目的 探讨脓毒症患儿血清降钙素原（PCT）与小儿危重病例评分（PCIS）的相关性及与预后的关系。方法 选取儿童重症监护病房脓毒症患儿61 例，按PCIS 评分标准分为非危重组（n=18）、危重组（n=20）和极危重组（n=23）。入院24 h 内检测患儿血清PCT、C 反应蛋白（CRP）、乳酸（LA）含量及血常规，比较上述指标在不同危重程度患儿中的差异；采用Pearson 相关分析检验PCT 与PCIS 及血清各指标相关性；再依据患儿的治疗结局，分为存活组（n=39）和死亡组（n=22），比较PCT、PCIS 评分及其他血清指标在不同治疗结局患儿中的差异。结果 非危重组PCT 和CRP 水平均低于危重组和极危重组（均P<0.05），且危重组PCT 和CRP 水平均低于极危重组（均P<0.05），极危重组患儿病死率（61%）显著高于危重组（35%）和非危重组（6%）（均P<0.05）；PCT 与PCIS 评分呈明显负相关（r=-0.63，P<0.001），与CRP 呈明显正相（r=0.73，P=0.003）；死亡组PCT 和LA 水平明显高于存活组（均P<0.05），而PCIS 评分明显低于存活组（P<0.05）。结论 血清PCT 和PCIS 评分具有较好的相关性，脓毒症患儿PCIS 评分越低，血清PCT 升高越明显，预后越差，两者联合是预测脓毒症患儿预后较为敏感的指标。
Abstract
Objective To investigate the correlation between serum procalcitonin (PCT) level and pediatric critical illness score (PCIS) and their prognostic values in children with sepsis. Methods Sixty-one children with sepsis in the pediatric intensive care unit were enrolled. According to PCIS, these patients were divided into non-critical (n=18), critical (n=20), and extremely critical groups (n=23). Within 24 hours after admission, serum levels of PCT, C-reactive protein (CRP), and lactic acid (LA) and routine blood counts were measured. These parameters were compared between the three groups. The Pearson correlation analysis was performed to determine the correlation of PCT with PCIS and other serological parameters. Based on clinical outcomes, these patients were divided into survival (n=39) and death groups (n=22). The PCT, PCIS, and other serological parameters were compared between the two groups. Results The serum levels of PCT and CRP in the non-critical group were significantly lower than those in critical group and extremely critical groups (P<0.05), and the two parameters were significantly lower in the critical group than in the extremely critical groups (P<0.05). The extremely critical group had a significantly higher mortality than the critical group non-critical groups (61% vs 35% and 6%, P<0.05). Serum PCT level had a significantly negative correlation with PCIS (r=-0.63, P<0.001) but a significantly positive correlation with serum CRP level (r=0.73, P=0.003). Compared with the death group, the survival group had significantly higher serum levels of PCT and LA (P<0.05) but a significantly lower PCIS (P<0.05). Conclusions There is a good correlation between serum PCT level and PCIS. For children with sepsis, the lower the PCIS, the higher the serum PCT level, resulting in a poorer prognosis. A combination of serum PCT and PCIS can be used as an early prognostic indicator in children with sepsis.
关键词
降钙素原 /
脓毒症 /
小儿危重病例评分 /
预后 /
儿童
Key words
Procalcitonin /
Sepsis /
Pediatric critical illness score /
Prognosis /
Child
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参考文献
[1] 胡亚美, 江载芳. 诸福棠实用儿科学[M]. 第7 版. 北京: 人 民卫生出版社, 2005: 2559-2567.
[2] Burn-Buisson C. The epidemiology of the systemic inflammatory response[J]. Intensive Care Med, 2000, 26 Suppl 1: S64-S74.
[3] Olaciregui I, Hernandez U, Munoz JA, et al. Markers that predict serious bacterial infection in infants under 3 months of age presenting with fever of unknown origin[J]. Arch Dis Child, 2009, 94(7): 501-505.
[4] Venkatesh B, Kennedy P, Kruger PS, et al. Changes in serum procalcitonin and C-reactive protein following antimicrobial therapy as a guide to antibiotic duration in the critically ill: a prospective evaluation[J]. Anaesth Intensive Care, 2009, 37(1): 20-26.
[5] Simon P, Milbrandt EB, Emlet LL. Procalcitonin-guided antibiotics in severe sepsis[J]. Crit Care, 2008, 12(6): 309.
[6] Nakamura A, Wada H, Ikejiri M, et al. Efficacy of procalcitonin in the early diagnosis of bacterial infections in a critical care unit[J]. Shock, 2009, 31(6): 586-591.
[7] 范江花, 祝益民, 张新萍. 脓毒症患儿低蛋白血症与CRP 及 PCT 的相关性[J]. 中国当代儿科杂志, 2010, 12(11): 870-873.
[8] 中华医学会儿科学分会急救学组, 中华医学会急诊学分会儿 科组《中华儿科杂志》编辑委员会. 儿科感染性性休克(脓 毒性休克)诊疗推荐方案[J]. 中华儿科杂志, 2006, 44(8): 596-598.
[9] 中华医学会儿科学会急救组. 小儿危重病例评分法(草案)[J]. 中华儿科杂志, 1995, 33(6): 370-373.
[10] 汪芸, 李尔珍. 降钙素原在临床的应用研究进展[J]. 实用儿 科临床杂志, 2007, 18(3): 1427.
[11] Dahaba AA, Metzler H. Procalcitonin's role in the sepsis cascade. Is procalcitonin a sepsis marker or mediator?[J]. Minerva anestesiol, 2009, 75(7-8): 447-452.
[12] Indino P, Lemarchand P, Bady P, et al. Prospective study on procalcitonin and other systemic infection markers in patients with leukocytosis[J]. Int J Infect Dis, 2008, 12(3): 319-324.
[13] Tang BM, Eslick GD, Craig JC, et al. Accuracy of procalcitonin for sepsis diagnosis in critically ill patients: systematic review and meta-analysis[J]. Lancet Infect Dis, 2007, 7(3): 210-217.
[14] 小儿危重病例评分试用协作组. 小儿危重病例法(草案) 临 床应用的评价[J]. 中华儿科杂志, 1998, 36(10): 579.
[15] Castelli GP, Pognani C, Cita M, et al. Procalcitonin, C-reactive protein, white blood cells and SOFA score in ICU: diagnosis and monitoring of sepsis[J]. Minerva Anestesiol, 2006, 72(1-2): 69-80.
[16] Suarez-Santamaria M, Santolaria F, Perez-Ramirez A, et al. Prognostic value of inflammatory markers (notably cytokines and procalcitonin), nutritional assessment, and organ function in patients with sepsis[J]. Eur Cytokine Netw, 2010, 21(1): 19-26.
[17] Giamarellos-Bourboulis EJ, Tsangaris I, Karenni T, et al. Procalcitonin as an early indicator of outcome in sepsis: a prospective observation study[J]. J Hosp Infect, 2011, 77(1): 58-63.
[18] Rey C, Los Arcos M, Concha A, et al. Procalcitonin and C-reactive protein as markers of systemic inflammatory response syndrome severity in critically ill children[J]. Intensive Care Med, 2007, 33(3): 477-484.
[19] Muller B, Harbarth S, Stolz D, et al. Diagnostic and prognostic accuracy of clinical and laboratory parameters in communityacquired pneumonia[J]. BMC Infect Dis, 2007, 7: 10.
[20] Marik PE. Definition of sepsis: not quite time to dump SIRS?[J]. Crit Care Med, 2002, 30(3): 706-708.
[21] 邢豫宾, 戴路明, 赵焕之, 等. 血清降钙素原和常用炎症指 标结合SOFA 评分对脓毒症早期诊断和预后价值的评价[J]. 中国危重病急救医学, 2008, 20(1): 23-28.
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