儿童重症监护病房肿瘤相关与非肿瘤相关脓毒症的预后分析  

Clinical features and outcomes of cancer-related versus non-cancer-related sepsis in pediatric intensive care unit

作　　者：周谭丽 周益平[1] 张育才[1] 崔云[1] 王斐[1] 陈容欣[1] 戎群芳[1] 王春霞[1] Zhou Tanli;Zhou Yiping;Zhang Yucai;Cui Yun;Wang Fei;Chen Rongxin;Rong Qunfang;Wang Chunxia(Department of Critical Care Medicine,Shanghai Children's Hospital,Shanghai Jiao Tong University,Shanghai 200062,China)

机构地区：[1]上海交通大学附属儿童医院重症医学科,200062

出　　处：《中华儿科杂志》2020年第6期482-487,共6页Chinese Journal of Pediatrics

基　　金：上海交通大学医学院高峰高原学科技术项目(DLY201618);上海市科委"科技创新行动计划"项目(18411951000)。

摘　　要：目的对比分析儿童肿瘤相关与非肿瘤相关脓毒症的临床特征与预后。方法回顾性总结2016年8月至2019年7月上海交通大学附属儿童医院儿童重症监护病房(PICU)收治的768例脓毒症患儿资料,根据是否存在肿瘤性疾病,分为肿瘤相关脓毒症组(135例)与非肿瘤相关脓毒症组(633例);前者又根据肿瘤类型分为血液系统肿瘤组(80例)、实体瘤组(43例)和噬血细胞综合征组(12例)。采用t检验、非参数检验(Mann-WhitneyU检验)或χ^2检验比较组间临床特征、主要治疗措施和住院病死率差别。结果768例脓毒症患儿中,肿瘤相关脓毒症患儿135例,占17.6%。肿瘤相关脓毒症组消化道感染比例[43.0%(58/135)比28.6%(181/633),χ^2=10.718,P=0.001]、血液感染[29.6%(40/135)比17.1%(108/633),χ^2=11.297,P=0.001]、皮肤软组织感染[22.2%(30/135)比4.1%(26/633),χ^2=54.013,P<0.01]明显高于非肿瘤相关脓毒症组;肿瘤相关脓毒症组患儿入PICU后首次血红蛋白[71(61,83)比106(92,116)g/L,Z=13.594,P<0.01]、白细胞计数[1.4(0.3,5.2)比9.8(5.8,15.1)×10^9/L,Z=11.213,P<0.01]、血小板计数[51(15,121)比286(192,384)×10^9/L,Z=13.336,P<0.01]、中性粒细胞[0.449(0.170,0.730)比0.683(0.537,0.800),Z=5.974,P<0.01]和CD19^+细胞[0.106(0.008,0.274)比0.325(0.224,0.454),Z=6.555,P<0.01]明显低于非肿瘤相关脓毒症组,差异均有统计学意义;C反应蛋白[82(25,155)比36(11,86)mg/L,Z=-5.257,P<0.01]、降钙素原[1.5(0.3,12.0)比0.8(0.2,4.0)μg/L,Z=-2.767,P=0.006]、CD8^+细胞[0.329(0.253,0.514)比0.209(0.156,0.275),Z=-5.699,P<0.01]、白细胞介素(IL)-6[0.1(0.1,522.4)比0.1(0.1,0.1)ng/L,Z=-2.747,P=0.006]、IL-8[0.1(0.1,177.0)比0.1(0.1,4.5)ng/L,Z=-2.087,P=0.037]、IL-10[0.1(0.1,42.7)比0.1(0.1,6.6)ng/L,Z=-2.148,P=0.032]明显高于非肿瘤相关脓毒症患儿组,差异均有统计学意义。肿瘤相关脓毒症组需要连续性肾替代治疗(CRRT)[34.8%(47/135)比16.9%(107/633),χ^2=26.267,P<0.01]和静脉注射人免疫球蛋白[83.0%(112/135)比66.2%Objective To compare the clinical features and outcomes of cancer-related and non-cancer-related sepsis in children who were admitted pediatric intensive care unit(PICU).Methods The clinical history of patients with sepsis,who were admitted to PICU in Shanghai Children′s Hospital,Shanghai Jiao Tong University from August 2016 to July 2019,were retrospectively reviewed.A total of 768 patients were divided into the cancer-related sepsis group(135 cases)and the non-cancer-related sepsis group(633 cases).The patients in the cancer-related group were further categorized into three subgroups including hematological malignancy(80 cases),solid tumor(43 cases)and hemophagocytic lymphohistiocytosis(HLH)(12 cases).The variables of clinical features,laboratory tests,pathogens,management strategies and in-hospital mortality were compared between the two groups by student t test,Mann-Whitney U test or Chi-square test.Results The patients with cancer-related sepsis accounted for 17.6%of all patients(135/768).Regarding the site of initial infection,the incidence of gastrointestinal infection(43.0%(58/135)vs.28.6%(181/633),χ^2=10.718,P=0.001),blood stream infection(29.6%(40/135)vs.17.1%(108/633),χ^2=11.297,P=0.001)and skin and soft tissue infection(22.2%(30/135)vs.4.1%(26/633),χ^2=54.013,P<0.01)were higher in the patients with cancer-related sepsis than in those with non-cancer-related sepsis.On first PICU admission,the levels of hemoglobin(71(61,83)vs.106(92,116)g/L,Z=13.594,P<0.01),white blood cell(1.4(0.3,5.2)vs.9.8(5.8,15.1)×10^9/L,Z=11.213,P<0.01),platelet count(51(15,121)vs.286(192,384)×10^9/L,Z=13.336,P<0.01),CD19^+ cells(0.106(0.008,0.274)vs.0.325(0.224,0.454),Z=6.555,P<0.01),and neutrophil(0.449(0.170,0.730)vs.0.683(0.537,0.800),Z=5.974,P<0.01)were significantly lower in patients with cancer-related sepsis;however,the levels of C-reactive protein(82(25,155)vs.36(11,86)mg/L,Z=-5.257,P<0.01),procalcitonin(1.5(0.3,12.0)vs.0.8(0.2,4.0)μg/L,Z=-2.767,P=0.006),CD8^+ cells(0.329(0.253,0.514)vs.0.209(0.156,0.275),Z=-5.699

关 键 词：脓毒症 肿瘤 重症监护病房 儿科 

分 类 号：R720.597[医药卫生—急诊医学]