小剂量糖皮质激素对小儿脓毒症血清sTREM-1、PCT、CD64的影响

Influence of small doses of hormones on serum sTREM-1,PCT,CD64 in pediatric sepsis

目的探讨小剂量糖皮质激素对小儿脓毒症血清可溶性髓系细胞触发受体1(sTREM-1)、降钙素原(PCT)、CD64的影响。方法选取2014年3月~2016年3月中国石油中心医院儿科住院收治66例脓毒症患儿,采用随机数字表法分成两组,每组33例。均予原发病和退热等对症治疗,对照组予脓毒症集束化(抗生素、强化胰岛素、营养支持等)治疗,研究组在上述基础上再予小剂量注射用甲泼尼龙琥珀酸钠静脉滴注,治疗7 d。检测外周血T淋巴细胞、炎症指标PCT、C反应蛋白(CRP)、白介素-8(IL-8)和sTREM-1、可溶性细胞间黏附因子-1(sICAM-1)以及可溶性血管细胞黏附分子-1(sVCAM-1)水平。评估小儿危重病例评分标准(PCIS)及急性生理学及慢性健康状况评分系统Ⅱ(APACHEⅡ)评分,比较治疗效果。结果与治疗前比较,两组治疗后CD3^+、CD4^+及CD8^+升高(P<0.01),CD64^+降低(P<0.01),PCT、CRP、IL-8降低(P<0.01),sTREM-1、sICAM-1、sVCAM-1降低(P<0.01),PCIS评分升高(P<0.01),APACHEⅡ评分降低(P<0.01);与对照组比较,研究组CD3^+、CD4^+及CD8^+较高(P<0.01),CD64^+较低(P<0.01),PCT、CRP、IL-8较低(P<0.01),sTREM-1、sICAM-1、sVCAM-1较低(P<0.01),PCIS评分较高(P<0.05),APACHEⅡ评分较低(P<0.01),总有效率较高(P<0.05)。结论小剂量糖皮质激素能有效降低脓毒症患儿血清sTREM-1、PCT、CD64^+水平,具有重要临床价值。

Objective To explore the influence of small doses of hormones on serum sTREM-1, PCT, CD64 in pediatric sepsis.Methods 66 cases of children with sepsis treated in Pediatrics Department of CNPC Central Hospital from March 2014 to March 2016 were selected as research objects.They were divided into two groups according to random number table method, 33 cases in each group.All pateints were given symptomatic treatment.Patients in the control group were given bundle of treatment, inculding antibiotics, intensive insulin, nutritional support.On the basis of the control gorup, patients in the study group were given small dose Methylprednisolone Sodium Succinate for Injection for7 d.The levels of peripheral blood T lymphocyte, inflammatory index（PCT, CRP, IL-8） and sTREM-1, sICAM-1 and sVCAM-1 were detected.The scores of PCIS and APACHE Ⅱ were evaluated.The therapeutic effect was compared between the two groups.Results Compared with before treatment, after treatment two groups of CD3＋, CD4＋and CD8＋increased（P 〈0.01）, CD64＋decreased（P〈 0.01）, levels of PCT, CRP, IL-8 decreased（P 〈0.01）, levels of sTREM-1,sICAM-1, sVCAM-1 decreased（P〈 0.01）, PCIS score increased（P〈 0.01）, APACHE Ⅱ score decreased（P 〈0.01）.Compared with the control group, the study group had higher CD3＋, CD4＋and CD8＋（P〈 0.01）, lower CD64＋（P〈 0.01）,lower levels of PCT, CRP, IL-8 and sTREM-1、sICAM-1、sVCAM-1（P〈 0.01）, higher PCIS score（P〈 0.05）, lower APACHE Ⅱ score（P 〈0.01）, and higher total effective rate（P 〈0.05）.Conclusion Small doses of glucocorticoid can effectively reduce serum sTREM-1, PCT, CD64＋ levels of sepsis patients, which has important clinical value.