降钙素原、C反应蛋白和D-二聚体水平检测在危重症患儿感染中的临床意义

Clinical significance of Procalcitonin, C-reactive protein and D-dimer level in critical illness children with infection

目的探讨血清降钙素原(PCT)、C反应蛋白(CRP)和血浆D-二聚体(D-D)水平的检测在危重症患儿感染中的临床意义。方法采用免疫荧光法和免疫比浊法检测198例危重患儿血清PCT、CRP和血浆D-D。结果临床感染者(100例)患儿血清PCT、CRP和血浆D-D水平分别为(24.5±10.2)μg/L,(45.3±10.5)mg/L,(1.85±0.55)mg/L,均显著高于临床非感染者(98例)的(0.5±0.15)μg/L,(6.1±0.6)mg/L,(0.5±0.25)mg/L,差异有统计学意义(P<0.05)。血清PCT、CRP和血浆D-D水平均与患儿的病情严重程度呈正相关(P<0.05)。临床感染组患儿PCT、CRP、D-D阳性率分别为93(93%)、80(80%)、89(89%),均高于临床非感染组35(35.7%),25(25.5%),40(40.5%),差异有统计学意义(P<0.05)。结论血清PCT、CRP和血浆D-D水平检测可作为早期诊断危重症患儿感染病情严重程度评估及疗效判断的重要敏感性指标。血浆D-D水平检测对早期判断危重患儿感染时凝血功能异常程度具有重要临床指导意义。

Objective To investigate clinical significance of serum procalcitonin （ PCT）, C reactive protein （CRP） and plasma D- dimer （D-D） level in critical illness children with infection. Methods Immu- nofluorescence and immunoturbidimetric assay was used respectively for detecting serum PCT, CRP and plasma D-D level in 198 cases of critical illness children with infection. Results Serum PCT, CRP and plasma D-D levels of the 100 cases of critical illness children with clinical infection were （24. 5 ± 10. 2） μg/L, （45.3 ± 10. 5） mg/L, （1.85 ± 0. 55） mg/L, which were significantly higher than that of 98 cases of critical illness children without clinical infection[ （0. 5 ± 0. 15）μg/L, （6. 1 ± 0. 6） mg/L, （0. 5 ± 0. 25） mg/L], and the difference was statistically significant （P 〈 0.05）. Serum PCT, CRP and plasma D-D levels positively cor- related with severity of illness children （ P 〈 0. 05 ）. Prevalence of positivity of serum PCT, CRP and plasma D- D in critical illness children with clinical infection were 93 （93%）, 80（80% ）, 89（89% ）, greater than that in critical illness children without clinical infection, which were respectively 35 （ 35. 7% ）, 25 （ 25. 5% ）, 40 （40. 5% ）, and the difference was statistically significant （ P 〈 0.05 ）. Conclusion Serum PCT, CRP and plasma D-D level may be important sensitive index of assessing severity of infection and evaluating the treatment for early diagnosis of children with critical disease. Detection of the plasma D-D level has important clinical sig- nificance for early evaluating the degree of coagulation abnormality in critical illness children with infection.