浙江医学
浙江醫學
절강의학
ZHEJIANG MEDICAL JOURNAL
2014年
3期
187-189,197
,共4页
脓毒症%肝素结合蛋白%白细胞%C反应蛋白
膿毒癥%肝素結閤蛋白%白細胞%C反應蛋白
농독증%간소결합단백%백세포%C반응단백
Sepsis Heparin- binding protein%Leukocytes%C- reactive protein
目的研究脓毒症患儿血清肝素结合蛋白（HBP）水平的变化及意义。方法将104例发热患儿根据脓毒症分级标准分成5组：脓毒症组23例、严重脓毒症不伴休克组21例、严重脓毒症伴休克组19例、感染不伴全身炎症反应综合征（SIRS）组23例、非感染伴SIRS组18例。采用ELISA法检测患儿血清HBP水平，同时检测外周血白细胞（WBC）、C反应蛋白（CRP）水平，分别进行比较，并分析HBP与WBC的相关性；制作ROC曲线，分析并比较HBP、WBC、CRP诊断脓毒症的敏感度、特异度、阳性预测值、阴性预测值。结果血清HBP水平为严重脓毒症伴休克组＞严重脓毒症不伴休克组＞脓毒症组，感染不伴SIRS组、非感染伴SIRS组、对照组间的差异无统计学意义；脓毒症、严重脓毒症不伴休克组、严重脓毒症伴休克组的血清HBP水平与WBC水平之间均存在较强的相关性（r=0.96、0.95、0.62）；ROC曲线分析示HBP诊断脓毒症的敏感度为95.24%、特异度为98.39%，阳性预测值为98.36%，阴性预测值为95.31%，均明显高于WBC、CRP。结论检测发热患儿的血清HBP水平、分析其与外周血WBC的相关性，可以较好预测是否会发生脓毒症。
目的研究膿毒癥患兒血清肝素結閤蛋白（HBP）水平的變化及意義。方法將104例髮熱患兒根據膿毒癥分級標準分成5組：膿毒癥組23例、嚴重膿毒癥不伴休剋組21例、嚴重膿毒癥伴休剋組19例、感染不伴全身炎癥反應綜閤徵（SIRS）組23例、非感染伴SIRS組18例。採用ELISA法檢測患兒血清HBP水平，同時檢測外週血白細胞（WBC）、C反應蛋白（CRP）水平，分彆進行比較，併分析HBP與WBC的相關性；製作ROC麯線，分析併比較HBP、WBC、CRP診斷膿毒癥的敏感度、特異度、暘性預測值、陰性預測值。結果血清HBP水平為嚴重膿毒癥伴休剋組＞嚴重膿毒癥不伴休剋組＞膿毒癥組，感染不伴SIRS組、非感染伴SIRS組、對照組間的差異無統計學意義；膿毒癥、嚴重膿毒癥不伴休剋組、嚴重膿毒癥伴休剋組的血清HBP水平與WBC水平之間均存在較彊的相關性（r=0.96、0.95、0.62）；ROC麯線分析示HBP診斷膿毒癥的敏感度為95.24%、特異度為98.39%，暘性預測值為98.36%，陰性預測值為95.31%，均明顯高于WBC、CRP。結論檢測髮熱患兒的血清HBP水平、分析其與外週血WBC的相關性，可以較好預測是否會髮生膿毒癥。
목적연구농독증환인혈청간소결합단백（HBP）수평적변화급의의。방법장104례발열환인근거농독증분급표준분성5조：농독증조23례、엄중농독증불반휴극조21례、엄중농독증반휴극조19례、감염불반전신염증반응종합정（SIRS）조23례、비감염반SIRS조18례。채용ELISA법검측환인혈청HBP수평，동시검측외주혈백세포（WBC）、C반응단백（CRP）수평，분별진행비교，병분석HBP여WBC적상관성；제작ROC곡선，분석병비교HBP、WBC、CRP진단농독증적민감도、특이도、양성예측치、음성예측치。결과혈청HBP수평위엄중농독증반휴극조＞엄중농독증불반휴극조＞농독증조，감염불반SIRS조、비감염반SIRS조、대조조간적차이무통계학의의；농독증、엄중농독증불반휴극조、엄중농독증반휴극조적혈청HBP수평여WBC수평지간균존재교강적상관성（r=0.96、0.95、0.62）；ROC곡선분석시HBP진단농독증적민감도위95.24%、특이도위98.39%，양성예측치위98.36%，음성예측치위95.31%，균명현고우WBC、CRP。결론검측발열환인적혈청HBP수평、분석기여외주혈WBC적상관성，가이교호예측시부회발생농독증。
Objective To assess the diagnostic value of serum heparin- binding protein(HBP) levels in children with sep-sis. Methods One hundred and four children with fever were divided into five groups:sepsis(n=23), severe sepsis without shock (n=21), severe sepsis with shock (n=19), infection without systemic inflammatory response syndrome (SIRS, n=23), non- infection with SIRS (n=19). Two- site sandwich enzyme- linked immunosorbent assay (ELISA) was used to detect the levels of serum HBP. The levels of peripheral blood WBC, C- reactive protein (CRP) were also detected. The areas under the curve (AUC) of receiver operating characteristic (ROC) curve of HBP, WBC and CRP in diagnosing sepsis were compared. The sensitivity, specificity, positive predictive value and negative predictive value of HBP in diagnosis of sepsis were analyzed. Results The levels of serum HBP in severe sepsis with shock group(11.12±9.93ng/ml), severe sepsis without shock group(6.81±2.05ng/ml) and sep-sis group(3.93±1.65ng/ml ) were al higher than those in infection without SIRS group(1.13±0.64 ng/ml), non- infection with SIRS group (0.82±0.26ng/ml) and control group (0.86±0.18ng/ml);while there was no significant difference among three non- sepsis groups. There was strong linear correlation between the levels of serum HBP and peripheral blood WBC in children with sepsis (rsepsis group=0.96, rsevere sepsis without shock=0.95, rsevere sepsis with shock group=0.62. ROC curve analysis showed that the AUC of HBP in diagnosing sepsis (0.977) was larger than that of WBC (0.897) and CRP (0.848). Taking 2.65ng/ml as the cutoff value for diagnosis of sepsis, the sensitivity, specificity, positive predictive value and negative predictive value of HBP were 95.24%, 98.39%, 98.36% and 95.31%, respectively. Conclusion Serum HBP levels are increased in sepsis; and detection of serum HBP in children with fever is of diagnostic value for sepsis.
