肺炎合并脓毒症患儿血清降钙素原水平变化的临床意义

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摘要目的分析肺炎合并脓毒症患儿血清降钙素原(PCT)水平变化的临床意义及对预后的判断价值。方法 80例肺炎合并脓毒症患儿依据病情分为肺炎合并严重脓毒症组30例(A组)、肺炎合并脓毒症50例(B组),另取普通肺炎患儿60例作为对照组(C组)。入院24 h对入组患儿进行小儿危重症评分(PCIS),检测血清PCT水平,比较3组血清PCT与PCIS水平差异,并对血清PCT与PCIS评分进行相关性分析。依据预后结局将脓毒症患儿分为存活组67例,病死组13例。依据入院24 h血清PCT水平(PCT_24h)、PCT_72h及72 h内血清PCT水平变化率[PCT_{(24h-72h)/24h}],采用受试者工作特征曲线(ROC)分析各指标对肺炎合并脓毒症患儿21 d病死率的预测价值。结果 A、B、C组入院PCT_24h逐渐降低,PCIS评分逐渐升高(P<0.05)。血清PCT与PCIS评分呈负相关(r=-0.625,P<0.05)。存活组与病死组PCT_24h水平差异无统计学意义(P>0.05),而PCT_72h及PCT_{(24h-72h)/24h}比较差异有统计学意义(P<0.05)。当PCT_24h≥8.79 ng/ml、PCT_72h≥9.36ng/ml、PCT_{(24h-72h)/24h}＜30.00%时,其预测患儿21 d病死率的敏感性较高。结论血清PCT与PCIS有相关性,动态监测血清PCT水平有助于肺炎合并严重脓毒症患儿预后判断。

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关键词 ：降钙素原, 脓毒症, 肺炎, 预后

Abstract：Objective To explore the clinical significance and prognostic value of serum procalcitonin (PCT) in pneumonia children with sepsis. Methods A total of 80 pneumonia children with sepsis were divided into severe sepsis group (group A, n=30), sepsis group (group B, n=50), and another common pneumonia group (group C, n=60). Twenty-four hours after admission, the pediatric critical illness score (PCIS) was evaluated, serum PCT was detected by double antibodies sandiwich immuno-ELISA, the PCT and PCIS were compared between the three groups, the correlation of which was analyzed. All the patients were again divided into survival group (n=67) and death group(n=13) according to prognosis. The predictive value of PCT_{24 h},PCT_{72 h} and PCT_{(72 h-24 h)/24 h} for death rate within 21 days was analyzed by ROC. Results The serum PCT of group A, B and C after admission decreased gradually, but PCIS increased gradually(P<0.05). There was negative correlation between PCT and PCIS(r=-0.625, P<0.05). There was no significant difference in PCT_24h between survival group and death group(P>0.05), but there was significant difference in PCT_72h and PCT_{(72h-24h)/24h} (P<0.05).When PCT_24hwas above8.79 ng/ml, PCT_72h above9.36 ng/ml,and PCT_{(72h-24h)/24h}was below30.00%, the sensibility was e high when predicting the death of children within 21 d. Conclusion PCT and PCIS have a significant correlation and dynamic monitoring of PCT can facilitate prognosis of pneumonia children with sepsis.

Key words： procalcitonin sepsis pneumonia prognosis

出版日期: 2016-11-02

基金资助:河北省科技厅科研课题项目(No.20151851)

引用本文:

李虹光, 徐晓军, 杨建荣, 王春明. 肺炎合并脓毒症患儿血清降钙素原水平变化的临床意义[J]. 解放军预防医学杂志, 2016, 34(5): 709-711.
LI Hongguang, XU Xiaojun, YANG Jianrong, WANG Chunming. Clinical Value of Serum Procalcitonin in Pneumonia Children with Sepsis. Journal of Preventive Medicine of Chinese People's Liberation Army, 2016, 34(5): 709-711.

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http://manu37.magtech.com.cn/Jwk_jsyxkx/jfj/CN/ 或 http://manu37.magtech.com.cn/Jwk_jsyxkx/jfj/CN/Y2016/V34/I5/709

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