降钙素原与小儿危重病例评分对脓毒症患儿预后的影响

Prognostic values of serum procalcitonin level and pediatric critical illness score in children with sepsis

目的探讨脓毒症患儿血清降钙素原(PCT)与小儿危重病例评分(PCIS)的相关性及与预后的关系。方法选取儿童重症监护病房脓毒症患儿61例,按PCIS评分标准分为非危重组(n=18)、危重组(n=20)和极危重组(n=23)。入院24 h内检测患儿血清PCT、C反应蛋白(CRP)、乳酸(LA)含量及血常规,比较上述指标在不同危重程度患儿中的差异;采用Pearson相关分析检验PCT与PCIS及血清各指标相关性;再依据患儿的治疗结局,分为存活组(n=39)和死亡组(n=22),比较PCT、PCIS评分及其他血清指标在不同治疗结局患儿中的差异。结果非危重组PCT和CRP水平均低于危重组和极危重组(均P<0.05),且危重组PCT和CRP水平均低于极危重组(均P<0.05),极危重组患儿病死率(61%)显著高于危重组(35%)和非危重组(6%)(均P<0.05);PCT与PCIS评分呈明显负相关(r=-0.63,P<0.001),与CRP呈明显正相关(r=0.73,P=0.003);死亡组PCT和LA水平明显高于存活组(均P<0.05),而PCIS评分明显低于存活组(P<0.05)。结论血清PCT和PCIS评分具有较好的相关性,脓毒症患儿PCIS评分越低,血清PCT升高越明显,预后越差,两者联合是预测脓毒症患儿预后较为敏感的指标。

Objective To investigate the correlation between serum procaicitonin （PCT） level and pediatric critical illness score （PCIS） and their prognostic values in children with sepsis. Methods Sixty-one children with sepsis in the pediatric intensive care unit were enrolled. According to PCIS, these patients were divided into non-critical （n=18）, critical （n=20）, and extremely critical groups （n=23）. Within 24 hours after admission, serum levels of PCT, C-reactive protein （CRP）, and lactic acid （LA） and routine blood counts were measured. These parameters were compared between the three groups. The Pearson correlation analysis was performed to determine the correlation of PCT with PCIS and other serological parameters. Based on clinical outcomes, these patients were divided into survival （n=39） and death groups （n=22）. The PCT, PCIS, and other serological parameters were compared between the two groups. Results The serum levels of PCT and CRP in the non-critical group were significantly lower than those in critical group and extremely critical groups （P〈0.05）, and the two parameters were significantly lower in the critical group than in the extremely critical groups （P〈0.05）. The extremely critical group had a significantly higher mortality than the critical group non-critical groups （61% vs 35% and 6%, P〈0.05）. SerumlPCT level had a significantly negative correlation with PCIS （r=-0.63, P〈0.001） but a significantly positive correlation with serum CRP level （r=0.73, P=0.003）. Compared with the death group, the survival group had significantly higher serum levels of PCT and LA （P〈0.05） but a significantly lower PCIS （P〈0.05）. Conclusions There is a good correlation between serum PCT level and PCIS. For children with sepsis, the lower the PCIS, the higher the serum PCT level, resulting in a poorer prognosis. A combination of serum PCT and PCIS can be used as an early prognostic indicator in children with sepsis.