肺部超声评分及血清SP-A、IL-6水平与新生儿呼吸窘迫综合征病情及预后的相关性

doi:10.11958/20252398

天津医药 ›› 2026, Vol. 54 ›› Issue (2): 173-178.doi: 10.11958/20252398

肺部超声评分及血清SP-A、IL-6水平与新生儿呼吸窘迫综合征病情及预后的相关性

文艺(), 张君, 王英俊, 王铁锋, 董玉斌()

周口市中心医院NICU（邮编466000）

收稿日期:2025-07-01 修回日期:2025-09-03 出版日期:2026-02-15 发布日期:2026-02-12
通讯作者: 董玉斌 E-mail:13838691130@126.com;dongyubindy@163.com
作者简介:文艺（1983），男，副主任医师，主要从事儿内科疾病诊疗方面研究。E-mail：13838691130@126.com
基金资助:
河南省科技发展计划项目(222102310274)

Correlation analysis of lung ultrasound score, serum pulmonary surfactant protein A and IL-6 levels with disease severity and prognosis in neonatal respiratory distress syndrome

WEN Yi(), ZHANG Jun, WANG Yingjun, WANG Tiefeng, DONG Yubin()

Department of NICU, Zhoukou Central Hospital, Zhoukou 466000, China

Received:2025-07-01 Revised:2025-09-03 Published:2026-02-15 Online:2026-02-12
Contact: DONG Yubin E-mail:13838691130@126.com;dongyubindy@163.com

文艺, 张君, 王英俊, 王铁锋, 董玉斌. 肺部超声评分及血清SP-A、IL-6水平与新生儿呼吸窘迫综合征病情及预后的相关性[J]. 天津医药, 2026, 54(2): 173-178.

WEN Yi, ZHANG Jun, WANG Yingjun, WANG Tiefeng, DONG Yubin. Correlation analysis of lung ultrasound score, serum pulmonary surfactant protein A and IL-6 levels with disease severity and prognosis in neonatal respiratory distress syndrome[J]. Tianjin Medical Journal, 2026, 54(2): 173-178.

摘要/Abstract

摘要：

目的探讨肺部超声评分（LUS）及血清肺表面活性蛋白A（SP-A）和白细胞介素-6（IL-6）水平对新生儿呼吸窘迫综合征（NRDS）病情及预后评估的临床价值。方法选取205例NRDS患儿的临床资料，根据入院时氧合指数（OI）分为重度组（55例）、中度组（78例）和轻度组（72例）。根据随访临床结局分为预后良好组（143例）和预后不良组（62例）。比较各组间LUS，血清SP-A及IL-6水平差异；采用Pearson相关性分析各指标与OI的相关性；通过多因素Logistic回归分析NRDS患儿预后不良的危险因素；采用受试者工作特征（ROC）曲线进行预测效能分析。结果与轻度组相比，中度和重度组LUS评分、SP-A和IL-6水平均升高，且重度组各项指标显著高于中度组（P<0.05）。NRDS患儿的LUS评分、SP-A和IL-6水平与OI呈正相关（r分别为0.572、0.613、0.695，P<0.05）。与预后良好组相比，预后不良组NRDS患儿胎龄较小，OI、白细胞计数、LUS、SP-A、IL-6水平较高（P<0.05）。多因素Logistic回归分析结果显示，高OI值（OR=3.374，95%CI：2.063~5.518）、高LUS评分（OR=3.068，95%CI：1.533~6.140）、高SP-A（OR=2.356，95%CI：1.327~4.184）及高IL-6水平（OR=1.929，95%CI：1.348~2.761）是NRDS患儿预后不良的独立危险因素（P<0.05）。ROC曲线分析结果显示，IL-6、LUS、血清SP-A和OI指标单独及联合应用预测预后不良的曲线下面积（AUC）及其（95%CI）分别为0.721（0.654~0.781）、0.769（0.705~0.825）、0.698（0.630~0.760）、0.785（0.722~0.839）、0.896（0.846~0.934），联合模型的预测效能最高。结论 LUS、血清SP-A及IL-6水平与NRDS患儿病情严重程度呈正相关，三者联合OI构建的预测模型能有效预测NRDS患儿预后。

关键词: 新生儿呼吸窘迫综合征, 肺表面活性物质蛋白, 病情严重程度, 氧合指数, 白细胞介素6, 肺部超声评分

Abstract:

Objective To evaluate the clinical value of lung ultrasound score (LUS), serum pulmonary surfactant-associated protein A (SP-A) and interleukin-6 (IL-6) levels in the condition and prognosis of neonatal respiratory distress syndrome (NRDS). Methods The clinical data of 205 neonates with NRDS were retrospectively analyzed. Based on the oxygenation index (OI) at admission, patients were divided into the severe group (n=55), the moderate group (n=78) and the mild group (n=72). According to the clinical outcomes during follow-up, they were categorized into the good prognosis group (n=143) and the poor prognosis group (n=62). Differences in LUS, serum SP-A and IL-6 levels were compared between the groups. Pearson correlation analysis was used to assess the relationship between these indicators and OI. Multivariate Logistic regression analysis was performed to identify independent risk factors for poor prognosis. The predictive efficacy of each indicator was evaluated using receiver operating characteristic (ROC) curve analysis. Results Compared with the mild group, the LUS scores, SP-A and IL-6 levels were all increased in the moderate group and the severe group, and all indicators were significantly higher in the severe group than those in the moderate group (P<0.05). The LUS score, SP-A and IL-6 levels were positively correlated with OI in children with NRDS (r was 0.572, 0.613 and 0.695 respectively, P<0.05). Compared with the good prognosis group, children with NRDS in the poor prognosis group had a lower gestational age, higher OI, white blood cell count, LUS score, SP-A and IL-6 levels (P<0.05). Multivariate Logistic regression analysis showed that high OI (OR=3.374, 95%CI: 2.063-5.518), high LUS score (OR=3.068, 95%CI: 1.533-6.140), high serum SP-A (OR=2.356, 95%CI: 1.327-4.184) and high IL-6 level (OR=1.929, 95%CI: 1.348-2.761) were independent risk factors for poor prognosis in children with NRDS (P<0.05). ROC curve analysis showed that the areas under the curve (95%CI) for predicting poor prognosis using IL-6, LUS, SP-A and OI individually and in combination were 0.721 (0.654-0.781), 0.769 (0.705-0.825), 0.698 (0.630-0.760), 0.785 (0.722-0.839) and 0.896 (0.846-0.934), respectively. The combined model demonstrated the highest predictive efficacy. Conclusion LUS score, serum SP-A and IL-6 levels are positively correlated with the severity of NRDS. A predictive model combining these indicators with OI can effectively predict the prognosis of neonates with NRDS.

Key words: neonatal respiratory distress syndrome, pulmonary surfactant protein, disease severity, oxygenation index, interleukin-6, lung ultrasound score

中图分类号:

R722.12，R725.6

图/表 6

参考文献 24

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组别	n	LUS评分/分	SP-A/（mg/L）	IL-6/（ng/L）
轻度组	72	8.65±2.14	23.69±7.58	16.64±3.61
中度组	78	16.26±3.32^a	49.72±13.46^a	21.55±4.48^a
重度组	55	25.47±5.09^ab	68.24±15.35^ab	28.79±4.23^ab
F		282.208^＊＊	210.263^＊＊	135.133^＊＊

组别	n	LUS评分/分	SP-A/（mg/L）	IL-6/（ng/L）
轻度组	72	8.65±2.14	23.69±7.58	16.64±3.61
中度组	78	16.26±3.32^a	49.72±13.46^a	21.55±4.48^a
重度组	55	25.47±5.09^ab	68.24±15.35^ab	28.79±4.23^ab
F		282.208^＊＊	210.263^＊＊	135.133^＊＊

组别		n		性别（男/女）			胎龄/周		出生体质量/kg				败血症		肺炎		胎粪吸入综合征
预后良好组		143		78/65			33.53±3.17		2.26±0.55				13（9.0）		25（17.5）		37（25.9）
预后不良组		62		32/30			32.16±3.50		2.14±0.61				7（11.3）		12（19.4）		10（16.1）
t或χ²				0.150			2.753^＊＊		1.446				0.238		0.103		2.324
组别	窒息				5 min Apgar评分/分			正压通气		产妇年龄/岁		分娩方式（顺产/剖宫产）				产次/次			妊娠期糖尿病
预后良好组	68（47.6）				7.11±1.25			131（91.6）		29.35±5.62		38/105				1.96±0.68			18（12.6）
预后不良组	33（53.2）				6.79±1.38			59（95.2）		30.63±4.27		18/44				2.13±0.74			10（16.1）
t或χ²	0.557				1.643			0.805		1.601		0.132				1.613			0.460
组别			OI/（mmHg）			WBC/（×10⁹/L）					Hb（g/L）			PLT/（×10⁹/L）				ALB/（g/L）
预后良好组			10.43±3.22			12.38±2.49					179.57±41.28			186.56±46.34				23.28±4.69
预后不良组			14.18±3.57			15.74±3.63					172.94±40.64			179.41±45.17				22.43±4.35
t			7.400^＊＊			7.636^＊＊					1.063			1.021				1.205

组别		n		性别（男/女）			胎龄/周		出生体质量/kg				败血症		肺炎		胎粪吸入综合征
预后良好组		143		78/65			33.53±3.17		2.26±0.55				13（9.0）		25（17.5）		37（25.9）
预后不良组		62		32/30			32.16±3.50		2.14±0.61				7（11.3）		12（19.4）		10（16.1）
t或χ²				0.150			2.753^＊＊		1.446				0.238		0.103		2.324
组别	窒息				5 min Apgar评分/分			正压通气		产妇年龄/岁		分娩方式（顺产/剖宫产）				产次/次			妊娠期糖尿病
预后良好组	68（47.6）				7.11±1.25			131（91.6）		29.35±5.62		38/105				1.96±0.68			18（12.6）
预后不良组	33（53.2）				6.79±1.38			59（95.2）		30.63±4.27		18/44				2.13±0.74			10（16.1）
t或χ²	0.557				1.643			0.805		1.601		0.132				1.613			0.460
组别			OI/（mmHg）			WBC/（×10⁹/L）					Hb（g/L）			PLT/（×10⁹/L）				ALB/（g/L）
预后良好组			10.43±3.22			12.38±2.49					179.57±41.28			186.56±46.34				23.28±4.69
预后不良组			14.18±3.57			15.74±3.63					172.94±40.64			179.41±45.17				22.43±4.35
t			7.400^＊＊			7.636^＊＊					1.063			1.021				1.205

组别	n	LUS评分/分	SP-A/（mg/L）	IL-6/（ng/L）
预后良好组	143	12.06±3.57	40.15±6.43	19.62±3.59
预后不良组	62	25.27±4.12	57.99±7.16	26.72±4.71
t		23.700^＊＊	15.213^＊＊	14.456^＊＊

肺部超声评分及血清SP-A、IL-6水平与新生儿呼吸窘迫综合征病情及预后的相关性

Correlation analysis of lung ultrasound score, serum pulmonary surfactant protein A and IL-6 levels with disease severity and prognosis in neonatal respiratory distress syndrome

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变量	β	SE	Wald χ²	P	OR（95%CI）
OI	1.216	0.251	23.470	<0.001	3.374（2.063~5.518）
LUS	1.121	0.354	10.028	<0.001	3.068（1.533~6.140）
SP-A	0.857	0.293	8.555	<0.001	2.356（1.327~4.184）
IL-6	0.657	0.183	6.209	<0.001	1.929（1.348~2.761）
常数项	-0.429	0.185	5.377	0.006	0.651

指标	AUC（95%CI）	最佳截断值	敏感度/%	特异度/%	约登指数	Z
LUS	0.769（0.705~0.825）	14分	85.48	61.54	0.470	3.171^＊＊
SP-A	0.698（0.630~0.760）	40.26 mg/L	70.97	60.84	0.318	4.457^＊＊
IL-6	0.721（0.654~0.781）	24.32 ng/L	67.74	71.33	0.391	3.699^＊＊
OI	0.785（0.722~0.839）	16 mmHg	64.52	86.01	0.505	2.696^＊＊
联合	0.896（0.846~0.934）		85.48	86.71	0.722

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