| Objective:In this study,the expression levels and changes of serum keratinocyte growth factor-2(KGF-2)and pre-B cell colony enhancing factor(PBEF)in children with acute respiratory distress syndrome(ARDS)were studied.To explore the clinical value of the two in the early identification and evaluation of neonatal ARDS.Methods:1.From January 2021 to January 2023,neonates who were hospitalized in the Neonatology Department of Northern Jiangsu People’s Hospital and met mechanical ventilation were selected as the research subjects.According to the Montreux Criteria for Neonatal Acute Respiratory Distress Syndrome(2017 Edition),the newborns were divided into ARDS group and non-ARDS group.2.According to the oxygenation index(OI),the degree of oxygenation disorder and disease severity were evaluated:mild ARDS:4≤OI<8;moderate ARDS:8≤OI<16;severe ARDS:OI≥16.3.The general data of the subjects were collected:gestational age,birth weight,gender,mode of delivery,birth asphyxia,maternal risk factors,premature rupture of membranes(≥18h),number of cases of invasive ventilation,duration of oxygen inhalation,Downes score.4.The samples of the subjects were collected:1ml of peripheral blood was taken from the two groups of subjects at 24 h,3d and 7d after birth and placed in an anticoagulant tube.The centrifuge was centrifuged at 3000r/min for 10 min within 24hours.The supernatant was stored in a refrigerator at-80℃and labeled for inspection.Enzyme-linked immunosorbent assay(ELISA)was used to determine the concentration of KGF-2 and PBEF in serum and record the data.5.SPSS 26.0 statistical software was used for data processing.The normality test was used to verify whether the measurement data conformed to the normal distribution.The measurement data conforming to the normal distribution were analyzed by mean±standard deviation(x±s).Independent sample t test was used for comparison between the two groups,and single factor difference analysis was used for overall comparison within the group.Further pairwise comparison within the group,the least significant difference(LSD-t)method was used.The count data were expressed by composition ratio(%),and the groups were compared byχ~2test and continuity correctionχ~2test.The receiver operating characteristic(ROC)curve was used to analyze the early predictive efficacy of serum KGF-2 and PBEF for neonatal ARDS.The area under curve(AUC),optimal cut-off value,sensitivity and specificity were used.When AUC>0.7,the prediction accuracy was high.Pearson correlation analysis was used to analyze data correlation.P<0.05 was considered statistically significant.Results:1.A total of 54 neonates who met the inclusion criteria were collected,including31 females(57.40%)and 23 males(42.60%).There were 24 cases in ARDS group and 30 cases in non-ARDS group.There was no significant difference between the two groups in gestational age,birth weight,gender,mode of delivery,birth asphyxia,maternal risk factors,and premature rupture of membranes(P>0.05).The number of neonates with invasive ventilation,duration of oxygen inhalation and Downes score in ARDS group were higher than those in non-ARDS group(P<0.05).2.The level of serum KGF-2 in ARDS group was lower than that in non-ARDS group at 24 hours,third day and seventh day after birth,and the difference between the two groups was statistically significant(P<0.05).The level of serum KGF-2 in ARDS group was significantly different between the third day and the seventh day after birth and the 24 hours after birth(P<0.05),and the difference between the seventh day and the third day after birth was statistically significant(P<0.05).There was no significant difference in serum KGF-2 between the non-ARDS group at 24 hours,the third day and the seventh day after birth(P>0.05).3.The level of serum PBEF in ARDS group was higher than that in non-ARDS group at 24 hours,the third day and the seventh day after birth(P<0.05).The serum PBEF level of ARDS group on the third day and the seventh day after birth was significantly different from that at 24 hours after birth(P<0.05),and the difference between the seventh day and the third day after birth was statistically significant(P<0.05).There was no significant difference in serum PBEF between the non-ARDS group at 24 hours,the third day and the seventh day after birth(P>0.05).4.The AUC of serum KGF-2,PBEF and their combination in predicting ARDS at24 h after birth were 0.703,0.682 and 0.768,respectively,the sensitivity were 0.500,0.767 and 0.833,respectively,and the specificity were 0.958,0.583 and 0.625,respectively.The AUC of serum KGF-2,PBEF and their combination in predicting ARDS at 3 days after birth were 0.835,0.789 and 0.906,respectively.The sensitivity was 0.667,0.800 and 0.800,respectively,and the specificity was 0.875,0.750 and 0.875,respectively.The AUC of serum KGF-2,PBEF and the combination of the two were0.649,0.649 and 0.685,respectively.The sensitivity was 0.433,0.733 and 0.733,respectively.The specificity was 0.833,0.583 and 0.583,respectively.5.The serum KGF-2 level in the moderate to severe ARDS group was lower than that in the mild group at 24 hours,the third day and the seventh day after birth,and the difference was statistically significant(P<0.05).The serum PBEF level in the moderate and severe ARDS group was higher than that in the mild group at 24 hours,the third day and the seventh day after birth(P<0.05).6.Serum KGF-2 was negatively correlated with the severity of neonatal ARDS(r=-0.786,P<0.05).Serum PBEF was positively correlated with the severity of neonatal ARDS(r=0.793,P<0.05).Conclusions:1.Serum KGF-2 and PBEF may be involved in the occurrence and development of neonatal ARDS.2.Serum KGF-2 and PBEF have a certain predictive effect on the occurrence of neonatal ARDS at 24 hours and the third day after birth,and the efficacy of KGF-2combined with PBEF in predicting ARDS is better than that of single serum KGF-2 and PBEF,suggesting that serum KGF-2 and PBEF are helpful for the early diagnosis of neonatal ARDS,and have good sensitivity and specificity.3.The level of KGF-2 in serum of ARDS neonates decreased significantly,while the level of PBEF increased significantly,and they were negatively and positively correlated with the severity of the disease.It is suggested that serum KGF-2 and PBEF levels are also helpful to evaluate the severity of neonatal ARDS. |
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