降钙素原及白介素-6测定在急性扁桃体炎合并脓毒症患儿中的诊断价值研究

Value of procalcitonin and interleukin-6 in diagnosis of acute tonsillitis children complicated with sepsis

目的研究降钙素原及白介素-6测定在小儿急性扁桃体炎并脓毒症患儿中的诊断价值。方法选取2013年6月-2015年7月急性扁桃体炎并脓毒症患儿86例为脓毒症组,急性扁桃体炎患儿90例为扁桃体炎组、健康儿童44例为对照组;分别对患儿进行降钙素原(PCT)、白介素-6(IL-6)、C-反应蛋白(CRP)、白细胞计数(WBC)、中性粒细胞比值(N)水平以及急性生理与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分测定,比较其结果在三组中治疗前、第3天、第5天及治疗结束变化情况。结果治疗前,脓毒症组、扁桃体炎组PCT为(14.92±3.84)ng/mL、(11.10±1.00)ng/mL、IL-6为(365.20±78.00)ng/L、(262.20±47.00)ng/L)、CRP为(19.48±2.00)mg/L、(16.20±2.32)mg/L、WBC为(18.50±7.40)×109/L、(11.60±2.40)×109/L、N为(85.00±4.70)%、(78.00±2.15)%水平以及APACHEⅡ评分(20.60±4.20)分、(14.61±2.10)分,均高于对照组,差异有统计学意义(P<0.05);脓毒症组,治疗第3天各项指标(PCT(25.12±4.10)ng/mL、IL-6(468.20±64.00)ng/L、CRP(24.60±3.10)mg/L、WBC(22.72±2.10)×109/L、N(89.00±3.84)%水平以及APACHEⅡ评分(27.10±3.10)分,均高于治疗前;治疗第5天(PCT(13.05±2.16)ng/mL、IL-6(80.50±4.10)ng/L、CRP(14.20±3.30)mg/L、WBC(7.20±1.00)×109/L、N(89.00±3.84)%水平以及APACHEⅡ评分(14.20±3.30)分,低于治疗第3天;治疗第3天和第5天,各项指标高于扁桃体炎组,差异有统计学意义(P<0.05);治疗结束,与扁桃体炎组比较,差异无统计学意义。结论 PCT及IL-6检测有助于小儿急性扁桃体炎合并脓毒症的早期诊断、病情评估和临床指导,且PCT、IL-6的截断值14.50ng/mL、365.50ng/L,能为临床早期诊断提供参考。

OBJECTIVE To study the value of proealcitonin （PCT） and interleukin-6 （IL-6） in diagnosis of acute tonsillitis children complicated with sepsis. METHODS From Jun 2013 to Jul 2015, a total of 86 acute tonsillitis children complicated with sepsis were chosen as the sepsis group, 92 children with acute tonsillitis were assigned as the tonsillitis group, and 44 healthy children were set as the control group. The levels of PCT, IL-6, C-reactive protein （CRP）, white blood cell counts （WBC）,and neutrophil ratio （N） as well as acute physiology and chronic health evaluation Ⅱ （APACHE Ⅱ ） score were respectively determined for the childreng the results were observed and compared among the three groups before the treatment, on day 3, 5 of treatment, and at the end of treatment. RESULTS Before the treatment, the PCT level was （14. 92±3.84） ng/mL in the sepsis group, （11. 10±1.00） ng/mL in the tonsillitis group the IL-6 level was （365.20±78.00） ng/L in the sepsis group, （262.20±47.00） ng/L in the tonsillitis group the CRP level was （19. 48± 2.00）mg/L in the sepsis group, （16.20 ±2.32） mg/L in the tonsillitis group the WBC counts were （18.50±7.40） ×109/L in the sepsis group, （11. 60±2.40） × 109/ L in the tonsillitis group the N was （85. 00±4.70） % was in the sepsis group, （78. 00±2.15） % in the tonsillitis group the APACHE Ⅱ score was （20. 60±4. 20） points in the sepsis group, （14. 61± 2. 10）points inthe tonsillitis group the above indexes were higher in the sepsis group and tonsillitis group than in the control group, and there was significant difference （P〈0.05）. The indexes of the sepsis group were higher on day 3 of treatment （PCT（25.12±4.10） ng/mL, IL-6（468.20±64.00） ng/L, CRP（24.60±3.10）mg/L, WBC（22.72± 2.10）× 109/L, N（89.00±3.84） %, APACHE Ⅱ score （27.10±3.10） points） than before the treatment the indexes of the sepsis group were lower on day 5 of treatment （PCT（13. 05±2.16） ng/mL, IL-6（80.50±4.10） ng/L, CRP（14.20±3.30）mg/L, WBC（7. 20±1. 00） ×109/L, N（89.00±3.84） %, APACHE 11 score （14.20 ±3, 30） points） than on day 3 of treatment the indexes of the sepsis group were higher than those of the tonsillitis group on day 3 and 5 of treatment, and there was significant difference （P〈0.05） ; there was no significant difference between the sepsis group and the tonsillitis group at the end of treatment. CONCLUSION The detection of PCT and IL-6 is conducive to early diagnosis of the acute tonsillitis children complicated with sepsis and evalua- tion of illness condition as well as clinical guidance. The cutoff values of PCT and IL-6 are respectively 14.50ng/ mL and 365.50ng/L, which may provide guidance for early clinical diagnosis.