降钙素原评估儿童创伤严重程度和创伤后脓毒症的研究  

Procalcitonin as a Predictor of Trauma Severity and Post-traumatic Sepsis in Children

作　　者：刘少锋[1] 袁高品[2] 杨健[1] 何涛贞[1] 冯海欢[3] 刘敏[1] 

机构地区：[1]四川大学华西医院小儿外科,成都610041 [2]四川大学华西医院内分泌代谢科,成都610041 [3]四川大学华西公共卫生学院卫生统计学教研室,成都610041

出　　处：《四川大学学报（医学版）》2012年第5期706-710,共5页Journal of Sichuan University(Medical Sciences)

摘　　要：目的探讨血浆降钙素原(PCT)水平与儿童创伤严重程度和创伤后脓毒症的相关性。方法检测30例严重创伤儿童创伤后第1、2、3、4d及23例正常对照相同时点的血浆PCT、白细胞介素-6(IL-6)、C-反应蛋白(CRP)、白细胞计数(WBC)水平,计算儿童创伤评分(pediatric trauma score,PTS),统计脓毒症发生率、住院时间,分析血浆PCT的变化特征,与其他指标对临床结局的预测价值进行比较。结果与正常对照相比,30例创伤儿童血浆PCT水平均升高,23.33%(7例)患儿发生脓毒症,脓毒症组PCT水平高于全身炎症反应综合征(systemic inflammatory response syndrome,SIRS)组(7例)和非SIRS组(16例),SIRS组高于非SIRS组(P均<0.05),创伤后第2d血浆PCT水平达到峰值。儿童创伤后PCT值与创伤严重程度相关,创伤后第2d的血浆PCT值是脓毒症和SIRS的预测因素。结论创伤后儿童血浆PCT值普遍升高。创伤后第2d血浆PCT值是创伤后发生脓毒症和SIRS的独立预测因素,血浆PCT水平与儿童创伤严重程度相关。Objective To determine the association of procalcitonin （PCT） with trauma severity and post traumatic sepsis in children. Methods The blood samples of 30 children with acute trauma in a Pediatric unit were collected for four consecutive days. The levels of PCT, IL-6, CRP and WBC were measured. The pediatric trauma score （PTS）, length of stay in hospital, incidence of sepsis and clinical outcomes of the children were recorded. The value of PCT for predicting prognosis of children with trauma was compared with other inflammatory markers. Results Plasma PCT levels increased significantly in the patients in our study. Sepsis occurred in 23.33% of the patients. The patients with sepsis had higher levels of PCT than those with and without systemic inflammatory response syndrome （SIRS） and the healthy controls （P〈0. 05）. The peak level of PCT emerged on day 2 after trauma. The plasma PCT levels were positively correlated with trauma severity. The level of PCT on day 2 was an independent predictor for post-trauma sepsis and SIRS. Conclusion Plasma PCT levels increase markedly in post trauma children. Plasma PCT of day 2 after trauma is an independent predictor of post traumatic sepsis and SIRS complications. There is a significant correlation between the severity of injury and plasma PCT.

关 键 词：降钙素原 创伤 脓毒症 全身炎症反应综合征 儿童创伤评分 

分 类 号：R726.1[医药卫生—儿科]