降钙素原和淋巴细胞动态变化分层对儿童严重脓毒症死亡的预测作用  

Effect of stratified PCT and lymphocytes on the prediction of mortality in severe sepsis children

作　　者：徐梅先[1] 刘刚 曹利静[1] 白新凤 康磊[1] 赵欣[1] 石晓娜[1] 李丽景[1] Xu Mei-xian;Liu Gang;Cao Li-jing;Bai Xin-feng;Kang Lei;Zhao Xin;Shi Xiao-na;Li Li-jing(PICU of HeBei Children's Hospital,Shijiazhuang 050000,China)

机构地区：[1]河北省儿童医院重症医学科,河北石家庄050000

出　　处：《中国急救医学》2021年第9期773-778,共6页Chinese Journal of Critical Care Medicine

基　　金：河北省重点研发计划儿童脓毒症循证医学研究项目(182777133);河北省政府资助临床医学优秀人才培养项目计划(2019年)。

摘　　要：目的探讨降钙素原(PCT)和淋巴细胞动态变化分层能否预测严重脓毒症儿童死亡。方法回顾性纳入2014年1月至2020年5月间严重脓毒症患儿268例,根据初始PCT数值分层为<10μg/L、10~100μg/L、≥100μg/L三组,根据入院72 h内首次和末次淋巴细胞差值(△淋巴细胞)分层为<0×10^(9)/L、(0~0.5)×10^(9)/L、(0.5~1.5)×10^(9)/L和≥1.5×10^(9)/L四组。分别统计PCT分层和△淋巴细胞分层的基本人口学、临床特征及院内病死率,采用受试者工作特征(ROC)曲线计算PCT和△淋巴细胞预测死亡的ROC曲线下面积(AUC),并计算△淋巴细胞的截断值。结果268例患儿中PCT<10μg/L组88例,10~100μg/L组128例,≥100μg/L组52例。PCT<10μg/L组中,△淋巴细胞分层的比例依次为59.1%、18.2%、18.2%、4.5%;PCT 10~100μg/L组中的比例依次为9.4%、28.1%、15.6%、46.9%;PCT≥100μg/L组中的比例依次为23.1%、7.7%、15.4%、53.8%,总体差异有统计学意义(P=0.000)。进一步两两比较,<10μg/L组和10~100μg/L组,<10μg/L组和>100μg/L组差异有统计学意义(P=0.000、0.011)。PCT分层组和△淋巴细胞分层组各自组间统计分析提示,性别、年龄、PICU住院时间、血液净化比例、机械通气比例等差异均无统计学意义。PCT分层组院内总体病死率依次为33.3%、28.1%、30.7%(P>0.05),△淋巴细胞分层院内总体病死率依次分别为47.3%、50%、27.3%、8.7%(P=0.019)。进一步两两分析,△淋巴细胞<0×10^(9)/L组和>1.5×10^(9)/L组、(0~0.5)×10^(9)/L组和≥1.5×10^(9)/L组之间差异有统计学意义(P=0.005、0.036)。△淋巴细胞分层和淋巴细胞对死亡的AUC分别为0.717和0.752,△淋巴细胞截断值是0×10^(9)/L(准确度为76.1%,特异度为71.4%)。结论入院72 h内严重脓毒症患儿首次和末次淋巴细胞差值<0×10^(9)/L能够准确预测院内死亡。Objective To explore the effect of predicting the mortality in severe sepsis of children by using stratified procalcitonin( PCT) and lymphocytes. Methods A total of 268 cases from January 2014 to May 2020 diagnosed as severe sepsis were enrolled and were grouped as the following two methods(1)based on initial PCT values: < 10 μg/L,( 10-100) μg/L,≥100 μg/L;(2)and based on the difference between the initial and the last lymphocytic absolute value( △lymphocytes) within 72 h: < 0 ×10^(9)/L,( 0-0. 5) × 10^(9)/L,( 0. 5-1. 5) × 10^(9)/L,≥ 1. 5 × 10^(9)/L. Differences including the demography,clinical features and mortality were analyzed among these groups. The area under the ROC curve( AUC) of PCT and △lymphocytes predicting the mortality of sepsis and the cut-off value of△lymphocytes was calculated. Results The cases in each group were 88 in PCT < 10 μg/L,128 in( 10-100) μg/L,52 in PCT≥100 μg/L. The percentage of △lymphocytes < 0 × 10^(9)/L,( 0-0. 5) ×10^(9)/L,( 0. 5-1. 5) × 10^(9)/L,≥1. 5 × 10^(9)/L were 59. 1%,18. 2%,18. 2%,4. 5% in PCT < 10 μg/L group;and 9. 4%,28. 1%,15. 6%,46. 9% in( 10-100) μg/L group;23. 1%,7. 7%,15. 4%,53. 8% in PCT≥100 μg/L group( P = 0. 000). And further pairwise comparison revealed that there were significant difference between ≤10 μg/L and( 10-100) μg/L,< 10 μg/L and > 100 μg/L( P =0. 000,0. 011). There were no differences in gender,age,the length of stay in PICU,the ratio of continuous blood purification,the ratio of invasive mechanical ventilation and so on in PCT stratified group and △lymphocytes stratified groups respectively. The mortality was 33. 3%,28. 1%,30. 7% in PCT stratified groups( P > 0. 05) and 47. 3%,50%,27. 3%,8. 7% in △lymphocytes stratified groups( P =0. 019). And further pairwise comparison revealed significant differences between △lymphocytes < 0 ×10^(9)/L and > 1. 5 × 10^(9)/L,( 0-0. 5) × 10^(9)/L and ≥1. 5 × 10^(9)/L( P = 0. 005,0. 036). Area under ROC curve of △lymphocyte and lymphocytes to predict the mortality

关 键 词：降钙素原分层 △淋巴细胞分层 院内总体病死率 严重脓毒症 儿童 

分 类 号：R720.597[医药卫生—急诊医学]