sCD14-ST在儿童脓毒症早期诊断中的应用  

Clinical significance of sCD14-ST in early diagnosis of children sepsis

作　　者：肖婷[1] 陈丽萍[1] 黄晓华[1] 刘辉[1] 陈媛[1] 吴定昌[1] 

机构地区：[1]福建省龙岩市第一医院福建医科大学附属龙岩第一医院检验科,364000

出　　处：《中华检验医学杂志》2016年第4期251-255,共5页Chinese Journal of Laboratory Medicine

基　　金：福建省卫生厅青年科研资助课题（2013-2-149）

摘　　要：目的探讨全血可溶性白细胞分化抗原14-亚型（sCDl4-ST）在儿童脓毒症早期诊断和疗效监测中的临床意义。方法病例对照研究。检测2013年8月至2015年3月期间福建省龙岩市第一医院儿童重症监护病房（PICU）237例脓毒症[即感染性全身炎症反应综合征（SIRS），其中细菌性SIRS120例，非细菌性SIRS117例]、89例非感染性SIRS，156名体检健康患儿sCDl4-ST、WBC、CRP、PCT、APACHE—II水平，观察脓毒症患儿治疗前后各指标动态变化情况及相关性。受试者工作曲线（ROC）分析sCDl4．ST的脓毒症诊断价值。结果脓毒症组sCDl4-ST水平[643．47（596．47—690．46）ng／L]显著高于非感染性SIRS组[246．94（234．85～259．03）ng／L]和健康对照组[151．00（142．79～159．22）ng／L]（x2=121．850、325．663，P〈0．01）。细菌性SIRS组sCDl4-ST水平[606．17（542．71—669．63）ng／L]与非细菌性SIRS组[679．83（610．37～747．29）ng,／L]比差异无统计学意义（X2=0．854，P=0．335），与健康对照组比差异有统计学意义（X。=326．228，P〈0．01）。117例细菌性SIRS中有80例血培养阳性，sCDl4-ST在革兰阳性菌组[641．07（553．82～728．31）ng／L]与革兰阴性菌组[750．00（597．10—902．89）ns／L]间差异无统计学意义（X。=1．12，P=0．29），但均明显高于健康对照组（x。=117．46、155．846，P〈0．01）；sCDl4-ST、WBC、CRP、PCT、APACHE—II评分在治疗前、后均明显下降（x1=44．569、113．337、63．986、100．055、51．015，P〈0．01），治疗前sCDl4-ST与CRP、APACHE．II评分呈显著正相关（R=0．553、0．807，P〈0．01），与WBC、PCT则无相关性（R=0．187、-0．042，P〉0．05）。脓毒症患儿sCDl4-ST的ROC曲线下面积为0．901，与WBC、CRP曲线下面积（ROC．AUC=0．875、0．836）比较，差异有统计学意义（z=-8．172、-11．398、8．625，P均〈0．01），sCDl4．ST的敏感度、特异度分�Objective To explore the clinical sepsis and monitoring the treatment effects. Methods significance of sCD14-ST in diagnosing children Case-control study. Patients were recruited by Longyan First Hospital from August 2013 to March 2015. The sCD14-ST, WBC, CRP, PCT and APACHE- I1 levels were measured in 237 septic children （infectious SIRS, including 120 bacterial and 117 nonbacterial SIRS） , 89 non-infectious SIRS and 156 healthy children. The changes and the correlation of the five indicators in septic children before and after treatment was compared~ The diagnosis value of sCD14- ST in sepsis by the receiver operationg characteristic curves （ROC） was analyzed. Results The sCD14-ST level in septic children [ 643.47 （ 596.47 - 690.46 ） ng/L ] was higher than that in non-infectious SIRS [ 246.94 （234.85 - 259~ 03 ） ng/L ] and healthy control [ 151.00 （ 142~ 79 - 159.22 ） ng/L ] （ ~2 = 121. 850, 325. 663, P 〈 0. 01 ）. The whole blood level of sCD14-ST in bacterial sepsis [ 606.17 （ 542.71 - 669.63 ） ng/L] and non-bacterial sepsis [ 679~ 83 （610~ 37 - 747.29 ） ng/L ] were no significance （ ~2 = 0. 854, P = 0. 335 ）, while compared with the control group, they had significant differences （ X2 = 326. 228, P 〈 0. 01 ） ~ Totally 80 blood culture samples were positive in 117 bacterial septic children, and the sCD14-ST level was not significant between Gram positive bacteria infection and [ 641.07 （553.82 - 728.31 ） ng/L ] Gram negative bacteria infection[ 750.00 （ 597.10 - 902.89 ） ng/L ] （ X2 = 1.12, P = 0. 29 ）, but the sCD14-ST level in blood culture positive children was significantly higher than healthy controls （chi-square = 117.46, 155. 846, P 〈 0. O1 ）. sCD14-ST, WBC, CRP, PCT, APACHE- II score before and after treatment were all significantly decreased （ X2 =44. 569, 113. 337, 63. 986, 100. 055, 51. 015, P 〈 0. 01 ）. The sCD14-ST was significantly positively related withCRP and APACHE-II score before treatment, but there were no correlation wit

关 键 词：脓毒症 儿童 全身炎症反应综合征 抗原 分化 病例对照研究 

分 类 号：R720.597[医药卫生—急诊医学]