血清学指标水平变化对儿童软组织感染继发脓毒症的早期预测价值研究  

Study on the early predictive value of changes in serum markers in children with sepsis secondary to soft tissue infection

作　　者：任强 冯彦华 李京宴 甄磊[1] 张放[1] 田苡任 REN Qiang;FENG Yan-hua;LI Jing-yan;ZHEN Lei;ZHANG Fang;TIAN Yi-ren(Department of Orthopedics,Hebei Children's Hospital,Shijiazhuang 050000,China;Department of Emergency,the Second Hospitalof Hebei Medical University,Shijiazhuang 050000,China)

机构地区：[1]河北省儿童医院骨一科,河北石家庄050000 [2]河北医科大学第二医院急诊科,河北石家庄050000

出　　处：《河北医科大学学报》2023年第9期1058-1062,共5页Journal of Hebei Medical University

基　　金：河北省医学科学研究重点课题计划(20170394)。

摘　　要：目的探讨血清学指标C反应蛋白(C-reactive protein,CRP)、红细胞沉降率(erythrocyte sedimentation rate,ESR)、降钙素原(procalcitonin,PCT)、白细胞介素6(interleukin 6,IL-6)及D-二聚体变化对儿童软组织感染继发脓毒症的早期预测价值研究。方法选取骨科收治的软组织感染患儿138例为软组织感染组,并依据是否继发脓毒症将其分为普通感染组(99例)和脓毒症组(39例),另选择同期正常儿童68例为对照组,所有患儿均检测CRP、ESR、PCT、IL-6及D-二聚体进行比较。结果软组织感染组CRP、ESR、PCT、IL-6、D-二聚体水平均高于正常对照组(P<0.05)。普通感染组CRP、ESR、PCT、IL-6、D-二聚体水平均低脓毒症组(P<0.05)。Logistic回归分析显示,CRP≥35 mg/L、ESR≥44 mm/1 h、PCT≥0.08 g/L、IL-6≥11 pg/L、D-二聚体≥0.72 mg/L是患儿软组织感染激发脓毒症的独立危险因素。ROC曲线分析显示CRP、ESR、PCT、IL-6、D-二聚体及五项指标联合检测AUC分别为0.578、0.680、0.784、0.881、0.824、0.921,5项联合检测的AUC大于单独检测。结论CRP、ESR、PCT、IL-6、D-二聚体检测在儿童软组织感染中明显升高,是软组织感染继发脓毒症的独立危险因素;5项联合检测对预测价值更高,对继发脓毒症的诊断具有一定价值。Objective To investigate the early predictive value of serum C-reactive protein(CRP),erythrocyte sedimentation rate(ESR),procalcitonin(PCT),interleukin-6(IL-6)and D-dimer(D-D)in children with sepsis secondary to soft tissue infection.Methods In total,138 children with soft tissue infection admitted to the Department of Orthopedics were selected as the soft tissue infection group,and were divided into a common infection group(n=99)and a sepsis group(n=39)based on presence of secondary sepsis.Additionally,68 normal children during the same period were selected as the control group,and all children were tested for CRP,ESR,PCT,IL-6,and D-D for comparison.Results The levels of CRP,ESR,PCT,IL-6,and D-D in the soft tissue infection group were higher than those in the normal control group(P<0.05).The levels of CRP,ESR,PCT,IL-6,and D-D in the common infection group were all lower than those in the sepsis group(P<0.05).Logistic regression analysis showed that CRP≥35 mg/L,ESR≥44 mm/1 h,PCT≥0.08 g/L,IL-6≥11 pg/L,and D-D≥0.72 mg/L were independent risk factors for soft tissue infection-induced sepsis in children.The receiver operating characteristic(ROC)curve analysis showed that the area under the ROC curve(AUC)values of CRP,ESR,PCT,IL-6,and D-D alone and in combination were 0.578,0.680,0.784,0.881,0.824,and 0.921,respectively.The AUC values of the combined detection of five indicators were greater than those of individual detection.Conclusion The levels of CRP,ESR,PCT,IL-6 and D-D are significantly increased in children with soft tissue infection,which are independent risk factors of sepsis secondary to soft tissue infection.The combined detection of five indicators has higher value in prediction and diagnosis of secondary sepsis.

关 键 词：软组织感染 脓毒症 血清学指标 

分 类 号：R631[医药卫生—外科学]