全身炎症反应综合征患儿血小板参数及超敏C反应蛋白变化及对预后的影响  

Impact of platelet parameters and high-sensitivity C-reactive protein on the prognosis in patients with systemic inflammatory response syndrome

作　　者：胡益飞 徐怡娜[1] 

机构地区：[1]金华市中心医院检验科,浙江金华321000

出　　处：《全科医学临床与教育》2016年第2期167-170,174,共5页Clinical Education of General Practice

摘　　要：目的探讨全身炎症反应综合征（SIRS）患者血小板参数及超敏C反应蛋白（hs-CRP）变化及对预后的影响。方法选取300例SIRS患者,按照是否出现多器官功能衰竭（MODS）分为MODS组以及非MODS组,另选取同期67例经体检未发现明显异常的儿童作为对照组,观察不同组别hs-CRP以及血小板参数值的变化,采用ROC曲线分析各项指标对SIRS的诊断效能,Cox风险比例模型分析患者预后的影响因素。结果治疗5 d后,MODS组hsCRP、血小板宽度（PDW）及平均血小板体积（MPV）含量明显高于非MODS组和对照组,差异均有统计学意义（t分别=17.86、7.93、6.76、16.68、4.58、4.72,P均〈0.05）;治疗5 d后与治疗前比较,MODS组和非MODS组hs-CRP均明显降低,血小板计数（PLT）、血小板压积（PCT）明显升高,差异均有统计学意义（t分别=11.23、8.89、17.67、9.22、7.47、6.76,P均〈0.05）。随访28 d后,MODS组和非MODS组患者无1例失访。MODS组hs-CRP、PDW、MPV均高于非MODS组,PLT、PCT低于非MODS组,差异均有统计学意义（t分别=16.97、8.37、8.59、10.11、12.23,P均〈0.05）。在转归情况中,MODS组相比非MODS组,痊愈率低,死亡率高,差异均有统计学意义（χ^2分别=9.66、11.87,P均〈0.05）。Cox模型分析发现,患者出现MODS、hs-CRP、PLT、PDW、MPV以及PCT均为SIRS患者预后的危险因素。曲线ROC AUC显示,hs-CRP的AUC为0.87,高于PDW、PLT、PCT及MPV（AUC分别为0.83、0.73、0.69、0.65）。诊断准确率的结果显示hsCRP〉PDW〉PLT〉PCT〉MPV。结论 hs-CRP以及血小板参数值（PLT、PCT、PDW以及MPV）与患者预后明显相关,其对SIRS均具有较高的临床诊断价值。Objective To investigate impact of platelet parameters and high-sensitivity C-reactive protein（hs-CRP） on the prognosis in patients with systemic inflammatory response syndrome（SIRS）. Methods A total of 300 cases of SIRS were divided into MODS group and non- MODS group according to whether MODS or not. 67 healthy children as the con-trol group at the same period were selected. The hs-CRP and platelet parameters in different group were observed, diagnostic efficacy of the indicators to SIRS were analyzed by ROC curve and the factors to prognosis were analyzed by Cox proportional hazards model. Results Five days after treatment, hs-CRP, PDW and MPV of MODS group were significantly higher than the non-MODS group and control group（t =17.86,7.93,6.76,16.68,4.58,4.72,P 0.05）. After treatment, hs-CRP of MODS group and non-MODS group were significantly decreased while PLT and PCT were increased sig-nificantly（t=11.23, 8.89, 17.67, 9.22, 7.47, 6.76, P〈0.05）. No one was lost in MODS group and non-MODS group after 28 days followed-up,and hs-CRP, RDW, MPV of MODS group were higher than the non-MODS group while PLT,PCT were lower than non-MODS group, the differences were statistically significant（t=16.97,8.37,8.59,10.11,12.23,P〈0.05）. The cure rate, high mortality of MODS group were the statistically different with non-MODS group（χ~2=9.66, 11.87,P〈0.05）. Cox model analysis found that MODS, hs-CRP, PCT, PDW, MPV and PCT were the risk factors of SIRS prognosis. ROC curve showed that the AUC of hs-CRP was 0.87 which was higher than the PDW, PLT, PCT and MPV（theAUC were 0.83, 0.73, 0.69, 0.65 respectively）. The diagnostic accuracy showed that hs-CRP 〉PDW 〉PLT〉PCT〉MPV. Conclusion The hs-CRP and platelet parameter values（PLT, PCT, PDW and MPV） were significantly associated with prognosis of SIRS, which had high diagnostic value.

关 键 词：全身炎症反应综合征 超敏C反应蛋白 血小板参数值 预后 

分 类 号：R720.597[医药卫生—急诊医学]