| 摘要: |
| 目的:探讨血清脂质运载蛋白2(LCN2)、可溶性晚期糖基化终末产物受体(sRAGE)、内源性分泌型晚期糖基化终末产物受体(esRAGE)与新生儿呼吸窘迫综合征(NRDS)病情严重程度的关系。方法:选取2022 年9 月至2024 年9 月临汾市妇幼保健院收治的151 例NRDS 患儿(NRDS 组),根据病情严重程度,分为轻度组59 例、中度组50 例和重度组42 例。选取同期在我院出生的90 例健康新生儿为对照组。另选取78 例同期于我院就诊的NRDS 患儿对预测模型进行外部验证。新生儿NRDS 严重程度的影响因素采用logistic 回归分析,血清LCN2、sRAGE、esRAGE 对重度NRDS 的诊断价值以受试者工作特征(ROC)曲线表示。结果:NRDS 组剖宫产和胎膜早破占比及血清LCN2、sRAGE 水平及sRAGE/ esRAGE 比值高于对照组,esRAGE 水平低于对照组( P <0. 05)。随着病情加重,患儿血清中LCN2、sRAGE 水平、sRAGE/ esRAGE 逐渐较高,esRAGE 水平逐渐降低( P <0. 05)。与轻、中度组比较,重度组患儿剖宫产分娩比例较高(P<0. 05);血清LCN2、sRAGE、esRAGE、sRAGE/ esRAGE 均为新生儿发生重度呼吸窘迫综合征( RDS) 的危险因素( P <0. 05);LCN2、sRAGE、esRAGE、sRAGE/ esRAGE 联合诊断的曲线下面积(AUC)优于单独诊断(均P<0. 05)。预测模型在外部验证中的AUC 为0. 919,灵敏度为86. 96%,特异度为87. 27%。联合检测指标在重度RDS 高风险新生儿中具有较高的预警效能,提示该类患儿可能需更积极的肺表面活性物质替代治疗及早期呼吸支持干预。在78 例接受PS 治疗的中、重度RDS 新生儿中,根据血清LCN2、sRAGE、esRAGE 水平将其分为高风险(3 项指标均高于截断值,20 例)、中风险(1~2 项指标高于截断值,39 例)和低风险组(3 项指标均低于截断值,19 例)。高风险组PS 治疗后12、24、72 h 的氧合指数(OI)改善率均低于中、低风险组(P<0. 05),呼吸困难缓解时间及有创呼吸机使用时间亦更长(P<0. 05)。经积极治疗,106 例(70. 20%)患儿病情得以有效控制并康复出院,23 例(15. 23%)病情好转但仍需后续随访,22 例(14. 57%)因病情过重救治无效死亡。结论:NRDS 中血清LCN2、sRAGE、sRAGE/ esRAGE、esRAGE 与病情严重程度密切相关,联合检测不仅有助于早期
识别重度RDS 高风险新生儿,还可为临床早期启动肺表面活性物质治疗、优化呼吸支持策略提供参考,具有较高的临床转化价值。 |
| 关键词: 脂质运载蛋白2 可溶性晚期糖基化终末产物受体 内源性分泌型晚期糖基化终末产物受体 新生儿呼吸窘迫综合征 |
| DOI：doi:10.13407/j.cnki.jpp.1672-108X.2026.04.008 |
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| 基金项目: |
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| Value of Combined Detection of Serum Lipocalin-2, Soluble Receptor of Advanced Glycation Endproduct, Endogenous Secretory Receptor of Advanced Glycation Endproduct in Guiding Early Intervention for Neonatal Respiratory Distress Syndrome and Timing Selection for Pulmonary Surfactant Therapy |
| Rao Fei, Wang Yufeng, Zhang Xue |
| ((Linfen Maternal and Child Health Care Hospital, Shanxi Linfen 041000, China)) |
| Abstract: |
| Objective: To probe into the correlation between serum lipocalin-2 (LCN2), soluble receptor of advanced glycation endproduct (sRAGE), endogenous secretory receptor of advanced glycation endproduct (esRAGE) and severity of neonatal respiratory distress syndrome (NRDS). Methods: From Sept. 2022 to Sept. 2024, totally 151 children with NRDS admitted into Linfen Maternal and Child Health Care Hospital were extracted (NRDS group), the children were assigned into the mild group (n =59), moderate group (n =50), and severe group (n =42) based on disease severity. Meanwhile, 90 healthy neonates born in our hospital during the same period were enrolled as control group. Another 78 children with NRDS attending our hospital during the same period were selected for external validation of the prediction model. The influencing factors of severe NRDS were analyzed by using logistic regression, and the value of serum LCN2, sRAGE, and esRAGE as predictive indicators for the occurrence of severe NRDS was represented by receiver operating characteristic (ROC) curve. Results: The rates of cesarean section and premature rupture of membranes, levels of LCN2, sRAGE, and sRAGE/ esRAGE in the NRDS group were higher than those in the control group, while the level of esRAGE in the NRDS group was lower than that in the control group (P<0. 05). As the disease progressed, the levels of LCN2, sRAGE, sRAGE/ ESRAGE increased and level of esRAGE decreased in children (P <0. 05). Compared with the mild group and moderate group, the rate of cesarean section in the severe group increased (P<0. 05); serum LCN2, sRAGE, esRAGE, and sRAGE/ esRAGE were risk factors for severe respiratory distress syndrome (RDS) in neonates (P<0. 05); the area under the curve (AUC) of combined diagnosis of LCN2, sRAGE, esRAGE, and sRAGE/ esRAGE was superior to that of single diagnosis (P <0. 05). The AUC of the predictive model in external validation was 0. 919, with a sensitivity of 86. 96% and a specificity of 87. 27%. Combined detection indicators demonstrated high predictive efficacy in newborns at high risk for severe NRDS, suggesting that such infants may require more aggressive pulmonary
surfactant replacement therapy and early respiratory support interventions. A total of 78 children with moderate-to-severe NRDS receiving PS therapy were categorized into high-risk (3 indicators were higher than the cutoff value, n =20), medium-risk (1 to 2 indicators were higher than the cutoff value, n = 39), and low-risk groups (3 indicators were lower than the cutoff value, n = 19) based on levels of LCN2, sRAGE, and esRAGE. The improvement rate of oxygenation index (OI) at 12, 24, and 72 h after PS therapy in the high-risk group was lower than that in the medium-risk group and low-risk group (P<0. 05), and the time for relief of dyspnea and duration of invasive ventilation were also longer ( P < 0. 05). After active treatment, 106 cases (70. 20%) were effectively controlled and discharged, 23 cases (15. 23%) were improved but still needed follow-up, 22 cases (14. 57%) died due to severe illness. Conclusion: Serum LCN2, sRAGE, sRAGE/ esRAGE, and esRAGE are closely related to the severity of NRDS. Combined detection not only helps in the early identification of high-risk neonates with severe RDS, but provides reference for early initiation of pulmonary surfactant therapy and optimization of respiratory support strategies in clinical practice, with high clinical translational value. |
| Key words: lipocalin-2 soluble receptor of advanced glycation endproduct endogenous secretory receptor of advanced glycation endproduct neonatal respiratory distress syndrome |
