血清PCT、PA、RBP对早期儿童脓毒血症的诊断价值及与病情严重程度的关系  

Diagnostic Value of Serum PCT,PA,RBP in Early Sepsis of Children and Their Correlations with Disease Severity

作　　者：夏巍[1] 江涛[1] 谭亚峰 李承彬[1] XIA Wei;JIANG Tao;TAN Yafeng;LI Chengbin(Department of Laboratory Medicine,Jingzhou Hospital Affiliated to Yangtze University,Jingzhou 434000,China)

机构地区：[1]长江大学附属荆州医院医学检验部,湖北荆州434000

出　　处：《医学综述》2023年第17期3531-3536,共6页Medical Recapitulate

摘　　要：目的探讨血清降钙素原(PCT)、前白蛋白(PA)、视黄醇结合蛋白(RBP)对儿童脓毒血症的诊断价值及与病情严重程度的关系。方法回顾性分析2018年1月至2021年12月长江大学附属荆州医院儿科病区收治的170例脓毒血症患儿(脓毒血症组)的临床资料,根据入院时患儿病情的严重程度分为轻症脓毒血症组(69例)和重症脓毒血症组(101例),并随机选取同期在长江大学附属荆州医院儿科病区住院治疗的170例非脓毒血症患儿作为局部感染组。比较两组患儿的一般资料和血清PCT、PA、RBP水平。采用Spearman法分析血清PCT、PA、RBP水平与脓毒血症患儿病情严重程度的相关性。采用受试者工作特征(ROC)曲线分析血清PCT、PA、RBP对重症脓毒血症的识别预测能力以及对早期脓毒血症的诊断价值。结果局部感染组与脓毒血症组性别、年龄比较差异无统计学意义(P>0.05)。脓毒血症组肺炎、化脓性脑膜炎、腹腔感染患儿占比高于局部感染组(P<0.05或P<0.01),而支气管肺炎、疱疹性咽峡炎患儿占比低于局部感染组(P<0.01),两组其他原发病类型占比比较差异无统计学意义(P>0.05)。脓毒血症组血清PCT水平高于局部感染组[2.33(0.92,10.32)μg/L比0.20(0.10,0.40)μg/L](P<0.01),PA、RBP水平低于局部感染组[(111±42)mg/L比(146±40)mg/L,15(12,18)mg/L比19(15,22)mg/L](P<0.01)。重症脓毒血症组PCT水平高于轻症脓毒血症组[5.83(1.75,18.60)μg/L比1.01(0.48,1.87)μg/L](P<0.01),而PA、RBP水平低于轻症脓毒血症组[(97±43)mg/L比(131±34)mg/L,12(10,16)mg/L比17(15,20)mg/L](P<0.01)。Spearman相关分析结果显示,血清PCT水平与脓毒血症病情严重程度呈正相关(r=0.541,P<0.001),而血清PA、RBP水平与脓毒血症病情严重程度呈负相关(r=-0.394,P<0.001;r=-0.436,P<0.001)。ROC曲线分析结果显示,血清PA、RBP、PCT三者联合检测在鉴别重症脓毒血症以及早期诊断脓毒血症方面均优于各指标单独检测(P<0Objective To explore the diagnostic value of serum procalcitonin(PCT),prealbumin(PA)and retinol binding protein(RBP)for the diagnosis value and their correlations with severity of sepsis in children.Methods The clinical data of 170 children(children in the sepsis group)with sepsis admitted to the pediatric ward of Jingzhou Hospital Affiliated to Yangtze University from Jan.2018 to Dec.2021 were analyzed retrospectively.The cases were divided into a mild sepsis group(69 cases)and a severe sepsis group(101 cases)based on their assessment of disease severity at admission.170 children with no sepsis who were hospitalized in the pediatric ward of Jingzhou Hospital affiliated to Yangtze University during the same period were randomly inlcuded as a local infection group.The general data and serum levels of PCT,PA and RBP were compared between the two groups.The Spearman method was used to analyze the correlation of serum PCT,PA,RBP,with disease severity of the septic children.Receiver operator characteristic(ROC)curve was adopted to analyze the ability of serum PA,RBP and PCT to identify and predict severe sepsis and their diagnostic value for early sepsis.Results There was no significant statistical difference in gender and age between the local infection group and the sepsis group(P>0.05).Children in the sepsis group had higher proportions of pneumonia,purulent meningitis,and abdominal infections than those in the local infection group(P<0.05 or P<0.01),while children in the sepsis group had lower proportions of bronchopneumonia and herpes pharyngitis than those in the local infection group(P<0.01).There was no significant statistical difference in the proportions of other primary diseases between the two groups(P>0.05).The serum PCT level in the sepsis group was higher than that in the local infection group[2.33(0.92,10.32)μg/L vs 0.20(0.10,0.40)μg/L](P<0.01),while the levels of PA and RBP were lower than those in the local infection group[(111±42)mg/L vs(146±40)mg/L,15(12,18)mg/L vs 19(15,22)mg/L](P<0.01).The PC

关 键 词：脓毒血症 降钙素原 前白蛋白 视黄醇结合蛋白 

分 类 号：R446.11[医药卫生—诊断学]