高敏C-反应蛋白及肿瘤坏死因子检测对小儿急性肺损伤的临床意义

Clinical significance of high sensitivity C-reactive protein and tumor necrosis factor detection in acute lung injury in children

目的观察小儿急性肺损伤(ALI)患者高敏C-反应蛋白(hsCRP)和肿瘤坏死因子α(TNF-α)水平的改变,并探讨其临床意义。方法选择符合诊断标准的30例ALI患者作为观察组,分别于明确诊断后第1,3,5,7天清晨7:00空腹肘正中静脉取血检测hsCRP和TNF-α浓度,并与30例健康体检者进行对照。观察hsCRP和TNF-α浓度及变化情况。结果观察组第1,3,5,7天血清hsCRP和TNF-α水平均高于健康对照组(P<0.01)。观察组中多脏器功能障碍综合征(MODS)和非MODS患者随着病情的缓解,hsCRP测定值均呈逐渐下降趋势;且MODS血清hsCRP高于非MODS(P<0.05);APACHEⅡ≥20分患者的血清hsCRP和TNF-α水平均明显高于APACHEⅡ<20分患者(P<0.01)。血清hsCRP、TNF-α与APACHE Ⅱ评分进行多元逐步回归分析显示,血清hsCRP,TNF-α评分与APACHE Ⅱ评分均有显著相关性(P<0.01)。结论血清中hsCRP、TNF-α可作为ALI患者的病情监测和评估有用的临床指标。

Objective To investigate the level change of high-sensitivity C-reactive protein （hsCRP） and tumor necrosis factor α （TNF-α） in patients with pediatric acute lung injury （ALI）, and to explore its clinical significance. Methods Selected 30 patients with ALI who meet the diagnostic criteria as the observation group and chose 30 healthy cases as control group. Empty stomach ulnar vein blood was obtained at 7 ：00a. m. at1,3,5,7day time-point after diagnosed. Then tested the serum changing of hsCRP and TNF-α concentration in two groups. Results The serum concentration of hsCRP and TNF-α at each time points were higher than that of the healthy control group （ P 〈0. 01）. The serum concentration of hsCRP in multiple organ dysfunction syndrome （MODS） and non MODS patients showed fall-off tendency,and the serum concentration of hsCRP in patients with MODS were higher than non MODS patients（ P d0.05）. Cases with acute physiology and chronic Health Evaluation （APACHE Ⅱ ） score ≤20,compared with cases that APACHE Ⅱ 〈20, have significantly higher serum concentration of hsCRP（ P 〈0.01）. Multielement gradually regression analysis of hsCRP and TNF-α serum concentration and APACHE Ⅱ score have significantly associated relationship（ P 〈0.01）. Conclusion Serum hsCRP,TNF-α in patients with ALI could be used as a condition monitoring and assessment of clinical target.