炎性因子在小儿脓毒症早期的临床对比初探

Comparative research of inflammatory factors in child patients with sepsis

目的探讨脓毒症诊断前不同时间点的炎性因子[肝素结合蛋白（HBP）、降钙素原（PCT）、白介素－6（IL－6）、白介素－10（IL－10）、超敏C反应蛋白（hs－CRP）]的临床价值对比。 方法采取回顾性研究模型，选取2014年1月至2016年10月舟山市妇幼保健院儿科病房小儿脓毒症患者24例，平均年龄（4.08±1.68）岁，男性16例，女性8例。收集患儿诊断脓毒症时刻的前72 h（A组）、前48 h（B组）、前24 h（C组）血浆；同期选取22名无器质性疾病的小儿健康体检者抽取血浆作为正常对照组，平均年龄（4.07±1.58）岁，男性12名，女性10名。酶联免疫吸附法检测肝素结合蛋白（HBP）、白介素－6（IL－6）、白介素－10（IL－10），免疫荧光法检测降钙素原（PCT）和超敏C反应蛋白（hs－CRP）。采用重复测量的方差分析和多重比较检验各时间点的差异，受试者工作特征曲线分析其诊断价值。结果HBP在正常对照组、A组、B组、C组的血浆水平分别为（9.69±1.30）μg/L、（12.82±2.03）μg/L、（15.46±1.02）μg/L、（18.60±1.10）μg/L，HBP的B组、C组时间点分别高于A组和B组水平（t＝5.62，P〈0.01；t＝10.25，P〈0.01），A、B、C组均高于正常对照组（t＝6.27，P〈0.01；t＝16.82，P〈0.01；t＝25.16，P〈0.01）。受试者工作特征曲线（ROC曲线）显示，HBP在A组的诊断效能（AUC）分别为0.823，均高于其他4种炎性因子（IL－6、IL－10、PCT、hs－CRP）（Z＝2.41, P〈0.01；Z＝2.02, P〈0.05；Z＝0.38, P〉0.05；Z＝0.32, P〉0.05），HBP在B组的诊断效能（AUC）分别为0.898，均高于其他4种炎性因子（IL－6、IL－10、PCT、hs－CRP）（Z＝0.43, P〉0.05；Z＝0.46, P〉0.05；Z＝0.26, P〉0.05；Z＝0.57, P〉0.05），PCT在C组的诊断效能（AUC）为0.941，高于其他4种炎性因子（IL－6、IL－10、HBP、hs－CRP）（Z＝0.12, P〉0.05；Z＝0.08, P〉0.05；Z＝0.03, P〉0.05；Z＝0.10, P〉0.05）。结论HBP具有较宽的诊断窗口期，可作为小儿脓毒症的早期预测指标之一。IL－6、IL－10、PCT及hs－CRP在小儿脓毒症的不同时期也分别具有一定的诊断价值。

ObjectiveTo investigate clinical value of inflame factors in child patients with sepsis at different time points before the diagnosis time.MethodsA retrospective model was performed in this study. 24 child patients with sepsis in Department of Paediatrics from January 2014 to October 2016 were selected . At the time 72 h（group A）, 48 h（group B）, 24 h（group C） before the diagnosis time, plasma levels of HBP and serum levels of IL-6, IL-10 were detected by ELISA, and pre calcitonin （PCT） and high sensitive C reactive protein （hs-CRP） were detected by immunofluorescence. Compared to the same period, 22 healthy cases were selected as the control. Repeated measure anova and Receiver operating characteristic curve analysis were performed.ResultsThe plasma levels of HBP were （9.69±1.30） μg/L, （12.82±2.03） μg/L, （15.46±1.02） μg/L, （18.60±1.10） μg/L at group A, group B, group C before the diagnosis time respectively. The plasma levels of HBP at all time points before the diagnosis time were significantly higher than the control（t=6.27, P〈0.01; t=16.82, P〈0.01; t=25.16, P〈0.01）. The serum levels of HBP at group B, group C were significantly higher than the last time point（t=5.62, P〈0.01; t=10.25, P〈0.01）. Receiver operating characteristic curve（ROC） revealed that the areas of HBP at group A（0.823）, group B （0.898）, was significantly higher than the other inflame factors（Z=2.41, P〈0.01; Z=2.02, P〈0.05; Z=0.38, P〉0.05; Z=0.32, P〉0.05）（ Z=0.43, P〉0.05; Z=0.46, P〉0.05; Z=0.26, P〉0.05; Z=0.57, P〉0.05）. It also revealed that at group C, area of PCT（0.941） was significantly higher than the other inflame factors （Z=0.12, P〉0.05; Z=0.08, P〉0.05; Z=0.03, P〉0.05; Z=0.10, P〉0.05）.ConclusionsHBP has a wide diagnostic window period for sepsis. IL-6, IL-10, PCT and hs-CRP have diagnostic value in partial periods of sepsis.