脓毒症患儿内生吗啡动态变化及临床意义

The Dynamic Change and Clinical Significance of Serum Endogenous Morphine in Children with Sepsis

目的:检测脓毒症患儿血清内生吗啡(EM)动态变化,探讨脓毒症患儿血清EM水平的临床意义。方法:选择2017年6月-2018年2月华中科技大学同济医学院附属同济医院收治的30例伴有严重脓毒症或脓毒症休克的患儿作为脓毒症组,30例全身炎症反应综合征(SIRS)患儿作为SIRS组,30例健康儿童作为对照组。脓毒症组、SIRS组及对照组分别于入组后第1、3、6、9天抽取外周静脉血,采用免疫荧光法检测血清降钙素原(PCT)水平,采用酶联免疫吸附试验(ELISA)测定血清EM水平,采用流式细胞术(FCM)检测细胞免疫功能。结果:SIRS组、脓毒症组患儿的第1、3、6天血清PCT水平显著高于对照组,且随时间延长PCT水平逐渐降低,至第9天降至正常水平(P<0.05),而脓毒症组与SIRS组间血清PCT水平无统计学差异(P>0.05)。脓毒症组第1、3、6天血清EM水平均高于SIRS组(P<0.05),第9天两组血清EM水平比较差异无统计学意义(P>0.05)。脓毒症组EM水平随时间延长而降低,至第9天降至SIRS组的水平(P<0.05)。与SIRS组相比,第1天脓毒症组的CD3^+T细胞数量增多(P<0.05),两组CD4^+、CD8^+T细胞数量、CD4^+/CD8^+比例比较无统计学差异(P>0.05)。结论:脓毒症患儿中血清EM水平较高,有可能作为诊断脓毒症特异性较高的生物标志物。

Objective: To detect the dynamic changes of plasma endogenous morphine(EM) in children with sepsis and to explore the clinical significance of serum EM level in children with sepsis. Methods: 30 children with severe sepsis or septic shock treated in our hospital from June 2017 to February 2018 were selected as sepsis group. 30 children with systemic inflammatory response syndrome(SIRS) as SIRS group and 30 healthy children as control group. Peripheral venous blood was collected from sepsis group, SIRS group and control group at 1 day, 3 days, 6 days, 9 days after admission respectively. Serum calcitonin(PCT) level was detected by immunofluorescence, serum EM was measured by enzyme linked immunosorbent assay(ELISA), and cell immunologic function was detected by flow cytometry(FCM). Results: The level of serum PCT in SIRS group and sepsis group was significantly higher than that of control group at 1 day, 3 days, 6 days, as time went on, the level of PCT decreased gradually, and decreased to normal level at 9 days(P<0.05).There was no significant difference in serum PCT level between sepsis group and SIRS group(P>0.05). The serum EM level in sepsis group was higher than that in SIRS group at 1 day, 3 days, 6 days(P<0.05). There was no significant difference in serum EM level between the two groups at 9 days(P>0.05). The level of EM in sepsis group decreased with time and decreased to SIRS level at 9 days(P<0.05).Compared with the SIRS group, the number of CD3^+T cells in the sepsis group increased at 1 day(P<0.05), and there was no significant difference in the number of CD4^+ and CD8^+T cells and the proportion of CD4+/CD8+in the two groups(P>0.05). Conclusion: Serum EM level in children with sepsis are relatively higher and may be used as biomarkers for the diagnosis of sepsis.