脓毒症患儿血清肝素结合蛋白水平变化及其意义研究

Diagnostic value of serum heparin-binding protein levels in children with sepsis

目的研究脓毒症患儿血清肝素结合蛋白(HBP)水平的变化及意义。方法将104例发热患儿根据脓毒症分级标准分成5组:脓毒症组23例、严重脓毒症不伴休克组21例、严重脓毒症伴休克组19例、感染不伴全身炎症反应综合征(SIRS)组23例、非感染伴SIRS组18例。采用ELISA法检测患儿血清HBP水平,同时检测外周血白细胞(WBC)、C反应蛋白(CRP)水平,分别进行比较,并分析HBP与WBC的相关性;制作ROC曲线,分析并比较HBP、WBC、CRP诊断脓毒症的敏感度、特异度、阳性预测值、阴性预测值。结果血清HBP水平为严重脓毒症伴休克组>严重脓毒症不伴休克组>脓毒症组,感染不伴SIRS组、非感染伴SIRS组、对照组间的差异无统计学意义;脓毒症、严重脓毒症不伴休克组、严重脓毒症伴休克组的血清HBP水平与WBC水平之间均存在较强的相关性(r=0.96、0.95、0.62);ROC曲线分析示HBP诊断脓毒症的敏感度为95.24%、特异度为98.39%,阳性预测值为98.36%,阴性预测值为95 31%,均明显高于WBC、CRP。结论检测发热患儿的血清HBP水平、分析其与外周血WBC的相关性,可以较好预测是否会发生脓毒症。

Objective To assess the diagnostic value of serum heparin- binding protein（HBP） levels in children with sep-sis. Methods One hundred and four children with fever were divided into five groups：sepsis（n=23）, severe sepsis without shock （n=21）, severe sepsis with shock （n=19）, infection without systemic inflammatory response syndrome （SIRS, n=23）, non- infection with SIRS （n=19）. Two- site sandwich enzyme- linked immunosorbent assay （ELISA） was used to detect the levels of serum HBP. The levels of peripheral blood WBC, C- reactive protein （CRP） were also detected. The areas under the curve （AUC） of receiver operating characteristic （ROC） curve of HBP, WBC and CRP in diagnosing sepsis were compared. The sensitivity, specificity, positive predictive value and negative predictive value of HBP in diagnosis of sepsis were analyzed. Results The levels of serum HBP in severe sepsis with shock group（11.12±9.93ng/ml）, severe sepsis without shock group（6.81±2.05ng/ml） and sep-sis group（3.93±1.65ng/ml ） were al higher than those in infection without SIRS group（1.13±0.64 ng/ml）, non- infection with SIRS group （0.82±0.26ng/ml） and control group （0.86±0.18ng/ml）;while there was no significant difference among three non- sepsis groups. There was strong linear correlation between the levels of serum HBP and peripheral blood WBC in children with sepsis （rsepsis group=0.96, rsevere sepsis without shock=0.95, rsevere sepsis with shock group=0.62. ROC curve analysis showed that the AUC of HBP in diagnosing sepsis （0.977） was larger than that of WBC （0.897） and CRP （0.848）. Taking 2.65ng/ml as the cutoff value for diagnosis of sepsis, the sensitivity, specificity, positive predictive value and negative predictive value of HBP were 95.24%, 98.39%, 98.36% and 95.31%, respectively. Conclusion Serum HBP levels are increased in sepsis; and detection of serum HBP in children with fever is of diagnostic value for sepsis.