血浆和肽素在脓毒症患儿病情严重程度分层中的意义初探

Preliminary exploration of the significance of plasma Copeptin for stratification according to severity in children with sepsis

目的通过观察小儿脓毒症和严重脓毒症患者体内血浆和肽素（Copeptin）水平的改变,探讨其在病情分层中的临床意义。方法入选住院脓毒症患儿48例,严重脓毒症患儿16例;另选取健康儿童30例作为正常对照组。同时检测两组患儿未经治疗时和对照组血浆中Copeptin、白细胞计数（WBC）、中性粒细胞计数（N）、C-反应蛋白（CRP）、降钙素原（PCT）及血清钠水平。结果脓毒症和严重脓毒症患儿体内血浆Copeptin及PCT均显著高于对照组（P〈0.01）,同时脓毒症和严重脓毒症间比较差异也有统计学意义（P〈0.05）;组间CRP及血清钠水平比较差异未见统计学意义（P〉0.05）,脓毒症与严重脓毒症组WBC、N比较差异未见统计学意义（P〉0.05）。各组外周血浆Copeptin与PCT有一定相关性（r=0.563,P〈0.01）,尚不能认为与余各炎症指标（WBC、N、CRP）和血清钠相关（r〈0.50或P〉0.05）。脓毒症患儿Copeptin和PCT受试者工作特征曲线（ROC曲线）分析显示,Copeptin对严重脓毒症有显著诊断价值[曲线下面积=0.872,95%可信区间（95%CI）：0.744~1.001,P=0.001],优于PCT（AUC=0.694）。取截点Copeptin〉0.91 ng/ml,对诊断有80.00%的敏感度和83.33%的特异度。结论检测脓毒症患儿体内血浆Copeptin和PCT水平有助于患儿病情及其严重程度分层判断,且Copeptin优于后者。

Objective To investigate the clinical significance of plasma Copeptin levels in children with sepsis and severe sepsis. Methods Forty-eight children with sepsis and 16 children with severe sepsis were selected,30 healthy children were selected as the control group. At the same time,plasma Copeptin levels,as well as white blood cell count（ WBC）,neutrophil count（ N）, C-reactive protein（ CRP）, procalcitonin（ PCT） and serum sodium levels were detected in each group.Results Plasma Copeptin and PCT levels in children with sepsis and severe sepsis were significantly higher than those in control group（ P〈0. 01）. There was statistical significant difference between children with sepsis and severe sepsis（ P〈0. 05）. As for levels of plasma CRP and serum sodium,there were no statistically significant differences（ P〈0. 05）,also for WBC,N between sepsis and severe sepsis cases（ P〈0. 05）. There was some correlation between plasma Copeptin and PCT levels,but no significant correlation between plasma Copeptin levels and inflammatory markers（ WBC,N and CRP） or serum sodium（ r 0. 50 or P〈0. 05） in each group. Test receiver operating characteristic curve（ ROC curve） analysis showed that plasma Copeptin levels had significant value for diagnosis of children with severe sepsis [area under the curve = 0. 872,95% of confidence interval（ 95% CI） ： 0. 744-1. 001,P = 0. 001],which was better than PCT（ AUC = 0. 694）; when Copeptin 0. 91 ng/ml was taken as the cut-off value,the sensitivity was 80. 00% and specificity was 83. 33%. Conclusion Plasma copeptin and PCT levels in children with sepsis might be helpful for judgement of patients＇ condition and its severity,and the former is better.