CAJ | 학술논문

目的：探讨危重症疾病患儿血液P-选择素和E-选择素的变化，及其与病情严重程度和预后的关系。方法前瞻性研究，对象为2012年9月至2013年3月上海交通大学附属儿童医院PICU收治的42例危重患儿（危重症组），入院24 h内留取首份血液标本；选择同期42例儿童体检残血样本作为对照组。采用儿童危重评分（PCIS评分）和PRISMⅢ评分评估病情的危重程度；双抗体夹心酶联免疫（ABC-ELISA）法测定血清中P-选择素和E-选择素浓度。结果对照组儿童血清P/E-选择素质量浓度分别为（37.23±8.99）ng/mL和（36.24±17.82）ng/mL；危重症组儿童血清P/E-选择素质量浓度分别为（107.24±35.53）ng/mL和（114.93±40.17）ng/mL，与对照组P/E-选择素质量浓度的差异均具有统计学意义（P＝0.000）。重症患儿急性期与恢复期P-选择素和E选择素差异具有统计学意义（P＝0.000）；P-选择素浓度和E-选择素与PCIS评分呈负相关（分别为r＝-0.673，P＝0.000；r＝-0.548，P＝0.000）；PRISMⅢ≥10组血清P-选择素和E-选择素明显高于PRISMⅢ＜10组（P＝0.003，P＝0.014）。危重症患儿中，死亡组患儿P-选择素和E-选择素水平明显高于存活组患儿（分别为P＝0.003；P＝0.000）；严重脓毒症患儿血清P-选择素和E-选择素高于非感染性疾病组（分别为P＝0.04；P＝0.025）。结论危重病患儿血液中P-选择素和E-选择素的变化与病情严重度及预后密切相关，血液P-选择素和E-选择素的变化对评估严重程度及判断预后提供依据。
목적：탐토위중증질병환인혈액P-선택소화E-선택소적변화，급기여병정엄중정도화예후적관계。방법전첨성연구，대상위2012년9월지2013년3월상해교통대학부속인동의원PICU수치적42례위중환인（위중증조），입원24 h내류취수빈혈액표본；선택동기42례인동체검잔혈양본작위대조조。채용인동위중평분（PCIS평분）화PRISMⅢ평분평고병정적위중정도；쌍항체협심매련면역（ABC-ELISA）법측정혈청중P-선택소화E-선택소농도。결과대조조인동혈청P/E-선택소질량농도분별위（37.23±8.99）ng/mL화（36.24±17.82）ng/mL；위중증조인동혈청P/E-선택소질량농도분별위（107.24±35.53）ng/mL화（114.93±40.17）ng/mL，여대조조P/E-선택소질량농도적차이균구유통계학의의（P＝0.000）。중증환인급성기여회복기P-선택소화E선택소차이구유통계학의의（P＝0.000）；P-선택소농도화E-선택소여PCIS평분정부상관（분별위r＝-0.673，P＝0.000；r＝-0.548，P＝0.000）；PRISMⅢ≥10조혈청P-선택소화E-선택소명현고우PRISMⅢ＜10조（P＝0.003，P＝0.014）。위중증환인중，사망조환인P-선택소화E-선택소수평명현고우존활조환인（분별위P＝0.003；P＝0.000）；엄중농독증환인혈청P-선택소화E-선택소고우비감염성질병조（분별위P＝0.04；P＝0.025）。결론위중병환인혈액중P-선택소화E-선택소적변화여병정엄중도급예후밀절상관，혈액P-선택소화E-선택소적변화대평고엄중정도급판단예후제공의거。
Objective To study the changes of P-selectin and E-selectin in pediatric patients with critical illness ,and analyze their relationship with the severity and prognosis of diseases.Methods Forprospective study,42 critically ill patients admitted in pediatric intensive care unit (PICU ) from September,2012 to March,2013 as critically ill group were enrolled,and blood specimens were collected with 24 hours after admission.Another 42 cases blood samples were collected from children's physical examination as control group.The severity of the critically ill patients were evaluated by Pediatric Critical illness Score (PICS)and Pediatric risk of score mortality (PRISM)-III.The levels of serum P-selectin and serum E-selectin were measured by double antibody sandwich enzyme-linked immunoassay (ABC-ELISA). Results P-selectin and E-selectin in control group children and critically ill patients group were (37.23 ± 8.99)ng/mL,(36.24 ±17.82)ng/mL,and (107.24 ±35.53)ng/mL,(114.93 ±40.17)ng/mL, respectively.There were statistical differences between two groups (P=0.000).The levels of P-selectin and E-selectin in acute phase were higher than that of levels in recovery phase in critically ill group (P =0.000).Negative correlation was observed between P-selectin concentration and the PCIS score (r =-0.673,P=0.000),as well as E-selectin (r=-0.548,P=0.000).P-selectin level and E-selectin level based upon PRISMⅢ≥10 group were significantly higher than they in PRISMⅢ <10 group (P=0.003,P=0.014).In critically ill children,the differences in P-selectin,E-selectin were significant higher in death patients (P=0.003;P =0.000).Compared with the non-sepsis illness group,the level of P-selectin and E-selectin in the severe sepsis patients were significantly higher (P =0.04,P =0.025 ). Conclusions The levels of P-selectin and E-selectin are closely related to the severity and prognosis in critically ill children.Measuring the level of P-selectin and E-selectin could be used as a judegment the severity and to understand pathological physiological process.