PBEF与儿童急性呼吸窘迫综合征、噬血细胞综合征的临床相关性

发布时间：2018-01-04 20:23

本文关键词：PBEF与儿童急性呼吸窘迫综合征、噬血细胞综合征的临床相关性　出处：《广西医科大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的：探讨血浆前B细胞集落刺激因子（pre-B cell colony-stimulatingfactor, PBEF）水平与儿童急性呼吸窘迫综合征（acute respiratory distresssyndrome, ARDS）的临床相关性。方法：1、收集入住我院PICU的ARDS患儿及健康儿童的血浆及相关临床资料。2、评定ARDS患儿的PIM2及PRISM评分。3、使用ELISA法检测ARDS患儿及健康儿童血浆PBEF浓度。4、应用相应统计学方法分析比较PBEF水平与相关临床指标的相关性。结果：1、本研究共收集了59例ARDS患儿及20例健康儿童的血浆及相关临床资料。59例ARDS患儿中，幸存患儿46例，死亡患儿13例。2、死亡患儿PIM2评分及PRISM评分高于幸存患儿（P＜0.001；P=0.044）。3、ARDS患儿血浆PBEF浓度显著高于健康儿童［10.74ng/m（lIQR：5.84-18.81ng/ml）VS6.72ng/ml（IQR：5.18-8.73ng/ml）；P=0.017］。ARDS死亡患儿血浆PBEF水平显著高于幸存患儿［21.55ng/ml（IQR：13.24-23.71ng/ml）VS8.41ng/ml（IQR：5.02-12.23ng/ml）；P=0.002］。4、血浆PBEF水平与WBC（r=0.236，，P=0.036）、Neu（r=0.294，P=0.009）呈正相关。血浆PBEF水平与PIM2评分、PRISM评分之间无明显相关性（P均＞0.05）。结论：ARDS患儿血浆PBEF水平显著升高，死亡患儿血浆PBEF水平明显高于幸存患儿，提示PBEF可能是诊断儿童ARDS及判断ARDS患儿预后的生物标志物；但血浆PBEF水平与PIM2评分、PRISM评分之间无明显相关性，提示PBEF帮助判断ARDS患儿预后的效价仍有待进一步研究。目的：探讨血清前B细胞集落刺激因子（pre-B cell colony-stimulatingfactor, PBEF）水平与噬血细胞综合征（hemophagocytic syndrome, HPS）的临床相关性。方法：1、分别收集我院确诊为HPS患儿不同疾病阶段的血清标本，并收集与患儿年龄、性别、BMI相匹配的健康儿童血清标本；收集临床诊断为脓毒症，急性淋巴细胞性白血病（acute lymphoblastic leukemia, ALL）患儿的血清标本；收集以上所有研究对象的相关临床资料。2、分组：将以上研究对象分为：HPS治疗前组、HPS治疗有效组、HPS死亡组、健康儿童组、脓毒症组及ALL组。3、使用ELISA法检测以上血清标本的PBEF水平。4、应用相应统计学方法比较各组血清PBEF水平，并分析血清PBEF水平与HPS的临床相关性。结果：1、HPS治疗前组血清PBEF水平明显高于健康儿童组［33.78ng/ml（IQR：10.28-63.40ng/ml）VS5.37ng/ml（IQR：4.84-6.38ng/ml）；P=0.003］。2、HPS治疗前组血清PBEF水平明显高于脓毒症组（8.36ng/ml，IQR：4.00-13.01ng/ml）及ALL组（5.75ng/ml，IQR：4.71-7.34ng/ml），差异均有统计学意义（P=0.01，P=0.004）；脓毒症组、ALL组与健康儿童组血清PBEF水平差异无统计学意义（P＞0.05）。3、HPS治疗前组血清PBEF水平（33.78ng/ml，IQR：10.28-63.40ng/ml）明显高于HPS治疗有效组（5.87ng/ml，IQR：4.14-7.75ng/ml）（P=0.001）；HPS治疗前组与HPS死亡组（95.24ng/ml, IQR:16.76-211.82ng/ml）血清PBEF水平差异无统计学意义（P=0.328）；HPS治疗有效组（5.87ng/ml, IQR:4.14-7.75ng/ml）与健康儿童组（5.37ng/ml，IQR:4.84-6.38ng/ml）血清PBEF水平差异无统计学意义（P=0.550）；HPS死亡组血清PBEF水平明显高于HPS治疗有效组及健康儿童组（P=0.004，P=0.001）。4、PBEF与体温（r=0.343，P=0.004）、SF（r=0.651，P=0.001）呈正相关。结论：1、与健康儿童、脓毒症及ALL患儿相比，HPS患儿治疗前血清PBEF水平均明显升高，提示检测PBEF水平可能有助于HPS的诊断和鉴别诊断。2、HPS患儿有效治疗后血清PBEF水平降至正常，而死亡患儿PBEF水平依然处于较高水平，提示PBEF与HPS疾病活性相关，有可能成为HPS的预后指标；HPS患儿治疗过程中，若其血清PBEF水平无明显降低时，应警惕患儿病情是否未得到控制或恶化。
[Abstract]:Objective: To investigate the clinical correlation between plasma B pre-B cell Colony-StimulatingFactor (PBEF) level and acute respiratory distresssyndrome (ARDS) in children.
Methods: 1 patients with ARDS and healthy children were collected in our hospital PICU plasma and clinical data of.2, PIM2 and PRISM ARDS were assessed using.3 score, ELISA was detected with ARDS and healthy children in the plasma concentration of PBEF and.4, application of appropriate statistical methods to analyze the correlation between PBEF level and related clinical indicators.
Results: 1, this study collected a total of 59 cases of ARDS and 20 cases of healthy children in plasma and clinical data of.59 patients with ARDS, 46 patients survived, 13 cases were dead.2, death with PIM2 score and PRISM score was higher than that of surviving patients (P < 0.001;.3, P=0.044) ARDS children plasma the concentration of PBEF was significantly higher than that of healthy children 10.74ng/m (lIQR:5.84-18.81ng/ml) VS6.72ng/ml (IQR:5.18-8.73ng/ml); plasma PBEF level in P=0.017 patients was significantly higher than that of the children who survived.ARDS death 21.55ng/ml (IQR:13.24-23.71ng/ml) VS8.41ng/ml (IQR:5.02-12.23ng /ml); P=0.002.4, plasma PBEF level and WBC (r=0.236, P=0.036), Neu (r=0.294, P=0.009) were positively related to plasma. The level of PBEF and PIM2 scores, no significant correlation between PRISM scores (P < 0.05).
Conclusion: the level of PBEF in plasma of patients with ARDS significantly increased the plasma level of PBEF was significantly higher than that with the death of the children who survived, suggesting that PBEF may be a diagnosis of children ARDS and ARDS children to determine prognosis biomarkers; but the level of plasma PBEF and PIM2 score, PRISM score had no significant correlation between, suggesting that PBEF help to judge the prognosis of ARDS remains to be. Further study.
Objective: To investigate the clinical correlation between serum B pre-B cell Colony-StimulatingFactor (PBEF) level and hemophagocytic syndrome (HPS).
Methods: 1 patients in our hospital were collected for serum samples of HPS patients in different stages of disease, gender and age of the patients were collected, and BMI matched healthy children serum samples collected; clinical diagnosis of sepsis, acute lymphoblastic leukemia (acute lymphoblastic, leukemia, ALL) of serum samples were collected from all of the above studies; the clinical data of.2, grouping: the above research object is divided into: before HPS treatment group, HPS treatment group, HPS death group, healthy children group, sepsis group and ALL group.3, using ELISA method to detect serum PBEF levels above.4, serum PBEF levels were compared using the corresponding statistical method clinical relevance, and analysis of the serum level of PBEF and HPS.
Results: 1, HPS group before the treatment, the serum level of PBEF was significantly higher than that of healthy children in group 33.78ng/ml (IQR:10.28-63.40ng/ml) VS5.37ng/ml (IQR:4.84-6.38ng/ml); P=0.003.2, HPS group before the treatment, the serum level of PBEF was significantly higher than that in sepsis group (8.36ng/ml, IQR:4.00-13.01ng/ml) and ALL group (5.75ng/ml, IQR:4.71-7.34ng/ml), the differences were statistically significant (P=0.01. P=0.004); sepsis group, there was no significant difference between ALL group and the group of healthy children serum PBEF levels (P > 0.05).3, HPS group before the treatment, the serum level of PBEF (33.78ng/ml, IQR:, 10.28-63.40ng/ml) was significantly higher than that of HPS treatment group (5.87ng/ml, IQR:4.14-7.75ng/ml) (P=0.001); HPS group and HPS group before the treatment of death (95.24ng/ml, IQR:16.76-211.82ng/ml) had no significant difference between the serum level of PBEF (P=0.328); HPS treatment group (5.87ng /ml, IQR:4.14-7.75ng/ml (5.3) and the group of healthy children There was no significant difference in serum PBEF level between 7ng/ml and IQR:4.84-6.38ng/ml (P=0.550); the serum PBEF level in HPS death group was significantly higher than that in HPS treatment group and healthy children group (P=0.004, P=0.001).4, and there was a positive correlation between PBEF and body temperature (P=0.001).
Conclusion: 1, compared with healthy children, sepsis and ALL patients, HPS patients before treatment serum PBEF levels were significantly increased, suggesting that.2 diagnosis and differential diagnosis to detect the level of PBEF may contribute to HPS, effective treatment of HPS patients after serum PBEF level decreased to normal, and death PBEF levels were still at high level. The results indicated that the activity of PBEF and HPS related diseases, may become a prognostic marker in HPS patients treated with HPS; in the process, if the serum level of PBEF had no significant decrease, should be alert to whether children with the disease has not been controlled or worse.

【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R725.6

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