儿童脓毒症及严重脓毒症患儿血液sCD163变化及其意义

Changes and significance of soluble CD 163 in sepsis and severe sepsis in children

目的探讨脓毒症及严重脓毒症患儿血液可溶性CD163（sCD163）水平，评估其在病情严重程度及脓毒症免疫状态判断中的价值。方法前瞻性实验，采用双抗体夹心ELISA方法，测定入住本院儿童重症医学科（PICU）50例脓毒症／严重脓毒症患儿血清sCD163含量，同期选择23例健康检查儿童作为对照；分析sCD163与病情严重程度评分（pediatriccriticalillnessscore．PCIS：pediatricriskofmortalitym，PRISMm）、淋巴细胞亚群、C反应蛋白（CRP）、肿瘤坏死因子d（TNFc~）之间的关系。研究方案经医院伦理委员会批准，签转家长知情同意书。结果实验组患儿与健康组儿童血清sCD163分别为（171．04±177．85）mg／L和（44．19±86．48）mg／L，差异有统计学意义（P〈0．01）。脓毒症与严重脓毒症患儿sCD163分别为（105．32-4-145．87）mg／L和（233．32±171．78）mg／L．差异有统计学意义（P〈0．05）。PCIS分值≥90、70-89及〈70患儿中，PCIS分值越低，sCD163水平越高，三组差异有统计学意义（P〈0．01）。PRISMHI≥10组血清sCD163浓度明显高于PRISMⅢ〈10组（P〈0．01）。死亡组sCD163水平高于生存组，差异有统计学意义。sCD163与CD4＋、CIM＋／CD8＋呈负相关（R=-0．820，P〈0．05，R=-0．839，P〈0．叭）。结论血清sCD163测定有助于预测脓毒症患儿病情严重程度，是脓毒症患儿免疫状态判断参考指标之一。

Objective To investigate the changes of serum soluble CD 163 （ sCD 163 ） level, to assess the severity of critical illness and to evaluate the immune status of sepsis or severe sepsis in children. Method A prospective study was conducted. The sCD 163 was determined in 50 cases with sepsis or severe sepsis in pediatric intensive care unit （PICU） and 23 cases of age- and gender-matched healthy children were enrolled as control during the period from April 2010 to March 2011. Double-antibody sandwich ELISA was used for sCD 163 measurement. The relationship with sCD 163 level and disease severity score （ pediatric critical illness score, PCIS; and pediatric risk of mortalityⅢ, PRISMⅢ）, lymphocyte subsets, C-reactive protein （CRP）, tumor necrosis factor α （TNFa） were analyzed. Result The sCD 163 in sepsis/severe sepsis groups （ 171.04± 177. 85） mg/L was significantly higher than that in control group （44. 19 ±86.48） mg/L （P 〈0. 01 ）. sCD 163 in sepsis group [ （ 105.32 ± 145.87） mg/L] was significantly lower than that of severe sepsis group [ （233.32 ± 171.78 ） mg/L] （ P 〈 0. 05 ）. sCD 163 level was significantly higher in lower PCIS score patients. （P 〈0. 01 ）. The sCD 163 levels was higher in PRISMⅢ≥10 than the PRISM Ⅲ 〈 10 group. The sCD 163 levels were higher in death group than the survival group. The sCD 163 was negatively correlated with CD4 ＋ , CD4 ＋ /CD8 ＋ （R = - 0. 820,P 〈0. 05;R = -0. 839, P 〈0.01 ）. Conclusion Detection of sCD 163 was helpful in predicting the severity of sepsis and severe sepsis, and sCD 163 may reflect the immune status of critically ill children with sepsis.