中国小儿急救医学
中國小兒急救醫學
중국소인급구의학
CHINESE PEDIATRIC EMERGENCY MEDICINE
2014年
11期
684-688
,共5页
脓毒症%降钙素原%C-反应蛋白
膿毒癥%降鈣素原%C-反應蛋白
농독증%강개소원%C-반응단백
Sepsis%Procalcitonin%C-reactive protein
目的 研究血清降钙素原(procalcitonin,PCT)对脓毒症患儿的诊断价值和PCT在评估严重脓毒症方面的意义.方法 采用前瞻性研究,研究对象为2011年7月至2012年4月湖南省儿童医院PICU收治的脓毒症患儿125例,将其分为重症脓毒症组及脓毒症组,同时根据分泌物细菌培养结果分为细菌性脓毒症组及非细菌性脓毒症组,并将同期入住该病房的非脓毒症患儿172例作为对照组.所有入选患儿住院后进行儿童危重病例评分及感染相关性器官功能衰竭评分,采集血标本动态检测PCT,同时检测C-反应蛋白(CRP)、WBC计数、中性粒细胞比例.结果 脓毒症组及非脓毒症组PCT平均值分别为(21.31±18.27) ng/ml、(4.35 ±2.63) ng/ml,脓毒症组PCT较非脓毒症组明显增高(t=4.744,P＜0.05).脓毒症患儿PCT、CRP及WBC的ROC曲线下面积分别为:0.737(95％可信区间:0.633 ～0.840)、0.704(95％可信区间:0.610～0.799)、0.666(95％可信区间:0.554～0.778),PCT诊断严重脓毒症时的最佳临界值为10 ng/ml,此时敏感度为80.2％,特异度为82.6％.细菌感染所致脓毒症抗生素治疗第5天,临床症状好转、体温下降时,血清PCT迅速回落,而CRP、WBC在细菌感染被控制后仍维持在高水平,其回落速度慢于血清PCT.死亡组PCT水平呈持续上升趋势,PCT水平与小儿危重病例评分呈负相关(r=-0.621,P＜0.05)、与感染相关性器官功能衰竭评分呈正相关(r =0.755,P＜0.01).结论 PCT是诊断严重脓毒症及细菌性脓毒症价值较高的指标,动态监测脓毒症患儿PCT变化趋势有助于患儿疴情变化的判断,为临床医师评估病情转归提供客观依据.
目的 研究血清降鈣素原(procalcitonin,PCT)對膿毒癥患兒的診斷價值和PCT在評估嚴重膿毒癥方麵的意義.方法 採用前瞻性研究,研究對象為2011年7月至2012年4月湖南省兒童醫院PICU收治的膿毒癥患兒125例,將其分為重癥膿毒癥組及膿毒癥組,同時根據分泌物細菌培養結果分為細菌性膿毒癥組及非細菌性膿毒癥組,併將同期入住該病房的非膿毒癥患兒172例作為對照組.所有入選患兒住院後進行兒童危重病例評分及感染相關性器官功能衰竭評分,採集血標本動態檢測PCT,同時檢測C-反應蛋白(CRP)、WBC計數、中性粒細胞比例.結果 膿毒癥組及非膿毒癥組PCT平均值分彆為(21.31±18.27) ng/ml、(4.35 ±2.63) ng/ml,膿毒癥組PCT較非膿毒癥組明顯增高(t=4.744,P＜0.05).膿毒癥患兒PCT、CRP及WBC的ROC麯線下麵積分彆為:0.737(95％可信區間:0.633 ～0.840)、0.704(95％可信區間:0.610～0.799)、0.666(95％可信區間:0.554～0.778),PCT診斷嚴重膿毒癥時的最佳臨界值為10 ng/ml,此時敏感度為80.2％,特異度為82.6％.細菌感染所緻膿毒癥抗生素治療第5天,臨床癥狀好轉、體溫下降時,血清PCT迅速迴落,而CRP、WBC在細菌感染被控製後仍維持在高水平,其迴落速度慢于血清PCT.死亡組PCT水平呈持續上升趨勢,PCT水平與小兒危重病例評分呈負相關(r=-0.621,P＜0.05)、與感染相關性器官功能衰竭評分呈正相關(r =0.755,P＜0.01).結論 PCT是診斷嚴重膿毒癥及細菌性膿毒癥價值較高的指標,動態鑑測膿毒癥患兒PCT變化趨勢有助于患兒疴情變化的判斷,為臨床醫師評估病情轉歸提供客觀依據.
목적 연구혈청강개소원(procalcitonin,PCT)대농독증환인적진단개치화PCT재평고엄중농독증방면적의의.방법 채용전첨성연구,연구대상위2011년7월지2012년4월호남성인동의원PICU수치적농독증환인125례,장기분위중증농독증조급농독증조,동시근거분비물세균배양결과분위세균성농독증조급비세균성농독증조,병장동기입주해병방적비농독증환인172례작위대조조.소유입선환인주원후진행인동위중병례평분급감염상관성기관공능쇠갈평분,채집혈표본동태검측PCT,동시검측C-반응단백(CRP)、WBC계수、중성립세포비례.결과 농독증조급비농독증조PCT평균치분별위(21.31±18.27) ng/ml、(4.35 ±2.63) ng/ml,농독증조PCT교비농독증조명현증고(t=4.744,P＜0.05).농독증환인PCT、CRP급WBC적ROC곡선하면적분별위:0.737(95％가신구간:0.633 ～0.840)、0.704(95％가신구간:0.610～0.799)、0.666(95％가신구간:0.554～0.778),PCT진단엄중농독증시적최가림계치위10 ng/ml,차시민감도위80.2％,특이도위82.6％.세균감염소치농독증항생소치료제5천,림상증상호전、체온하강시,혈청PCT신속회락,이CRP、WBC재세균감염피공제후잉유지재고수평,기회락속도만우혈청PCT.사망조PCT수평정지속상승추세,PCT수평여소인위중병례평분정부상관(r=-0.621,P＜0.05)、여감염상관성기관공능쇠갈평분정정상관(r =0.755,P＜0.01).결론 PCT시진단엄중농독증급세균성농독증개치교고적지표,동태감측농독증환인PCT변화추세유조우환인아정변화적판단,위림상의사평고병정전귀제공객관의거.
Objective To research the diagnostic value of serum procalcitonin (PCT)for sepsis and bacterial infection in children,and evaluate the value of severity and prognosis evaluation by dynamic monitoring for PCT levels in children with sepsis.Methods Prospective study.From July 2011 to April 2012,297 children in PICU were divided into sepsis group(n =125)and non-sepsis group(n =172).The sepsis group were divided into severe sepsis group and non-severe sepsis group,at same time,to be divided into bacterial sepsis group and non-bacterial sepsis group.The concentrations of serum PCT,C-reactive protein (CRP),WBC,neutrophil ratio in different time periods were obtained;the pediatric critical illness scores were conducted and sepsis related organ failure assessment were evaluated,the condition of prognosis was observed.Results The level of PCT in sepsis group and non-sepsis group were (21.31 ± 18.27)ng/ml,(4.35 ± 2.63)ng/ml,respectively.PCT of sepsis group was higher than that of non-sepsis group (t =4.744,P ＜ 0.01).The area under ROC curve of PCT,CRP and WBC in sepsis group were 0.737 (95 ％ confidence interval:0.633 ～ 0.840),0.704 (95 ％ confidence interval:0.610 ～ 0.799),0.666 (95 ％ confidence interval:0.554 ～0.778),respectively.When the level of PCT was 10 ng/ml,the diagnosis of severe sepsis had critical value,with sensitivity 80.2％ and specificity 82.6％.We found that PCT rapidly increased at the early infection by dynamically observing PCT,CRP and WBC of sepsis group.Furthermore,when the infection was controlled after using the antibiotic for 5 days,PCT also quiekly came down.However,CRP,WBC remained high level after controlling the infection and they declined slower than PCT.The PCT level of the children in the dead group was significantly higher than that in the survival group.PCT showed negative correlation with pediatric critical illness score (r =-0.621,P ＜ 0.05),and positive correlation with sepsis related organ failure assessment(r =0.755,P ＜ 0.01).Conclusion PCT has important value for diagnosing severe sepsis and bacterial sepsis.Dynamic PCT monitoring is valuable in severity classification and prognosis assessment for critically ill children with sepsis,and provide guides for clinicians to adjust the antibiotic use in time.
