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

doi:10.11958/20252398

Abstract

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

CLC Number:

R722.12，R725.6

Figures/Tables 6

References 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^＊＊