布洛芬在全身炎症反应综合征治疗中对血清降钙素原的影响

Effect of ibuprofen on level of plasma procalcitonin in children with systemic inflammatory response syndrome

目的观察布洛芬对全身炎症反应综合征(SIRS)患儿血清降钙素原(PCT)的影响。方法采用前瞻性、多中心、随机对照临床研究,收集2008年3月—2009年3月,3家医院的儿科重症监护中心符合SIRS诊断的患儿(炎症组)154例,分为单独抗生素组(69例)、抗生素+布洛芬组(85例),并取正常对照组20例。测定入院时(基线)、药物干预48 h后血清PCT水平,观察布洛芬干预后PCT的变化,分析布洛芬对SIRS的治疗作用;并对危重评分在80～100分、<80分的患儿进行分层研究。结果正常对照组未检测到PCT;炎症组基线时PCT为(2.35±3.91)ng/ml,其中单独抗生素组为(2.18±3.88)ng/ml,抗生素+布洛芬组为(2.49±3.95)ng/ml,两者差异无统计学意义;单独抗生素组治疗前后PCT差异无统计学意义(P>0.05),抗生素+布洛芬组治疗前后差异有统计学意义(P<0.05);抗生素+布洛芬组治疗后PCT下降幅度与单独抗生素组治疗后下降幅度比较差异有统计学意义(P<0.05)。分层研究提示,危重评分80～100的患儿,抗生素+布洛芬治疗后PCT下降幅度与单独抗生素组比较差异有统计学意义(P<0.05);而危重评分<80的患儿,抗生素+布洛芬治疗后PCT下降幅度与单独抗生素组比较差异无统计学意义(P>0.05)。结论经布洛芬干预48 h后,SIRS患儿外周血清PCT的水平均有明显下降,尤其在危重评分80～100的患儿中,提示布洛芬在抑制机体炎症反应过程中起一定作用,有助于控制炎症。

Objective To investigate the effect of ibuprofen on level of plasma procalcitonin（PCT）in children with systemic inflammatory response syndrome（SIRS）.Methods Patients with confirmed diagnosis of SIRS were enrolled from three research sites from March 2008 to March 2009 for a prospective,multi-centered,randomized controlled trial.The patients were divided into antibiotics only group or ibuprofen plus antibiotics group.Twenty healthy children were used as control group.Plasma PCT level was tested at both baseline and 48 hours after medication administration for investigating the effect of ibuprofen.Segmental analysis was done for patients with critical score less than 80 and 80-100.Results The plasma PCT was not detected in control group.At baseline,the plasma PCT level was 2.35 ± 3.91 ng/ml in SIRS patients：2.18 ± 3.88 ng/ml in the antibiotics only group and 2.49 ± 3.95 ng/ml in the ibuprofen plus antibiotics group.There was no significant difference.Compared with the baseline,the plasma PCT level was not different in antibiotics only group after medication administration.However,after medication administration,the plasma PCT level was significantly decreased compared with baseline in ibuprofen plus antibiotics group（P 0.05）.The extent of decline in plasma PTC in ibuprofen plus antibiotics group was significantly more than in antibiotics only group.Segmental analysis showed that only in patients with critical score 80-100,the extent of decline in plasma PCT in ibuprofen plus antibiotics group was significantly more than in antibiotics only group after medication administration（P 0.05）.Conclusions The level of plasma PCT was significantly decreased 48 hours after ibuprofen administration in SIRS patients,especially for patients with critical score 80-100.It is suggested that ibuprofen plan a role in suppression of inflammatory response.