降钙素原、超敏C反应蛋白、胰石蛋白联合检测对脓毒症患儿预后的预测价值

发布时间：2019-01-03 15:43

【摘要】：目的探讨降钙素原(procalcitonin,PCT)、超敏C反应蛋白(high sensitivity C-reactive protein,hs-CRP)、胰石蛋白(pancreatic stone protein,PSP)对评估脓毒症患儿预后的价值。方法收集我院ICU收住的确诊为脓毒症的患儿106例,平均(4.4±1.6)岁。记录患儿一般情况及小儿危重病例评分(PCIS)。入院后第1天抽取静脉血,检测所有患者血清中PCT、hs-CRP、PSP的表达情况。随访28d,记录患儿生存情况。Pearson相关分析检验PCT、hs-CRP、PSP与PCIS的相关性;多因素logistic回归分析PCT、hs-CRP、PSP以及其他危险因素与脓毒症患儿预后生存(28d死亡与否)的相关性。ROC曲线分析比较PCT、hs-CRP、PSP单独或联合检测在脓毒症患儿预后评估中的价值。结果随访28d,34例患儿死亡,占整体的32.08%。相比于生存组,死亡组PCIS评分降低(P0.001);同时,死亡组患者血清中PCT、hs-CRP、PSP表达升高(P0.001)。Pearson相关分析显示PCT与PCIS呈负相关(r=-0.437 2,P0.001);hs-CRP与PCIS呈负相关(r=-0.649 7,P0.001);PSP与PCIS呈负相关(r=-0.645 3,P0.001)。多因素logistic回归结果显示,高水平PCT[标准偏回归系数(B’)=0.481,P=0.000]、hs-CRP(B’=0.392,P=0.014)、PSP(B’=0.314,P=0.041),都是脓毒症患儿28d死亡的独立危险因素。ROC曲线分析结果显示PCT、hs-CRP以及PSP曲线下面积(AUC)分别为0.86[95%可信区间(CI),0.78~0.92]、0.70(95%CI,0.61~0.79)以及0.69(95%CI,0.60~0.78)。PCT、hs-CRP和PSP三者联合(0.481×PCT+0.392×hs-CRP+0.314×PSP)检测的AUC值[0.92(95%CI,0.85~0.96)]优于单一检测PCT、hs-CRP或PSP(P0.001);联合检测值122.3时脓毒血症患儿预后好(28d生存),≥122.3时预后差(28d死亡)。结论血清PCT、hs-CRP、PSP均与PCIS呈负相关,且这3个血清学指标联合检测在评估脓毒症患儿预后时具有良好的预测价值。
[Abstract]:Objective to evaluate the prognostic value of procalcitonin (procalcitonin,PCT), hypersensitive C-reactive protein (high sensitivity C-reactive protein,hs-CRP) and pancreatic stone protein (pancreatic stone protein,PSP) in children with sepsis. Methods 106 cases of sepsis diagnosed by ICU in our hospital were collected, with an average age of (4.4 卤1.6) years. Record the general situation of children and the score of critical cases in children (PCIS). On the first day after admission, venous blood was taken to detect the expression of PCT,hs-CRP,PSP in serum of all patients. The survival status of the children was recorded for 28 days. The correlation between PCT,hs-CRP,PSP and PCIS was examined by Pearson correlation analysis. Multivariate logistic regression analysis of PCT,hs-CRP,PSP and other risk factors in children with sepsis and prognostic survival (28 days death or not). ROC curve analysis and comparison of PCT,hs-CRP, The value of PSP alone or in combination in evaluating the prognosis of children with sepsis. Results after 28 days of follow-up, 34 cases died, accounting for 32.08% of the total. Compared with the survival group, the PCIS score of the death group was lower (P0. 001), at the same time, the expression of PCT,hs-CRP,PSP in the serum of the patients with death was increased (P0. 001). Pearson correlation analysis showed that there was a negative correlation between PCT and PCIS (r = 0. 437 2 + P0. 001). There was a negative correlation between hs-CRP and PCIS (r -0.649 7); PSP and PCIS P 0.001). The results of multivariate logistic regression showed that the high level PCT [standard partial regression coefficient (B') = 0.481g P0. 000], hs-CRP (BX 0. 392), PSP (P0. 014), PSP (P0. 041), ROC curve analysis showed that PCT,hs-CRP and area under PSP curve were 0.86 [95% confidence interval (CI), 0.780.92], 0.70% (95% CI), respectively. The AUC value of PCT,hs-CRP combined with PSP (0.481 脳 PCT 0.392 脳 hs-CRP 0.314 脳 PSP) was better than that of single PCT,. Hs-CRP or PSP (P0. 001); The combined detection value 122.3 had a good prognosis (28 days survival) and a poor prognosis (28 days death) more than 122.3 days in children with sepsis. Conclusion there is a negative correlation between serum PCT,hs-CRP,PSP and PCIS, and the combined detection of these three serological markers has a good predictive value in evaluating the prognosis of children with sepsis.
【作者单位】：重庆医科大学附属儿童医院重症医学科儿童发育疾病研究教育部重点实验室儿童发育重大疾病国家国际科技合作基地儿科学重庆市重点实验室;重庆市中医院重症医学科;重庆市九龙坡区人民医院儿科;
【基金】：重庆市卫计委中医药科技项目(No.ZY201402043)资助
【分类号】：R720.597

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