Predictive value of serum angiopoietin-like protein 4 and syndecan-1 on the outcome of neonatal respiratory distress syndrome

doi:10.3877/cma.j.issn.1674-6880.2025.01.005

Abstract

Abstract:

Objective

To investigate the expression levels of serum angiopoietin-like protein 4 （ANGPTL-4） and syndecan-1 （SDC-1） in neonatal respiratory distress syndrome （NRDS）and their value in prognostic assessment.

Methods

A total of 135 children with NRDS admitted to Hainan Hospital，Shanghai Children's Medical Center，Shanghai Jiao Tong University School of Medicine from January 2022 to March 2024 were divided into a survival group （120 cases） and a death group （15 cases） according to their survival conditions within 28 days，and 60 healthy newborns born in the same period were selected as a control group.General information and levels of serum ANGPTL-4 and SDC-1 were detected in all subjects.According to the oxygenation index （OI），the children with NRDS were divided into a mild group （44 cases，4 mmHg ≤OI ＜8 mmHg），a moderate group （60 cases，8 mmHg ≤OI ＜16 mmHg），and a severe group （31 cases，OI ≥16 mmHg）.The receiver operating characteristic （ROC） curve was drawn to analyze the value of serum ANGPTL-4 and SDC-1 levels in predicting NRDS death.Pearson correlation was used to analyze the correlation between serum ANGPTL-4 and SDC-1 levels and clinical indexes in NRDS.

Results

The levels of serum ANGPTL-4 and SDC-1 of children among three groups were statistically significantly different （F = 29.716，34.825； both P ＜0.001），and they were significantly higher in the death group than in the survival group （both P ＜0.05）.The levels of serum ANGPTL-4 and SDC-1 in the control group，mild group，moderate group，and severe group were compared，and the differences were statistically significant （F = 21.615，27.318； both P ＜0.001）； they were significantly higher in the severe group than in the mild and moderate groups （all P ＜0.05）.The ROC curve showed that the combination of ANGPTL-4（326.40 μg/L） and SDC-1 （373.18 μg/L） had the largest area under the curve （AUC）［AUC=0.938，95% confidence interval （CI）（0.879，0.991）］ for determining mortality in NRDS children，with a sensitivity of 96.8% and a specificity of 80.3%.Pearson correlation analysis showed that the levels of serum ANGPTL-4 and SDC-1 in NRDS were positively correlated with interlukin-6（IL-6）（r=0.451，0.527； P = 0.005，＜0.001），IL-17 （r = 0.736，0.815； both P ＜0.001），IL-33 （r =0.784，0.773； both P ＜0.001），acute physiology and chronic health evaluation （APACHE） II score（r = 0.704，0.682； P = 0.006，＜0.001），and score for neonatal acute physiology with perinatal extension （SNAPPE） II （r=0.663，0.718； both P ＜0.001）.

Conclusion

The increase of serum ANGPTL-4 and SDC-1 levels is related to the severity of NRDS，and has good value in predicting its prognosis.

Key words: Neonatal respiratory distress syndrome, Angiopoietin-like protein 4, Syndecan-1, Prognosis

Yiyue Zhu, Xia Li, Xiangbi Chen. Predictive value of serum angiopoietin-like protein 4 and syndecan-1 on the outcome of neonatal respiratory distress syndrome[J]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2025, 18(01): 25-30.

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组别	例数	日龄（d）	性别（例，男/ 女）	出生体质量（g）	出生时孕周（周）	白细胞计数（×10⁹ / L）
对照组	60	3.5 ± 0.6	35 / 25	3 051 ± 263	37.1 ± 1.4	6.5 ± 1.2
存活组	120	3.4 ± 0.8	74 / 46	2 947 ± 234	36.3 ± 1.2	6.7 ± 1.7
死亡组	15	3.4 ± 0.7	10 / 5	2 954 ± 369	36.7 ± 2.0	7.2 ± 2.1
F / χ ² 值		0.948	0.871	1.406	0.905	0.793
P 值		0.396	0.352	0.175	0.427	0.475
组别	例数	IL-6（ng / L）	IL-17（ng / L）	IL-33（ng / L）	ANGPTL-4（μg / L）	SDC-1（μg / L）
对照组	60	57 ± 9	16 ± 5	91 ± 15	102 ± 26	71 ± 10
存活组	120	160 ± 17^a	42 ± 10^a	240 ± 27^a	205 ± 37^a	218 ± 34^a
死亡组	15	222 ± 36^ab	86 ± 12^ab	339 ± 47^ab	459 ± 91^ab	530 ± 98^ab
F / χ ²值		12.840	16.318	14.215	29.716	34.825
P 值		＜ 0.001	＜ 0.001	＜ 0.001	＜ 0.001	＜ 0.001

组别	例数	日龄（d）	性别（例，男/ 女）	出生体质量（g）	出生时孕周（周）	白细胞计数（×10⁹ / L）
对照组	60	3.5 ± 0.6	35 / 25	3 051 ± 263	37.1 ± 1.4	6.5 ± 1.2
存活组	120	3.4 ± 0.8	74 / 46	2 947 ± 234	36.3 ± 1.2	6.7 ± 1.7
死亡组	15	3.4 ± 0.7	10 / 5	2 954 ± 369	36.7 ± 2.0	7.2 ± 2.1
F / χ ² 值		0.948	0.871	1.406	0.905	0.793
P 值		0.396	0.352	0.175	0.427	0.475
组别	例数	IL-6（ng / L）	IL-17（ng / L）	IL-33（ng / L）	ANGPTL-4（μg / L）	SDC-1（μg / L）
对照组	60	57 ± 9	16 ± 5	91 ± 15	102 ± 26	71 ± 10
存活组	120	160 ± 17^a	42 ± 10^a	240 ± 27^a	205 ± 37^a	218 ± 34^a
死亡组	15	222 ± 36^ab	86 ± 12^ab	339 ± 47^ab	459 ± 91^ab	530 ± 98^ab
F / χ ²值		12.840	16.318	14.215	29.716	34.825
P 值		＜ 0.001	＜ 0.001	＜ 0.001	＜ 0.001	＜ 0.001

组别	例数	ANGPTL-4	SDC-1
对照组	60	102 ± 26	71 ± 10
轻度组	44	190 ± 33^a	206 ± 31^a
中度组	60	316 ± 60^ab	369 ± 72^ab
重度组	31	442 ± 91^abc	502 ± 106^abc
F 值		21.615	27.318
P 值		＜ 0.001	＜ 0.001

组别	例数	ANGPTL-4	SDC-1
对照组	60	102 ± 26	71 ± 10
轻度组	44	190 ± 33^a	206 ± 31^a
中度组	60	316 ± 60^ab	369 ± 72^ab
重度组	31	442 ± 91^abc	502 ± 106^abc
F 值		21.615	27.318
P 值		＜ 0.001	＜ 0.001

项目	最佳截断值	AUC	95%CI	P 值	敏感度（%）	特异度（%）	阳性预测值（%）	阴性预测值（%）
ANGPTL-4（μg / L）	326.40	0.805	0.737 ～ 0.859	＜ 0.001	81.6	77.2	80.3	78.5
SDC-1（μg / L）	373.18	0.854	0.795 ～ 0.917	＜ 0.001	85.2	80.7	84.5	81.7
两项联合	-	0.938	0.879 ～ 0.991	＜ 0.001	96.8	80.3	85.2	92.4

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