Jiang Feifei, Sun Lipeng
Department of Neonatology, Xiamen Humanity Maternity Hospital Xiamen 361006, Fujian, China.
Department of Neonatology, Bozhou People's Hospital Bozhou 236800, Anhui, China.
Am J Transl Res. 2025 May 15;17(5):3424-3434. doi: 10.62347/ZNNV1969. eCollection 2025.
This study aimed to investigate the relationships between Krüppel-like factor 2 (KLF2), YKL-40, and vitamin A levels, as well as their association with the severity and prognosis of Neonatal Respiratory Distress Syndrome (NRDS), with the goal of improving predictive accuracy and clinical management.
A retrospective cohort study was conducted at Bozhou Municipal People's Hospital between January 2019 and January 2022. A total of 128 neonates diagnosed with NRDS were included, along with 128 healthy neonates as controls. Blood samples were collected within one hour of admission. Levels of KLF2, YKL-40, and vitamin A were measured using enzyme-linked immunosorbent assay (ELISA) and high-performance liquid chromatography (HPLC). Neonates were grouped based on NRDS severity, and the relationships between biomarker levels and clinical outcomes were analyzed.
Significant differences in KLF2, YKL-40, and vitamin A levels were observed between the NRDS group and control group ( < 0.001). Elevated KLF2 and YKL-40 levels were strongly correlated with more severe disease, while lower vitamin A levels were associated with worse outcomes. Multivariate logistic regression identified KLF2, YKL-40, and vitamin A levels as independent predictors of NRDS severity ( < 0.05). The nomogram achieved a concordance index (C-index) of 0.93 (95% CI: 0.89-0.97), indicating excellent discrimination of different disease severity. Receiver's operating characteristic (ROC) curve analysis showed that combining these biomarkers improved the prediction of NRDS severity, with the joint model achieving an AUC of 0.95, sensitivity of 91.2%, and specificity of 90.1%.
KLF2, YKL-40, and vitamin A are significant biomarkers for predicting the severity and prognosis of NRDS. Combining these biomarkers enhances predictive accuracy, aiding in the early identification and personalized management of neonates with NRDS.
本研究旨在探讨Krüppel样因子2（KLF2）、YKL-40和维生素A水平之间的关系，以及它们与新生儿呼吸窘迫综合征（NRDS）严重程度和预后的关联，以提高预测准确性和临床管理水平。
2019年1月至2022年1月在亳州市人民医院进行了一项回顾性队列研究。共纳入128例诊断为NRDS的新生儿，以及128例健康新生儿作为对照。入院后1小时内采集血样。采用酶联免疫吸附测定（ELISA）和高效液相色谱法（HPLC）检测KLF2、YKL-40和维生素A水平。根据NRDS严重程度对新生儿进行分组，并分析生物标志物水平与临床结局之间的关系。
NRDS组与对照组之间KLF2、YKL-40和维生素A水平存在显著差异（<0.001）。KLF2和YKL-40水平升高与病情更严重密切相关，而维生素A水平降低与预后较差相关。多因素逻辑回归确定KLF2、YKL-40和维生素A水平是NRDS严重程度的独立预测因素（<0.05）。列线图的一致性指数（C指数）为0.93（95%CI：0.89-0.97），表明对不同疾病严重程度具有出色的区分能力。受试者操作特征（ROC）曲线分析表明，联合这些生物标志物可提高对NRDS严重程度的预测，联合模型的曲线下面积（AUC）为0.95，敏感性为91.2%，特异性为90.1%。
KLF2、YKL-40和维生素A是预测NRDS严重程度和预后的重要生物标志物。联合这些生物标志物可提高预测准确性，有助于早期识别和对NRDS新生儿进行个性化管理。
