内毒素联合降钙素原检测在儿童重症肺炎中的临床价值

The clinical value of endotoxin combined with procalcitonin in the treatment of children with severe pneumonia

目的探讨内毒素联合降钙素原(PCT)检测在儿童重症肺炎中的临床应用价值。方法回顾性分析2013年3月至2016年3月住我院PICU的241例重症肺炎患儿的临床资料。根据病原学分为细菌性重症肺炎组及非细菌性重症肺炎组,分别对两组的内毒素、PCT水平进行比较。细菌性重症肺炎再细分为革兰阴性菌感染组、革兰阳性菌感染组,并比较两组的内毒素及降钙素原水平。结果内毒素在革兰阴性菌感染的重症肺炎均值为(1.256±0.725)EU/ml,明显高于革兰阳性菌重症肺炎组的内毒素均值(0.453±0.247)EU/ml(P<0.05)。细菌感染组重症肺炎PCT均值为(6.87±2.34)ng/ml,显著高于非细菌感染重症肺炎组的PCT均值(1.76±0.57)ng/ml(P<0.05)。结论血内毒素检测有助于区分重症肺炎致病细菌的种类,血清降钙素原血清浓度可早期估计重症肺炎病原体的种类,对指导临床用药有重要价值。

Objective： To explore the clinical value of endotoxin combined with procalcitonin（ PCT） in the treatment of children with severe pneumonia. Methods： A retrospective analysis was made of the clinical data of 241 children with severe pneumonia who were hospitalized in the PICU between March 2013 and March 2016. According to the pathogen severe pneumonia group were classified into bacterial severe pneumonia group and non-bacterial pneumonia group,and the levels of endotoxin and PCT were compared between the two groups. Severe bacterial pneumonia group was subdivided into the Gram negative bacteria infection group and the Gram positive bacteria infection group,and endotoxin and PCT levels were compared between the two groups. Results： Endotoxin in the Gram negative bacteria infection of severe pneumonia was（ 1. 256 ±0. 725） EU/ml,which was significantly higher than the Gram positive bacteria（ 0. 453 ± 0. 247 EU/ml,P〈0. 05）. PCT mean of bacterial infection group of severe pneumonia was 6. 87 ± 2. 34 ng/ml,which was significantly higher than the nonbacterial infection in severe pneumonia group（ 1. 76 ± 0. 57 ng/ml,P〈0. 05）. Conclusion： Endotoxin is helpful to distinguish the species of pathogenic bacteria,and the serum levels of PCT can be used to estimate pathogens in the early stage of severe pneumonia to guide clinical drug adminstration.