败血症婴儿外周血游离肉碱和酰基肉碱水平分析  

Free carnitine and acylcarnitine levels in peripheral blood of septic infants

作　　者：查新祎 王丽[1] 陈峰[2] 韩连书[3] 钱继红[1] Zha Xinyi;Wang Li;Chen Feng;Han Lianshu;Qian Jihong(Department of Neonatology,Xinhua Hospital,School of Medicine,Shanghai Jiao Tong University,Shanghai 200092,China;Department of Clinical Laboratory,Xinhua Hospital,School of Medicine,Shanghai Jiao Tong University,Shanghai 200092,China;Department of Pediatric Endocrinology and Genetic Metabolism,Shanghai Institute for Pediatric Research,Xinhua Hospital,School of Medicine,Shanghai Jiao Tong University,Shanghai 200092,China)

机构地区：[1]上海交通大学医学院附属新华医院新生儿科,200092 [2]上海交通大学医学院附属新华医院检验科,200092 [3]上海交通大学医学院附属新华医院上海市儿科医学研究所内分泌遗传代谢病研究室,200092

出　　处：《国际儿科学杂志》2020年第10期736-740,共5页International Journal of Pediatrics

摘　　要：目的分析婴儿发生败血症时外周血中脂代谢产物游离肉碱和酰基肉碱水平,探索其在婴儿败血症中的变化及临床意义。方法收集上海交通大学医学院附属新华医院新生儿科46例住院确诊败血症患儿及同期住院的非感染患儿55例,回顾性比较两组血串联质谱游离肉碱及酰基肉碱水平,并分析其与C反应蛋白和降钙素原的相关性。对败血症患儿,根据是否有并发症分为并发症组和无并发症组,比较两组游离肉碱及酰基肉碱水平的差异。结果败血症患儿外周血中己二酰肉碱(C6DC)、肉豆蔻烯酰肉碱(C14:1)、3-羟基肉豆蔻酰肉碱(C14OH)、3-羟基棕榈酰肉碱(C16OH)水平高于非感染患儿(Z=-2.52、-2.05、-2.68、-2.82,P均<0.05),外周血中游离肉碱水平在两组中差异无统计学意义。相关性分析提示差异有统计学意义的四种酰基肉碱水平均与降钙素原水平呈正相关(r=0.44、0.44、0.40、0.49,P均<0.01)。有并发症组C16OH异常患儿的比例较无并发症组显著升高,差异有统计学意义(χ2=4.51,P<0.05)。结论败血症婴儿的部分酰基肉碱水平明显升高,且与感染的严重程度正相关,有并发症的患儿中长链酰基肉碱水平异常者比例更高,提示败血症婴儿的脂代谢发生了改变,检测血酰基肉碱水平可能有助于婴儿败血症严重程度的判断。Objective To analyze levels of carnitine and acylcarnitine in peripheral blood from septic infants and to investigate their changes and clinical values in sepsis in infants.Methods This retrospective research involved 46 septic infants and 55 infants with noninfectious diseases who were hospitalized in Xinhua Hospital,Shanghai Jiao Tong University School of Medicine.The clinical data were collected,the levels of carnitine and acylcarnitine in peripheral blood measured by tandem mass spectrometry were compared between the two groups,and the correlations of acylcarnitine levels with CRP and PCT were analyzed respectively.The septic infants were divided into two groups according to whether there were complications or not.The levels of free carnitine and acylcarnitine were compared between the two groups.Results The levels of C6DC,C14:1,C14OH and C16OH in peripheral blood were significantly higher in septic infants than those with noninfectious diseases(Z=-2.52、-2.05、-2.68、-2.82,all P<0.05).There is no significant difference in free carnitine level between two groups.These four acylcarnitine levels were positively correlated with PCT(r=0.44、0.44、0.40、0.49,all P<0.01).In septic group,the percent of infants with abnormal levels of C16OH was significantly higher in infants with complications than those without complications(χ2=4.51,P<0.05).Conclusion The peripheral blood levels of several acylcarnitine elevate in septic infants,and have positive correlations with the strength of infection.Meanwhile,there is a higher proportion of having abnormal level of long chain acylcarnitine among infants with complications than those without complications.These results suggest that lipid metabolism has changed in septic infants and detecting acylcarnitine levels can be helpful in assessing the severity of sepsis.

关 键 词：败血症 脂代谢 酰基肉碱 婴儿 

分 类 号：R722.131[医药卫生—儿科]