SIRS患儿凝血功能、D-二聚体、CRP水平变化与病情危重程度关系的探讨

A Study on the Association Among the Coagulation Function~D-Dimer~C reactive Protein with Severity of Illness in Children with SIRS

目的通过研究不同程度SIRS患儿凝血功能，c一反应蛋白（CRP）及D一二聚体（D—D）水平变化，探讨其与病情危重程度关系．指导治疗和预后判断。方法选取2008年10月至2011年3月间在山东大学齐鲁儿童医院PICU住院的SIRS患儿为研究对象，且小儿危重病情评分小于90分，共70例，男49例，女21例。根据SIRS诊断标准及病情程度将SIRS惠儿分为3组，SIRSI组（符合：项诊断指标）20例、SIRSlI组（符合三项诊断指标）23例、SIRSllI组（符合四项诊断指标）27例。选择同期儿童保健门诊健康查体儿童52例为正常对照组。SIRS组惠儿入院后24h内进行危重病例评分，监测生命体征．进行血常规，血生化检测。据原发病进行相关病原学检查，如ELISA方法检测血清单纯疱疹病毒，腺病毒，EB病毒，巨细胞病毒，呼吸道合胞病毒等特异性抗体，以明确感染病原。同时常规予抗感染及对症支持治疗。四组受试对象采集静脉血检测凝血酶原时间（PT）、凝血酶时间（TT）、部分活化凝血活酶时间（APTT）、纤维蛋白原（FIB）、D一二聚体（DD）、C一反应蛋白（ClIP）含量。结果SIRS三组患儿凝血功能均异常，CRP，D一二聚体水平均高于正常对照组。随着SIRS符合项数增多，SIRS危重症评分越低及受损器官增多，病死率明显增高。SIRSⅢ组发生MODS的例数高于SIRSⅡ和SIRSI组。SIRS组患儿凝血功能检测中PT、TT、APTT以及INR指数显著高于正常对照组，且随病情程度加重而增高，差异极显著；而SIRS组患儿FIB显著低于正常对照组，SIRS三组问无明显差异。SIRS组患儿C-反应蛋白，D-二聚体水平，显著高于对照组，差异极显著。结论SIRS惠儿存在凝血机制活化，符合SIRS诊断标准项数越多，病情越重。凝血功能紊乱越显著，脏器损害越重，病死率越高。病情越重组CRP浓度越高，CRP可作为判断SIRS病情及预后的指标。SIRS时血浆D-二聚体水平明显升高．提示血管内皮细胞受到损伤．凝血功能出现紊乱。且随SIRS程度加重、病情恶化时升高程度更显著。D-二聚体水平可作为检测SIRS的危重程度．预测MODS及其预后的重要指标。

Objective To study the changes of coagulation function, the levels of D-Dimer,C reactive protein,and to explore their relationship with severity of illness in children with different degrees of systemic inflammatory response syndrome （SIRS）.Method From October 2008 to October 2009, 70 children with SIRS were selected in PICU Department of Qilu children＇s Hospital of Shandong University, including 49 male and 21 female. According to diagnosis standard of SIRS and the patient＇s condition, these children were divided into three groups, SIRS group I （fulfilled two diagnostic criteria, n=20）, SIRS group H （fulfilled three diagnostic criteria, n=23）, SIRS group m （fulfilled four diagnostic criteria, n=27）. Meanwhile, 52 children were selected as health control group who did health examination in the same time. The MDSS, vital signs blood, regular tests and biochemistry parameters were analyzed within 24h from admission. The coagulation function which including prothrombin time （PT）, thrombin time （TI＇）, activated partial thremboplastin time （APTT）, fibrinogen （FIB）, the serum levels of DD and CRP were measured in the four groups. Pathogens such as herpes simplex virus, adenovirus, EB virus, cytomegalovirus and respiratory syncytial virus were detected by enzyme-linked immunosorbent assay （ELISA）. Meanwhile, anti-infection and supportive treatment followed. Result There was dysfunction of coagulation in the three SIRS groups. Compared with control group, the three SIRS groups had higher level of CRP and D-D. PT,TY,AFI＂F and INR in SIRS groups were higher than control groups, and there were significant difference in SIRS groups and a positive relationship between these levels and the degree of patient＇s condition. The level of FIB in SIRS groups was significantly lower than control group and there was no difference among the three SIRS groups. It is shown that the more the SIRS diagnostic criteria, the higher percentage of critical patients as well as higher mortality.Conclusion There was the activation of coagulation mechanism in SIRS children. The results showed that the more the SIRS diagnostic criteria, the more serious the illness, the more significant the coagulation dysfunction and the higher mortality. The relationship was positive between the patient＇s condition and CRP. CRP could be taken as an index for patient＇s condition as well as prognosis. D-D was the most valuable index for the diagnosis of SIRS.