[1]何秋红,任 盛,张 莉,等.基于血清Th1/Th2细胞因子及临床指标构建预测新生儿肺炎并发心肌损害列线图模型[J].现代检验医学杂志,2025,40(05):107-112,130.[doi:10.3969/j.issn.1671-7414.2025.05.020]
　HE Qiuhong,REN Sheng,ZHANG Li,et al.Construction of a Nomogram Model for Predicting Neonatal Pneumonia Complicated with Myocardial Damage Based on Serum Th1/Th2 Cytokines and Clinical Indicators[J].Journal of Modern Laboratory Medicine,2025,40(05):107-112,130.[doi:10.3969/j.issn.1671-7414.2025.05.020]
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基于血清Th1/Th2细胞因子及临床指标构建预测新生儿肺炎并发心肌损害列线图模型()

《现代检验医学杂志》[ISSN:/CN:]

卷:
第40卷
期数:
2025年05期
页码:
107-112,130
栏目:
论著
出版日期:
2025-09-15

文章信息/Info

Title:
Construction of a Nomogram Model for Predicting Neonatal Pneumonia Complicated with Myocardial Damage Based on Serum Th1/Th2 Cytokines and Clinical Indicators
文章编号:
1671-7414（2025）05-107-07
作者:
何秋红a，任 盛a，张 莉b，邹 良b，李兴洋b
绵阳市人民医院 a儿科；b新生儿科，四川绵阳 621000
Author(s):
HE Qiuhonga，REN Shenga，ZHANG Lib，ZOU Liangb，LI Xingyangb
a. Department of Pediatrics；b. Department of Neonatology，Mianyang People’s Hospital，Sichuan Mianyang 621000，China
关键词:
新生儿肺炎; 心肌损害; 辅助型T细胞1/辅助型T细胞2细胞因子; 临床指标; 列线图模型
分类号:
R722.135；R446
DOI:
10.3969/j.issn.1671-7414.2025.05.020
文献标志码:
A
摘要:
目的探讨新生儿肺炎并发心肌损害影响因素及辅助型T细胞1/辅助型T细胞2（Th1/Th2）细胞因子，并构建列线图模型。方法选取在绵阳市人民医院就医的390例新生儿肺炎患儿作为研究对象，根据7∶3比例随机分为建模队列（n=273）和验证队列（n=117），根据是否并发心肌损害分为心肌损害组和非心肌损害组。酶联免疫吸附试验（ELISA）测定Th1/Th2细胞因子[干扰素γ（IFN-γ）、白细胞介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）、IL-4，IL-2和IL-10]，迈瑞BS-280全自动生化分析仪测定超敏肌钙蛋白I（hs-cTnI）、肌酸激酶同工酶（CK-MB）、乳酸脱氢酶（LDH）和肌酸激酶（CK）。Logistic回归方程筛选新生儿肺炎并发心肌损害影响因素，R软件构建列线图模型，受试者工作特征（ROC）曲线及曲线下面积（AUC）分析模型预测能力。采用Hosmer-Lemeshow拟合优度检验，并绘制校准曲线评价模型校准度，决策曲线分析法(DCA)评价临床有效性。结果390例新生儿肺炎患儿心肌损害发生率为28.21%。建模队列和验证队列中，心肌损害组1min阿普加（Apgar）评分低于非心肌损害组（t=3.314，2.619），CK-MB，LDH，CK，hs-cTnI，IL-2，IFN-γ，TNF-α，IL-6，IL-10和IL-4均高于非心肌损害组（t=5.805～18.914），重症肺炎、低体重儿及早产儿比例均高于非心肌损伤组（χ2=4.464～41.497），差异具有统计学意义（均P＜0.05）。Logistic回归方程显示，低体重儿、1minApgar评分、早产儿、hs-cTnI，IL-2，IFN-γ，IL-6和IL-4是新生儿肺炎并发心肌损害的影响因素（Waldχ2=10.330～14.328，均P＜0.05）。基于新生儿肺炎并发心肌损害影响因素构建的列线图模型在建模队列、验证队列中AUC（95%CI）分别为0.880（0.839～0.921），0.910（0.856～0.964），校准曲线斜率均接近1，在0.1～0.8，0.0～0.7范围内临床净获益率最大。结论含Th1/Th2细胞因子、hs-cTnI，1minApgar评分、早产儿和低体重儿列线图模型预测新生儿肺炎并发心肌损害价值较高，可帮助临床医师识别高危人群，采取合理诊治措施，减少心肌损害发生风险。
Abstract:
Objective To explore the influencing factors of neonatal pneumonia complicated with myocardial damage and Th1/Th2 cytokines, and construct a line chart model. Methods A total of 390 neonates with pneumonia who were treated in Mianyang People’s Hospital were selected as the study subjects and randomly divided into a modeling cohort (n=273) and a validation cohort (n=117) according to a 7∶3 ratio. They were further divided into myocardial damage group and non-myocardial damage group according to whether they had concurrent myocardial damage. Enzyme linked immunosorbent assay（ELISA） was used to measure Th1/Th2 cytokines (IFN-γ，IL-6，TNF-α，IL-4，IL-2 and IL-10)，and the Mindray BS-280 automatic biochemical analyzer was used to measure hs-cTn I，CK-MB，LDH and CK. Logistic regression equation was used to screen the influencing factors of neonatal pneumonia complicated with myocardial damage. R software was used to construct a line chart model, and the receiver operating characteristic curve (ROC) and area under the ROC curve (AUC) were used to analyze the predictive ability of the model. The Hosmer-Lemeshow goodness-of-fit test was used, and a calibration curve was drawn to evaluate the calibration of the model. The decision curve analysis（DCA）was used to evaluate the clinical effectiveness. Results The incidence of myocardial damage in 390 neonates with pneumonia was 28.21%. Modeling cohort and validetion cohort, the 1min Apgar score in the myocardial damage group was lower than that in the non-myocardial damage group (t=3.314, 2.619), and CK-MB, LDH, CK, hs-cTnI, IL-2, IFN-γ, TNF-α, IL-6, IL-10 and IL-4 were higher than those in the non-myocardial damage group（t=5.805～18.914）, and the proportions of severe pneumonia，low birthweight infant， premature infants were higher than those in the non-myocardial damage group（χ2=4.464～41.497），and the differences were statistically significant (all P<0.05)，respectively. The Logistic regression equation showed that low birth weight ，1-minute Apgar score，premature birth，hs-cTnI，IL-2，IFN-γ，IL-6 and IL-4 were factors affecting neonatal pneumonia complicated with myocardial damage (Wald χ2=10.330～14.328，all P<0.05).The AUC(95%CI) of the nomogram model constructed based on the factors affecting neonatal pneumonia complicated with myocardial damage was 0.880(0.839～0.921) in the modeling cohort and 0.910(0.856～0.964) in the validation cohort, with slopes of the calibration curves close to 1, and the clinical net benefit rate was the highest in the ranges of 0.1～0.8 and 0.0～0.7. Conclusion The nomogram model, which includes Th1/Th2 cytokines, hs-cTnI, 1-minute Apgar score, premature infants and low-birth-weight infants has high predictive value for neonatal pneumonia complicated with myocardial damage. It can help clinicians identify high-risk populations, take reasonable diagnostic and treatment measures, and reduce the risk of myocardial damage.

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相似文献/References:

[1]白 石,周 卫,谷 颖.新生儿肺炎患者血清YKL-40，25(OH)D3 和HMGB1 表达水平与感染类型及病情评估的相关性研究[J].现代检验医学杂志,2022,37(06):166.[doi:10.3969/j.issn.1671-7414.2022.06.032]
　BAI Shi,ZHOU Wei,GU Ying.Correlation of Serum YKL-40, 25(OH)D3 and HMGB1 Expression Levels with Infection Types and Disease Assessment in Neonatal Pneumonia[J].Journal of Modern Laboratory Medicine,2022,37(05):166.[doi:10.3969/j.issn.1671-7414.2022.06.032]

备注/Memo

备注/Memo:
基金项目：2020年四川省医学（青年创新）科研课题（项目：S20386）。
作者简介：何秋红（1987-)，女，本科，主治医师，研究方向：发育行为儿童保健及儿内科。
通讯作者：李兴洋（1987-），男，本科，主治医师，研究方向：新生儿科，E-mail：b3105nqij@21cn.com。
更新日期/Last Update: 2025-09-15