脓毒症患儿血清可溶性CD14表达变化的临床研究

Changes of serum soluble CD14 in children with sepsis or septic shock

目的 探讨严重感染患儿血清脂多糖受体可溶性CD14（sCD14）的变化及其与脓毒症严重程度、预后的关系。方法以32例脓毒症患儿为研究对象进行前瞻性临床研究。根据诊断标准及病情程度将脓毒症患儿分为3组，脓毒症组（10例）、严重脓毒症组（12例）、脓毒性休克组（10例）。于发病后1d、3d,7d测定血清sCD14的浓度，同时记录当天的血白细胞计数、前降钙素、C-反应蛋白、脂多糖以及危重病例评分。对照组为20例同期儿童保健门诊健康体检儿童。结果脓毒症组发病1d内血清sCD14水平为（8．09±4．33）mg／L，显著高于对照组（4．28±2．74）mg／L，差异有显著性（P〈0．01）。发病后3d、7d的sCD14水平与对照组差异无显著性（P〉0．05）。脓毒症组、严重脓毒症组、脓毒性休克组在病程1d血清sCD14水平分别为（4．46±2．31）、（8．52±4．07）、（11．21±3．67）mg／L，差异有显著性（P〈0．05）。各组在病程3d、7d的血清sCD14水平差异无显著性（P〉0．05）。sCD14与前降钙素、C-反应蛋白、危重病例评分间存在显著相关（P〈0．05）。结论在脓毒症早期sCD14的水平显著升高，其升高的程度可提示炎症反应的严重程度及预后。

Objective To investigate the changes of serum soluble lipopolysaceharide receptor CD14 （sCD14） levels of children with sepsis or septic shock, and to evaluate the relationship between sCD14 and prognosis of septic patients. Methods Serum concentration of sCD14 was measured at day 1,3,7 after the onset of sepsis. Thirty-two septic children （ sepsis group） were recruited for prospective clinical study. According to the diagnostic criteria and disease severity,32 septic patients were sub-divided into 3 groups：10 cases of sepsis group, 12 cases of severe sepsis group, 10 cases of septic shock group. Twenty healthy volunteers were enrolled for control. WBC count, serum procalcitonin （PCT）, C-reactive protein （CRP） and lipopolysaceharide （LPS） were measured, as well as severity score and prognosis were simultaneously assessed. Results The concentration of serum sCD14 in sepsis group at day 1 [ （8.09±4. 33） mg/L] was significantly higher than that of control group[ （4. 28 ± 2. 74） mg/L] （ P 〈 0. 01 ）. Sepsis group had no significant difference in serum sCD14 level at day 3,7 as compared with control group. There was significant difference in serum sCD14 levels at day 1 among sepsis group,severe sepsis group and septic shock group,but there was no significant difference at day 3,7. Serum sCD14 level had significant correlation with PCT,CRP and severity score. Conclusion Serum sCD14 level increased significantly at septic prophase. Serum sCD14 level may be a useful predictor of the severity and prognosis of sepsis.