The Evaluation Value Of Heparin-binding Protein Levels In Bronchoaveolar Lavage Fluid For Sever Pneumonia In Children

Objective:To investigate the value of heparin-binding protein(HBP)level in alveolar lavage fluid on the prognosis of children with severe pneumonia.Methods:A cross-sectional study was conducted in 94 children with severe pneumonia in Hunan Children’s Hospital.Electronic bronchoscopy and lavage were performed within 3 days after admission.The HBP level of bronchoalveolar lavage fluid in the children was detected by enzymatic linked immunosorbent assay(ELISA).The vital signs of the children before and after 3 days of bronchoalveolar lavage were collected,as well as the etiological results of routine biochemical blood gas analysis and imaging results.According to the etiological results,the patients were divided into non-bacterial infection group and bacterial infection group,in which the bacterial infection group was further divided into the gram-negative bacterial infection group,gram-positive bacterial infection group,mixed bacterial infection group.According to JAMA’s Berlin definition of ARDS in 2012,the group was divided into non-ARDS group,mild ARDS group and moderate to severe ARDS group.According to the range of pulmonary infection shown in chest imaging results and whether fluid and pneumothorax were combined,the patients were divided into mild lung injury group,moderate lung injury group and severe lung injury group.SPSS18.0 was used to process the experimental data and compare the differences between each group.Receivers operating characteristic curve(ROC curve)was drawn,the area under the curve was calculated and the optimal truncation value was determined.The specificity sensitivity of HBP was calculated using P<0.05 was considered statistically significant.Results:The HBP level of BALF in the bacterial infection group was significantly higher than that in the non-bacterial infection group,which were 20.77 ng/ml(5.90 ng/ml,73.50 ng/ml),5.9 ng/ml(5.90 ng/ml,7.64ng/ml)(P<0.05).The HBP level of BALF in the moderate to severe ARDS group was significantly higher than that in the non-ARDS group and the mild ARDS group,respectively,300 ng/ml(169.29ng/ml,300ng/ml),11.90 ng/ml(5.90 ng/ml,36.95 ng/ml),15.13 ng/ml(7.41 ng/ml,46.44 ng/ml)(P<0.05).The HBP level of BALF was significantly higher in the imaging severe lung injury group than in the mild lung injury group and the moderate lung injury group,which were 55.02ng/ml(12.05 ng/ml,125.48 ng/ml),7.41(5.90 ng/ml,40.64ng/ml),12.59 ng/ml(5.90 ng/ml,36.73 ng/ml)(P<0.05).In the analysis of predicting the presence of bacterial infection in severe pneumonia,the area under the curve of BALF HBP,serum PCT,and serum CRP are respectively: 0.758,0.737,and 0.732.When the BALF HBP,serum PCT,and serum CRP are the best When the cutoff value is 8.4ng/ml,0.16ng/ml,8.39mg/dl,the prediction sensitivity is 70.7%,69.3%,46.7%,and the prediction specificity is 79.0%,79.0%,94.7%,respectively.Conclusions: The judgment of early pathogenic bacteria and the degree of lung damage is very important for the treatment and prognosis of severe pneumonia in children.In this study,we selected the expression level of HBP in BALF to verify its evaluation role in severe pneumonia.The results show that the HBP level of BALF can be used as one of the detection indicators for the presence of bacterial infection in the lungs,and can also be used as an important predictor of the degree of lung injury.