血清补体活性和C反应蛋白水平及血小板计数与全身炎症反应综合征的预后

The relationship between the levels of C_3 and C_4,C-reactive protein and platelet count and the prognosis of systemic inflammatory response syndrome in children

目的 探讨全身炎症反应综合征 (SIRS)患儿血清补体 (C3 、C4 )活性、C反应蛋白 (CRP)水平及血小板计数变化的临床意义。方法 采用前瞻性研究方法 ,用全自动免疫比浊定量分析法和全自动血细胞计数仪测定 6 8例SIRS患儿血清C3 、C4 、CRP水平和血小板计数及其动态变化。 结果SIRS患儿首次测定的血清C3 [(4 0 6± 1 0 9)g/L]、C4 [(1 6 4± 0 89)g/L]、CRP[(5 7± 2 0 )g/L]及血小板计数 [(6 10± 140 )× 10 9/L]均显著高于非SIRS患儿组和正常对照组 (F分别为 2 77 4、10 2 0、2 2 7 0及196 2 ,P <0 0 5或 <0 0 1) ,但非SIRS患儿组和正常对照组四组参数比较差异均无显著意义 (P >0 0 5 )。动态观察发现 :SIRS组病情好转后四项参数均较好转前低 (C3 、C4 、CRP及血小板成对比较的t值分别为 14 9、8 9、14 7及 18 0 ,P <0 0 1) ;而恶化组CRP持续升高、C3 、C4 和血小板计数持续下降 ,明显不同于好转前 (C3 、C4 、CRP及血小板计数的成对比较t值分别为 8 0、4 7、2 4及 11 4,P <0 0 5或 <0 0 1)。而且病情恶化组SIRS患儿病情变化后C3 、C4 和血小板水平均低于好转组 [C3(1 5 4± 0 6 8)g/L与 (0 86± 0 6 7)g/L ,P <0 0 5 ;C4 (0 45± 0 2 3)g/L与 (0 2 5± 0 0 9)g/L ,P <0 0 5 ;血?

Objective It was reported that systemic inflammatory response syndrome (SIRS) and multiple organ dysfunction syndrome (MODS) were common and their mortality was high in PICU. The mechanism of the progression from SIRS to MODS is unclear. We hypothesized that the complement system and coagulation system may change in the occurrence and development of SIRS. The study was designed to investigate the clinical significance of serum complement 3 and 4 (C_3 and C_4), C-reactive protein (CRP) and platelet count in children with SIRS. Methods The study was conducted on 68 children with SIRS in PICU. Children with cancer or blood diseases were excluded. According to their changes within 72 h after entering PICU, patients with SIRS were divided into 2 groups, the group with recovery condition (group A) and the group with worse condition (group B). The levels of C_3, C_4 and CRP were measured by photometry immun-turbidimetric test with automated biochemical analysis and the results were expressed as g/L, while the platelet count was determined by automated blood cells counter and the results were expressed as ×10 9/L. The samples were collected on admission to PICU, as well as in their recovery condition and worse condition. Two control groups including 48 children patients without SIRS (PC) and 42 healthy children (NC) were observed in the same way. The comparison of the results was conducted with SPSS 9.0. Results Among 68 patients with SIRS, there were 56 children in group A and 12 children in group B 72 h after entering PICU. The levels of C_3[(4.06±1.09) g/L], C_4[(1.64±0.89 ) g/L], CRP [(57±20 ) g/L] and platelet count [(611±140) ×10 9/L ]were significantly higher in 68 SIRS cases on admission to PICU than those in PC and NC ( F =277.4, 102.0, 227.0 and 196.2, respectively, P <0.01), but there was no difference between PC and NC ( P >0.05). In group A, there were lower levels of C_3, C_4, CRP and platelet count on recovery condition than those on admission to PICU [C_3 (1.54±0.68)g/L vs (3.89±0.96)g/L , C_4 0.45±0.23] vs (1.65±0.78) , CRP (12±6)g/L vs (56±21)g/L and platelet count (240±84)×10 9 /L vs (611±136)×10 9/L, t =14.9, 8.9, 14.7 and 18.0, respectively, P <0.01]. In group B, the levels of C_3, C_4 and platelet count in their worse condition were significantly lower than those in their admission to PICU. In group B, the levels of C_3, C_4 and platelet count in their worse condition were significantly lower than those in their admission to PICU[C_3(0.86±0.67)g/L vs (4.56±1.57)g/L, C_4(0.25±0.09)g/L vs (1.43±0.69)g/L and platelet count (87±14) ×10 9/L vs (608±167)×10 9/L, t =8.8, 4.7 and 11.4, respectively, P <0.01], and the level of CRP was higher in their worse condition [(79±18) g/L vs (62±16)g/L, t =2.4, P <0.05]. Furthermore, after the disease changed in PICU, the levels of C_3, C_4 and platelet count in group B were lower than those in group A ( t or t ′=3.15, 2.95 and 12.8, respectively, P <0.05 or <0.01), and the level of CRP was higher in group B ( t ′=12.60, P <0.01), though there was no difference the four parameters between the two groups before the disease changed ( P >0.05).Conclusion The measurement of C_3, C_4 and platelet count is helpful to evaluate the prognosis of the patient with SIRS. The gradual increase of CRP and the drop of C_3, C_4 and platelet count during the disease process may be the risk signals for serious status and bad prognosis of the disease. Complement activation might play an important role in the occurrence and progression of SIRS.