重症肺炎合并脓毒症患儿炎症因子及凝血指标与危重症评分相关性分析  

Analysis of correlations between inflammatory cytokines,coagulation function and pediatric critical illness score in children with severe pneumonia complicated with sepsis

作　　者：杨秀霖[1] 王程毅[2] 郑启安[2] 张荣娜[3] 王世彪[2] 宋朝敏[3] 

机构地区：[1]福建医科大学医学技术与工程学院,福州350004 [2]福建省妇幼保健院儿科,福州350001 [3]福建省妇幼保健院新生儿科,福州350001

出　　处：《中国循证儿科杂志》2013年第4期300-303,共4页Chinese Journal of Evidence Based Pediatrics

基　　金：福建省省妇幼保健院院内课题:妇保院研09-23;福建省卫生厅青年科研课题立项:2013-2-13

摘　　要：目的探讨重症肺炎合并脓毒症患儿炎症因子和凝血指标与危重症评分的相关性。方法选择2010年1月至2012年11月在福建省妇幼保健院PICU入住24h以上,符合重症肺炎合并脓毒症诊断的患儿为研究对象。根据小儿危重病例评分法分为极危重组(<70分)、危重组(～80分)和非危重组(>80分)。检测炎症因子(血WBC、PLT和CRP、IL-6)和凝血指标(D-二聚体和可溶性P-选择素)水平,采用多元线性逐步回归分析炎症因子、凝血指标与危重症评分的相关性。结果 101例患儿进入分析,男47例,女54例。非危重组53例,危重组42例,极危重组6例。①随着危重症评分分值降低,IL-6、D-二聚体和可溶性P-选择素水平逐渐增高,组间两两比较差异均有统计学意义(P均<0.05);CRP水平亦随危重症评分降低而逐渐增高,在非危重组和危重组间差异有统计学意义(P<0.05);PLT计数则随危重症评分降低呈降低趋势,组间两两比较差异均有统计学意义(P均<0.05);血WBC在各组间差异均无统计学意义(P均﹥0.05)。②IL-6、可溶性P-选择素和D-二聚体水平与危重症评分呈正相关,PLT计数与危重症评分呈负相关,血WBC和CRP与危重症评分无相关性。结论 IL-6、可溶性P-选择素、D-二聚体和PLT水平与儿童重症肺炎合并脓毒症的严重程度相关。Objective To investigate the relationship of inflammatory cytokines, coagulation function and pediatric critical illness score in children with severe pneumonia complicated with sepsis. Methods From January 2010 to November 2012, the children who stayed in PICU of Fujian Provincial Maternal and Children Hospital for more than 24 h and had been diagnosed as severe pneumonia complicated with sepsis were identified. According to the pediatric critical illness score （PCIS） criteria, three groups including extremely critical group （ 〈 70 scores） ,critical group （70 - 80 scores） and non-critical group （ 〉 80 scores） were recruited, and their inflammatory cytokines and coagulation function were measured at the same time. Results A total of 101 children comprising 47 males and 54 females were enrolled, 53 children were in non-critical group, 42 children in critical group and 6 children in extremely critical group. ~ With the childreng critical condition getting worse, interleukin-6, soluble P-selectin and D-dimer levels increased, platelet count level decreased, with significant differences among three groups （ P 〈 0.05 ）. The C- reactive protein level increased with the decrease of PCIS, but with no significant difference between the extremely critical group and the critical group, but the levels were significantly lower than that in the non - critical group （ 18.3 vs 37.8 vs 46.9, P = 0. 003 ）. The white cell counts did not significantly differ from each other among three groups （ P 〉 0.05 ）. ~ In this research, there was positive correlation between interleukin-6, soluble P-selectin, D-dimer and PCIS, negative correlation between platelet count and PCIS and no correlation between white blood cell level, C-reactive protein and PCIS. Conclusions Interleukin-6, soluble P- selectin, D-dimer, platelet count may reflect the severity of severe pneumonia.

关 键 词：血液凝固障碍 重症肺炎 脓毒症 儿童 危重评分 

分 类 号：R720.597[医药卫生—急诊医学]