/ml). Results (1) There was significant difference in the PTX3 level within 24 h after admission of patients among mild group, severe group and control group [72. 56 (96. 02) ng/ml,211. 00 ( 110. 72 ) ng/ml,9. 45 (3. 29) ng/ml,H＝87. 99,P<0. 001]. The PTX3 level of patients with respiratory failure was higher than non-respiratory failure group and the difference was statistically significant[225. 60(189. 56)ng/ml,138. 49 (144. 40) ng/ml,U ＝494. 00,P <0. 001]. (2) Receiver Operating Characteristic analysis with TNF-α, CRP,PCT and PTX3 showed that the area under the curve of PTX3 was largest in diagnosis of respiratory failure. The top three of accuracy were PTX3,PCT and TNF-α respectively to diagnose the severe pneumonia with respiratory failure. The sensitivity and specificity were 0. 826 and 0. 657,0. 783 and 0. 566,0. 730 and 0. 586,respectively. ( 3 ) The correlation analysis between PTX3 and other inflammatory biomarkers and clinic opathological features of patients with CAP showed that TNF-α,PCT were positively correlated with PTX3 level,the correlation coefficients were 0. 59,0. 18 respectively. PTX3 level was positively correlated with respiratory frequency (r＝0. 388),and negatively correlated with pulse oximetry ( r ＝ －0. 251) and PaO2(r＝ －0. 316). The D-dimer level of PTX3 severe group (group B) was higher than that of the mild group (P＝0. 022). There was a positive correlation between the PTX3 level and the D-dimer line ( r ＝0. 228,P＝0. 012). (4) Dynamic observation of PTX3 level in children with CAPPTX3 level [M(IQR), ng/ml] was highest at 24 h after hospital admission,equaling to 152. 55(152. 22); PTX3 equaled to 89. 12 (111. 44) after 3 days'treatment; and decreased to 47. 26(68. 51) after 7 days'treatment,and the difference among these time points were statistically significant(P<0. 01). The difference of PTX3 level between mild group and severe group in distinct time points(less 24 h,3 days and 7 days after hospital admission) was also statistically significant(P<0. 001). Conclusion The level of serum PTX3 in children with CAP was posi-tively correlated with TNF-α,PCT and D-dimer. Serum PTX3 is a potential new biomarker to revel the sever-ity of community-acquired pneumonia of children.