小儿脓毒症血清sE-选择素、D-二聚体检测的临床意义

Clinical Significance of Serum sE-selectin and D-dimer in Children with Sepsis

目的探讨s E-选择素、D-二聚体水平在小儿脓毒症中的价值。方法选取2014年1月到2015年4月保定市儿童医院接诊的60例脓毒症患儿,根据中华医学会儿科学会急救组制订的小儿危重病例评分标准将患儿分为严重脓毒症组(30例)和脓毒症组(30例),选择同期来医院就诊的30例普通感染患儿作为普通感染组(30例)。比较三组患者治疗前后s E-选择素和D-二聚体水平以及D-二聚体的阳性率。结果治疗前,严重脓毒症组s E-选择素和D-二聚体水平均高于脓毒症组和普通感染组[(45.17±14.25)mg/L比(15.70±3.08)mg/L、(6.10±1.02)mg/L,(3.74±1.03)mg/L比(1.65±0.37)mg/L、(0.20±0.05)mg/L],差异有统计学意义(P<0.05);治疗后,三组患者s E-选择素和D-二聚体的水平均较治疗前降低[(5.39±1.29)mg/L、(5.37±1.23)mg/L、(5.34±1.13)mg/L,(0.18±0.05)mg/L、(0.16±0.04)mg/L、(0.17±0.04)mg/L],但组间比较差异无统计学意义(P>0.05);治疗前,严重脓毒症组、脓毒症组以及普通感染组患儿D-二聚体的阳性率分别为93.33%(28/30)、76.67%(23/30)和26.67%(8/30),严重脓毒症组患儿的阳性率显著高于脓毒症组和普通感染组,而脓毒症组患者高于普通感染组,差异有统计学意义(P<0.05)。结论脓毒症患儿体内s E-选择素和D-二聚体水平可在一定程度上反映病情变化,特别是D-二聚体可在一定程度上反映病情的严重程度。

Objective To investigate the clinical value of s E-selectin and D-dimer level in children with sepsis. Methods Total of 60 patients with sepsis in children＇ s hospital of Baoding from Jan. 2014 to Apr.2015 were included in the study,according to pediatric critical illness score by First Aid Group of Chinese Academy of Medical Science,the patients were divided into severe sepsis group（ 30 cases） and sepsis group（ 30 cases）. 30 cases of normal infection who came to hospital during the same period were included as the normal infection group（ 30 cases）. The levels of s E-selectin and D-dimer and the positive rate of D-dimer in the three groups before and after treatment were compared. Results Before treatment,the levels of s E-selectin and D-dimer in the severe sepsis group were higher than the sepsis group and the normal infection group[（ 45. 17 ± 14. 25） mg/L vs（ 15. 70 ± 3. 08） mg/L,（ 6. 10 ± 1. 02） mg/L,（ 3. 74 ± 1. 03） mg/L vs（ 1. 65 ± 0. 37） mg/L,（ 0. 20 ± 0. 05） mg/L],the differences had statistically significance（ P 〈0. 05）; after treatmen,the s E-selectin and D-dimer of the three groups were reduced[（ 5. 39 ± 1. 29） mg / L vs（ 5. 37 ±1. 23） mg / L,（ 5. 34 ± 1. 13） mg / L,（ 0. 18 ± 0. 05） mg / L vs（ 0. 16 ± 0. 04） mg / L（ 0. 17 ± 0. 04） mg / L],there was no significant difference among the three groups（ P〉0. 05）. The positive rates of D-dimer in the severe sepsis group[93. 33%（ 28 /30） ] were higher than sepsis group [76. 67%（ 23 /30） ] and normal infection group [26. 67%（ 8 /30） ],while the sepsis group were higher than those in normal infection group,the difference were statistically significant（ P 〈0. 05）. Conclusion The levels of s E-selectin and D-dimmer can reflect the pathogenetic condition of sepsis in children,especially that D-dimmer can reflect the severity of the disease.