降钙素原水平与小儿重症细菌感染性疾病死亡率关系

The relation between procalcitonin level and mortality in children with severe bacterial infection

目的 :探讨降钙素原 (procalcitonin ,PCT)与小儿重症细菌感染性疾病死亡率的关系。方法 :运用放射免疫荧光法 ,对 73例重症细菌感染患儿 (其中化脓性脑膜炎 2 6例、感染性休克 19例、败血症 2 8例 )及 2 0例正常对照组儿童分别在入院当日及第 3d进行了PCT的测定。结果 :入院当日PCT测定值大于正常组 10 0倍以上的患儿 30例 ,死亡率为 2 0 0 % (6 /30 ) ;而PCT测定值小于正常组 10 0倍的患儿 4 3例 ,死亡率为 2 3% (1/4 3) ,两者比较 ,差异有显著性 (P <0 0 5 )。治疗第 3dPCT测定值大于正常组 10 0倍以上的患儿 5例 ,死亡率 80 0 % (4 / 5 ) ,PCT测定值小于正常组 10 0倍的患儿 6 7例 ,死亡率 1 5 % (1/ 6 7) ,两者比较 ,差异有极显著性 (P <0 0 1)。另外观察组入院当日PCT测定值大于正常组 10 0倍以上患儿的死亡率与第 3dPCT测定值大于正常组 10 0倍以上患儿的死亡率相比 ,差异有显著性意义 (P <0 0 5 ) ;而入院当日PCT测定值小于正常组 10 0倍患儿的死亡率与第 3dPCT测定值小于正常组 10 0倍患儿的死亡率相比 ,差异无显著性意义 (P >0 0 5 )。结论 :对重症细菌感染患儿进行血清PCT的监测 ,对判断患儿预后、及时调整治疗方案有很好的指导作用。

Objective:To explore the relation between procalcitonin(PCT)and mortality in children with severe bacterial infection(SBI).Methods:On the admission day and the third treatment day,immunoradiometric assay was used to measure the serum PCT level in 73 children with SBI(26 with bacterial meningitis,19 with septic shock and 28 with sepsis);meanwhile,20 healthy children were as control.Results:On the admission day,compared with that in control group,the PCT levels in 30 patients were higher by 100 times and in 43 patients were lower by 100 times,and on the third treatment day,the PCT levels in 5 patients were higher by 100 times than normal and in 67 patients were lower by 100 times than normal,and the mortality was 80.0%(4/5)and 1.5%(1/67),respectively.There was significant difference of the mortality in patients whose PCT levels were higher by 100 times than normal between the admission day and the third treatment day(P<0.05)but there was no significant difference of the mortality in patients whose PCT levels were lower than normal between the admission day and the third treatment day(P>0.05).Conclusion:PCT monitoring is very useful for predicting the prognosis and adjusting the treatment in children with SBI.