脓毒症患儿急性期血清铁、血磷、T淋巴细胞亚群水平变化及病情的相关性研究

发布时间：2018-04-30 12:42

本文选题：脓毒症 + 儿童　；参考：《昆明医科大学》2017年硕士论文

【摘要】：[目的]研究脓毒症患儿急性期血清铁、血磷、T淋巴细胞亚群水平变化特点,并探讨对脓毒症的早期预警价值,为脓毒症的早期诊断及早期干预提供理论依据。[方法]采用前瞻性的研究方法,收集2015年4月至2016年10月在昆明医科大学第二附属医院儿科住院部诊断为脓毒症的患儿35例、感染的患儿45例及同期住院的非感染患儿24例为研究对象。所有的患儿于入院后24小时内抽血,送检本院检验科,采用TPTZ法检测血清铁,磷钼酸盐法检测血磷,流式细胞仪法检测T淋巴细胞亚群,分组比较血清铁、血磷、T淋巴细胞亚群的变化。[结果]1.脓毒症组、一般感染组、非感染组年龄、性别的比较:脓毒症组、一般感染组、非感染组年龄M (P25, P75)分别为4. 0(2. 0,6. 2)岁、4. 5 (2. 3, 9. 3)岁、7. 6(3. 3,10. 9)岁,三组比较X2为5. 235,P=0. 073,差异无统计学意义(P0. 05)。性别(男%、女%)分别为 21 (60.0%)、14 (40.0%),29 (64.4%)、16 (35. 6%),11 (45.8%)、13 (54.2%),三组比较X2为2. 275, P=0. 321,差异无统计学意义(P0.05)。2.脓毒症组、一般感染组、非感染组血清铁、血磷水平的比较:脓毒症组、一般感染组、非感染组血清铁M(P25,P75)分别为2. 7(2. 0, 5. 1)、8. 8(4. 7,12. 2)、15. 8(11. 8,18. 1)umol/L,脓毒症组急性期血清铁水平明显低于一般感染组和非感染组,一般感染组患儿血清铁水平明显低于非感染组,X2值为44. 922, P=0. 000,差异有统计学意义(P0.05);血磷M (P25,P75)分别为1.49(1.29,1.61)、1. 71 (1. 56,1. 86)、1. 84 (1. 55, 1.86) mmol/L,脓毒症组急性期血磷水平明显低于一般感染组和非感染组,差异有统计学意义(P0. 05)。3.脓毒症组、一般感染组、非感染组T淋巴细胞亚群水平的比较:脓毒症组、一般感染组、非感染组 CD3 (%)分别为 59. 7(53. 7, 66. 7)、62. 9(56. 5, 69.0)、67. 8(63. 7, 71.1),CD4 (%)分别为 28. 7(24.6, 35. 3)、32. 1(27. 5, 39.2)、36.4(31.8,40.3),进行两两比较,脓毒症组CD3、CD4较非感染组明显减低,差异有统计学意义(P0. 017)。脓毒症组、一般感染组、非感染组CD8 (%)分别为 21. 4(16. 8,26. 1)、23.2(19. 6, 26. 5)、23. 5(19.6,25.95),CD4/CD8 分别为 1,34(1. 07, 1.74)、1.41(1.13,1.8)、1.58(1.27,1.81),三组间进行比较差异无统计学意义(P0. 05)。4.严重脓毒症组、普通脓毒症组血清铁、血磷水平的比较:严重脓毒症组、普通脓毒症组血清铁分别为2. 2 (1.9, 3.0)、4.3 (2. 3, 7.3) umol/L,两组比较Z为-2.197, P=0. 027,差异有统计学意义(P0. 05)。严重脓毒症组、普通脓毒症组血磷分别为1.5(1. 28,1.62)、1.48(1. 31,1. 6)mmol/L,两组比较Z为-0.066, P=0. 961,差异无统计学意义(P0. 05)。5.严重脓毒症组、普通脓毒症组T淋巴细胞亚群水平的比较:严重脓毒症组与普通脓毒症组 CD3 (%)分别为 56. 6 (49. 9, 64. 2)、61. 1 (57. 3, 70. 5), CD4(%)分别为 26. 7 (21.8,30.4)、31.9 (26. 3, 38.1),严重脓毒症组 CD3、CD4 明显低于普通脓毒症组,两组比较Z值分别为-2. 212、-2.113, P值分别为0.027、0.035,差异有统计学意义(P0. 05);严重脓毒症组、普通脓毒症组CD8 (%)分别为 22.1(19. 5, 25. 8)、21.4(16. 7,27.1), CD4/CD8 分别为 1.3(1.1,1.54)、1.4 (1.0, 2. 0),两组比较Z值分别为-0. 413和-0. 924,P值分别为0. 68和0. 369,差异无统计学意义(P0. 05)。6.血清铁、血磷、CD3、CD4四项指标单项检测及联合检测的ROC曲线分析:血清铁、血磷、CD3、CD4、联合检测预测变量PRE-1的ROC曲线下面积分别为:0. 859、0. 767、0. 638、0. 655、0. 881,均有明显统计学意义(P0. 05)。[结论]1.脓毒症患儿血清铁较一般感染患儿明显减低,对指导早期预警脓毒症有临床意义。2.血清铁减低程度与脓毒症的严重程度成正比,血清铁越低,预示着脓毒症患儿的病情越重。3.脓毒症患儿CD3、CD4较非感染患儿明显减低,可能存在感染所致的免疫抑制。4.血清铁、血磷、CD3、CD4各项检测对脓毒症均有诊断价值,联合检测优于单项检测,其中血清铁是诊断脓毒症较好的单项检测指标。
[Abstract]:[Objective] to study the changes of serum iron, blood phosphorus and T lymphocyte subsets in acute phase of children with sepsis, and to explore the early warning value of sepsis to provide theoretical basis for early diagnosis and early intervention of sepsis. [Methods] a prospective study method was used to collect the second attachment of Kunming Medical University from April 2015 to October 2016. 35 children diagnosed with sepsis were diagnosed as sepsis in the hospital department of hospital, 45 cases of infected children and 24 cases of non infected children in the same period were studied. All the children were collected from the hospital within 24 hours after admission to the hospital. The serum iron was detected by TPTZ method, phosphommolybdate method was used to test the blood phosphorus, and the flow cytometry was used to detect the T lymphocyte subgroup. The changes in serum iron, blood phosphorus and T lymphocyte subsets were compared. [results the age and sex of]1. sepsis group, general infection group, non infection group: 4 (2. 0,6. 2) years, 4.5 (2.3, 9.3) years old, 7.6 (3. 3,10. 9) years old, 7.6 (3. 3,10. 9) years, and three groups compared X2 to 5.235, P=0. 073, difference) No statistical significance (P0. 05). Sex (male, female%) were 21 (60%), 14 (40%), 29 (64.4%), 16 (35.6%), 11 (45.8%), 13 (54.2%), and the differences were compared with X2. The difference was not statistically significant (P0.05).2. sepsis group, general infection group, non infected group, serum iron, blood phosphorus levels: sepsis, general infection, non sense The serum iron M (P25, P75) was 2.7 (2, 5.1), 8.8 (4. 7,12. 2) and 15.8 (11. 8,18. 1) umol/L respectively. The serum iron level of the sepsis group was significantly lower than that of the general infection group and the non infected group. The serum iron level of the children in the general infection group was significantly lower than that in the non sensitive group, and the X2 value was 44.922, P=0. 000, and the difference was statistically significant (P0.05); the blood phosphorus M was statistically significant (P0.05). (P25, P75) were 1.49 (1.29,1.61), 1.71 (1. 56,1. 86), 1.84 (1.55, 1.86) mmol/L. The level of phosphorus in the acute phase of sepsis was significantly lower than that in the general infection group and the non infected group. The difference was statistically significant (P0. 05).3. sepsis group, the general infection group, the non infected group, and the comparison of the T lymphocyte subsets in the non infected group: the sepsis group, the general infection group, The non infected group CD3 (53.7, 66.7), 62.9 (56.5, 69), 67.8 (63.7, 71.1), and CD4 (%) were 28.7 (24.6, 35.3), 32.1 (27.5, 31.8,40.3), CD3 in sepsis group, CD4 compared with non infection group, the difference was statistically significant (P0.). The sepsis group, general infection group, non infection Group CD8 (16. 8,26. 1), 23.2 (19.6, 26.5), 23.5 (19.6,25.95), CD4/CD8 were 1,34 (1.07, 1.74), 1.41 (1.13,1.8), 1.58 (1.27,1.81). There was no statistically significant difference between the three groups (P0. 05) in.4. severe sepsis group, and the comparison of serum iron and blood phosphorus levels in common sepsis group: severe sepsis group, common sepsis. The serum iron of the disease group was 2.2 (1.9, 3), 4.3 (2.3, 7.3) umol/L, and the two group was Z -2.197, P=0. 027, the difference was statistically significant (P0. 05). The blood phosphorus in the severe sepsis group and the common sepsis group were 1.5 (1. 28,1.62), 1.48 (1. 31,1. 6) mmol/L, and the Z was -0.066, P=0., and the difference was not statistically significant (P0.) was serious pus Comparison of T lymphocyte subsets in toxic and common sepsis group: 56.6 (49.9, 64.2), 61.1 (57.3, 70.5), 26.7 (21.8,30.4), 31.9 (26.3, 38.1), 26.7 (21.8,30.4), 31.9 (26.3, 38.1) in severe sepsis and common sepsis group, 26.7 (21.8,30.4), 31.9 (26.3, 38.1), CD3 in severe sepsis group, CD4 significantly lower than that of common sepsis group, and in group two, Z values were respectively compared. The values of -2. 212, -2.113 and P were 0.027,0.035, and the difference was statistically significant (P0. 05). The CD8 (%) in the severe sepsis group and the common sepsis group were 22.1 (19.5, 25.8), 21.4 (16. 7,27.1), CD4/CD8 1.3 (1.1,1.54), 1.4 (1, 2) respectively. The Z values of the two groups were -0. 413 and -0. 924 respectively, and the differences were not statistically different. The study significance (P0. 05).6. serum iron, blood phosphorus, CD3, CD4 of the single test and the combined detection of the ROC curve analysis: serum iron, blood phosphorus, CD3, CD4, the joint detection predictive variable PRE-1 ROC curve area is: 0. 859,0. 767,0. 638,0. 881, there are significant statistical significance (05). [Conclusion serum iron of children with sepsis is more than one The lower level of serum iron reduction was proportional to the severity of sepsis, the lower the serum iron, the lower the serum iron, the lower the serum iron, the greater the severity of the disease in children with sepsis, the lower the serum iron, the lower the serum iron, the more CD3 of the children with sepsis, the lower the CD4 than the non infected children, and the possible presence of the immunosuppressed.4. serum iron caused by infection,.2.. Blood phosphorus, CD3 and CD4 are all diagnostic values for sepsis. Joint detection is better than single detection, and serum iron is a better single index for diagnosis of sepsis.

【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R720.597

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