血液肿瘤患儿合并脓毒症时血清巨噬细胞移动抑制因子的临床意义

Macrophage migration inhibitory factor in children with hematologic malignancy complicated with sepsis

目的评价血液肿瘤患儿并发脓毒症时血清巨噬细胞移动抑制因子（macrophage migration inhibitory factor，MIF）的临床意义。方法（1）以收入我院HCU的血液肿瘤合并脓毒症患儿（27例）为研究对象，同时期我院血液肿瘤化疗后骨髓抑制继发感染但尚未达到脓毒症诊断标准的患儿为非脓毒症组，共14例。（2）脓毒症组、非脓毒症组患儿分别在入院24h内留取血清标本，比较两组间血清MIF、促肾上腺皮质激素释放激素（corticotropin releasing hormone，CRH）、皮质醇、铁蛋白水平。采用多元回归分析方法研究MIF与CRH、皮质醇、小儿危重病例评分（pediatric critical illness score，PCIS）之间的关系。结果脓毒症组患儿MIF水平[（5022．71±3915．82）pg／m1]较非脓毒症组[（1722．81±1738．53）pg／ml]明显升高（P=0．001）。多元线性回归分析结果显示，PCIS和CRH是MIF的相关因素（t=-2．830，P=0．009；t=2．852，P=0．009）。CRH越高，PCIS越低，MIF越高。结论MIF一定程度上反映了血液肿瘤患儿合并脓毒症时疾病的严重程度，MIF越高，PCIS越低，疾病越严重。MIF与脓毒症患儿肾上腺皮质功能存在一定联系。

Objective To assess the relationship between serum macrophage migration inhibitory factor （MIF） and sepsis in children with hematologic malignancy. Methods （ 1 ） An observational study was performed in a university pediatric intensive care unit. Forty-one children were enrolled in our study, and were divided into two groups：sepsis group（27 cases） and non sepsis group（ 14 cases）. （2） Serum samples were taken in the both two groups in 24 h after they were admitted in hospital. Clinical and laboratory parameters,including the levels of serum MIF, cortisol, corticotropin releasing hormone （ CRH ）, and ferritin were measured and compared between the two groups. Multiple linear regression analysis was used to assess the relationship between MIF and CRH, cortisol and pediatric critical illness score（PCIS）. Results The level of MIF was significantly elevated in the sepsis group[ （5 022.71 ± 3 915.82） pg/ml] than that of non sepsis group[ （ 1 722. 81 ±1 738. 53） pg/ml] （P =0. 001 ）. Multiple linear regression analysis showed that CRH as well as PCIS were the correlative factors of MIF（t = -2. 830,P =0. 009;t =2. 852,P =0. 009）. The higher CRH concentration,the lower PCIS score, and the higher MIF was. Conclusion The level of serum MIF could reflect the severity of children with hematologic malignancy complicated with sepsis. The higher MIF concentration, the lower PCIS score, then the disease is more serious. To some extent, serum MIF is related with the adrenocortical function of sepsis children.