危重症患儿血清上皮来源中性粒细胞活化肽-78的变化及意义

Changes of epithelial neutrophil activating peptide-78 in critically sick children and its significances

目的 探讨危重症患儿血清上皮来源中性粒细胞活化肽-78（ENA-78）的变化,及其与儿童危重症病情严重程度和预后的关系.方法 采用前瞻性病例对照研究,选取2013年9月至11月上海交通大学附属儿童医院重症医学科收治的42例危重症患儿（危重症组）,入院后24h内（急性期）和第7天（恢复期）留取血标本;选取本院同期42例儿童体检残血样本作为对照.采用儿童危重病例评分标准（PCIS）和儿童死亡危险因素评分（PRISMⅢ）评估病情的危重程度;双抗体夹心酶联免疫法测定血清中ENA-78水平.结果 1.对照组血液ENA-78水平为（0.44 ±0.28） ng/L;危重症组急性期ENA-78为（2.85±0.89） ng/L,恢复期为（1.00±0.64） ng/L,危重症组与对照组、急性期与恢复期ENA-78水平比较差异均有统计学意义（P均=0.000）.2.ENA-78水平与PCIS评分呈负相关（r=-0.724,P=0.000）;PRISMⅢ≥10分组血清ENA-78水平明显高于PRISMⅢ＜10分组（P =0.000）.危重症患儿中,存活组ENA-78水平与死亡组比较差异有统计学意义（P=0.000）.3.严重感染患儿血清ENA-78水平与非感染性疾病组比较差异有统计学意义（P =0.000）.4.随着器官功能障碍损伤范围扩大ENA-78水平相应上升,差异有统计学意义（P =0.000）.结论 危重症患儿存在血液ENA-78水平的变化,测定血液中ENA-78水平,能对评估疾病严重程度及判断预后提供参考.

Objective To investigate the changes of epithelial neutrophil activating peptide-78 （ENA-78） in the serum of patients with critical illness,and to analyze the relationship between the severity and prognosis.Methods Prospective case-control study was performed,and 42 cases of critically ill patients admitted to Pediatric Intensive Care Unit,Children＆#39;s Hospital Affiliated to Shanghai Jiaotong University from Sep.to Nov.2013 were selected as critically ill group,blood specimens were collected within 24 hours and 7 days after their admission.Another 42 cases of blood samples were collected during physical examinations in this hospital as control group.The severity of critically ill patients were graded by Pediatric Critical Illness Score （PICS） and Pediatric Risk of Score Mortality （PRISM） Ⅲ,and the serum ENA-78 was measured by double antibody sandwich enzyme-linked immunoassay.Results 1.The level of ENA-78 in the control group was （0.44 ± 0.28） ng/L; ENA-78 in acute phase and recovery phase of critically ill group were （2.85 ± 0.89）ng/L and （1.00 ± 0.64）ng/L,respectively,there were statistical differences between control group and critically ill group,acute phase group and recovery phase group （all P =0.000）.2.The negative correlation was observed between ENA-78 concentration and PCIS score（r =-0.724,P =0.000）.ENA-78 in PRISM Ⅲ ≥ 10 group was significantly higher than that in PRISM Ⅲ〈 10 group（P =0.000）.The ENA-78 between death group and the survival group was significantly different（P =0.000）.3.ENA-78 in patients with severe infection was higher than that in the non-infectious cases（P =0.000）.4.With the organ dysfunction expanded ENA-78 rose accordingly,and the difference was statistically significant （P =0.000）.Conclusions The level of ENA-78 is different in critically ill patients in children.It can provide reference of assessing the severity of disease and predicting prognosis by determing the ENA-78 level.