降钙素原、白细胞介素-6及内毒素对儿童全身炎症反应综合征早期诊断价值研究

Study on Procalcitonin,Interleukin-6 and Endotoxin for the Early Diagnosis of Children with Systemic Inflammatory Response Syndrome

目的通过检测儿童全身炎症反应综合征（SIRS）患者血清中的降钙素原（PCT）、白细胞介素-6（IL-6）及内毒素（ET）水平，探讨三项指标联检对SIRS的早期诊断价值。方法选择临床确诊为SIRS惠儿142例，健康新生儿34例，检测其血清中的PCT，IL_6及ET，用统计软件SPSS17．0进行数据分析。结果SlRS患儿的检测结果分别为PCT（8．820±5．386ng／m1），IL-6（106．8±12．9ng／L）和ET（95．2±15．9pg／m1）明显高于健康对照组PCT（O．076±0．071ng／m1），IL-6（12．8±1．1ng／L）和ET（4．25士1．95pg／m1），差异有统计学意义（￡值分别为21．167，12．35l和9．523，尸均〈O．01）；PCT阳性率（90．9％）明显高于IL-6（78．9％），ET、（68．5％）和血培养（24．6％），差异有统计学意义（PCT与IL-6，ET，血培养相比，X2分别为18．96，23．16和42．55，P均〈0．01），而三项指标联检阳性率则为98．7％；比较受试者工作特征曲线下面积（AUC），IL-6对PCT水平（以0．25ng／L和0．50ng／L作为临界值）的预测能力最强（分别为0．780和0．885），hCRP的预测能力中等（分别为0．648和0．754），而ET的预测能力较差（分别为O．575和0．598）。PCT的敏感度（SE）、特异度（SP）、阳性预测值（PPV）、阴性预测值（NPV）和诊断符合率分别为90．5％，85．4％，86．6％，87．8％和87．2％。高于其它指标。三项指标联检的敏感度，阴性预测值和诊断符合率分别为94．9％，93．1％和93．0％，高于任一单项检测。结论与传统的炎症指标相比，PCT可以更灵敏、准确地反映SIRS惠儿全身炎症反应的严重程度及预后情况。PCT，IL-6及ET联栓对SIRS的早期诊断、鉴别诊断和指导临床抗生素治疗有重要意义。

Objective To detect procalcitonin （PCT）, interleukin-6 （IL-6）, and endotoxin （ET） of serum in Children with systemic inflammatory response syndrome （SIRS） and explore the value of early diagnosis to SIRS with the three indicators. Methods Selected clinically diagnosed 142 cases of children with SIRS and 34 cases of healthy newborns and detected PCT, IL-6 and ET in their serum. The data was analysed using statistical software spss 17.0. Results Of the test results of chil- dren with SIRS PCT （8. 820 ± 5. 386 ng/ml）, IL-6 （ 106.8 ± 12.9 ng/L） and ET （95.2 ± 15.9 pg/ml） was significantly higher than the healthy control group PCT （0. 076±0. 071 ng/ml） ,IL-6 （12.8±1.1 ng/L） and ET （4.25±1.95 pg/ml）, the difference was statistically significant （t= 21. 167,12. 351 and 9. 523, P〈0. 01） and PCT-positive rate （90.9%） was significantly higher than that of IL-6 （78.9 %）, ET （68.5 % ） and blood culture （24.6 % ） and the difference was statistically significant （PCT and IL-6,ET,blood cultures compared respectively Z2 18.96,23.16 and 42.55, P〈0.01）, compared with 98.7 % for the three indicators associated infection rates. Area under the receiver operating characteristic curve （AUC） ,1L- 6 levels of PCT （0.25 ng/L and most 0.50 ng/L as the critical value） predictive ability （0. 780 and 0. 885） ,the predictive a- bility of hCRP medium （0. 648 and 0. 754,respectively）,while the poor predictive ability of the ET （0. 575 and 0. 598,re- spectively）. PCT sensitivity （SE）, specific degree （SP）, positive predictive value （PPV） and negative predictive value （NPV） and diagnostic accuracy were 90.5%, 85.4%, 86.6%,87.8% and 87.2%, higher than the other indicators. The three indicators J IU SE,NPV and diagnostic coincidence rate were 94.9%93.1% and 93.0.%, higher than any of the indi- vidual tests. Conclusion Compared with traditional inflammatory markers,PCT can be more sensitive and accurate reflection of the systemic inflammatory response in children with SIRS severity and prognosis. Joint detection of PCT, IL-6 and ET play an important role in early diagnosis, differential diagnosis and guide clinical antibiotic treatment to children with system- ic inflammatory response syndrome.