Determination Of Clara Cell Secretory Protein 16 And Pulmonary Surfactant Protein D In Children With Severe Pneumonia And Its Clinical Significance

Community-acquired pneumonia is the most common cause of hospitalization in children,with high morbidity and mortality.Seriously affect children's physical and mental health.Timely diagnosis and accurate assessment of the disease and active treatment is the key to improving the prognosis of children with CAP.The incidence of pneumonia in children is not only related to its unique physiological anatomical features,but also with the pathogens causing excessive immune response after infection,When pneumonia occurs,a variety of cytokines in the body level changes,and play an important role in the development of the disease.In this study,we observed the changes of Clara cell secretory protein 16(CC16),tumor necrosis factor-?(TNF-?),interleukin-6(IL-6),and pulmonary surfactant protein D(SP-D)the difference in concentration,and dynamic changes of respiratory mechanics parameters such as Cdyn dynamic compliance(Cdyn),Peak inspiratory pressure(PIP)and Work of breathing(WOB)in children with mechanical ventilation,and compared the clinical judgment value of CC16,TNF-?,IL-6 and SP-D for severe pneumonia.To investigate the changes of serum CC16 levels in children with pneumonia and its clinical significance in order to provide a new reference for diagnosis and treatment of community-acquired pneumonia,especially severe pneumonia in children.Objective1.To investigate the changes and clinical significance of serum CC16,TNF-?,IL-6 and SP-D levels in children with different degrees of pneumonia.2.To investigate the changes of respiratory mechanics parameters and their clinical significance in Cdyn,Raw,PIP and WOB in children with mechanical ventilation of pneumonia.3.Analysis of serum CC16 concentration and TNF-?,IL-6,SP-D and Cdyn correlation.Methods81children patients with community-acquired pneumonia were selected,including severe pneumonia with mechanical ventilation group(21 cases),severe pneumonia with non-mechanical ventilation group(30 cases)and mild pneumonia group(30 cases),and the control group(20 cases)was selected in the physical examination of healthy children over the same period.We detected the concentration of serum CC16,TNF-?,IL-6 and SP-D for the 4 groups by ELISA,and evaluated the clinical values of serum CC16,TNF-?,IL-6 and SP-D for severe pneumonia by using ROC curve.We recorded pulmonary dynamic compliance(Cdyn),airway resistance(Raw),peak inspiratory pressure(PIP),work of breathing(WOB)and other respiratory mechanical parameters,and analyzed the correlations between CC16 and TNF-?,IL-6,SP-D and respiratory mechanical parameters.Results1.The concentrations of serum CC16 in pneumonia groups were all significantly lower than in the control group,and severe pneumonia groups were lower than mild pneumonia group,and mechanical ventilation group was lower than non-mechanical ventilation;the concentration of serum TNF-?,IL-6 and SP-D in pneumonia groups were all obviously higher than in the control group,and severe pneumonia groups were higher than mild pneumonia group,and mechanical ventilation group was also higher than non-mechanical ventilation group(P<0.05).2.Compared to before removing the ventilator,the concentration of serum CC16 in severe pneumonia with mechanical ventilation group decreased significantly at 1 hour and lower at 72 hours;but the concentration of serum TNF-?,IL-6 and SP-D in severe pneumonia with mechanical ventilation increased significantly at 1 hour and more higher at 72 hours,the differences were all statistically significant(all of P<0.05);3.Compared to before weaning from the ventilator,the value of Cdyn decreased obviously in severe pneumonia with mechanical ventilation at 72 hours and lower at 1 hour;but the values of Raw,PIP,WOB in severe pneumonia with mechanical ventilation increased obviously at 72 hours and more higher at 1 hour,the differences were all statistically significant(all of P<0.05).4.The concentration of serum CC16 showed all negative relations with TNF-?,IL-6 and SP-D(r=-0.714?-0.728?-0.676,all of P<0.01),but it showed positive relation with Cdyn(r=0.431,P=0.001).5.In the ROC curve,the AUC(the area under the ROC curve)of CC16,TNF-?,IL-6 and SP-D in serum was 0.905,0.704,0.832,0.825,respectively(all of P<0.01).ConclusionsThe concentrations of serum CC16 and SP-D and other factors were associated with the severity of community acquired-pneumonia in children;and the level of serum CC16 was positive associated with Cdyn in children with mechanical ventilation;CC16 has better prediction and evaluation effect on the change of severe pneumonia.