内生吗啡对儿童脓毒症的诊断价值

Diagnostic value of endogenous morphine in childhood sepsis

目的检测脓毒症患儿血浆内生吗啡浓度,探讨内生吗啡对脓毒症患儿发生休克、死亡及多器官功能障碍(MODS)的预测价值。方法符合诊断标准的脓毒症患儿(n=31),根据是否伴有休克分为脓毒症非休克组(n=19)和休克组(n=12);根据结局分为存活组(n=22)和死亡组(n=9);根据是否伴有MODS分为非MODS组(n=13)和MODS组(n=18)。另设普通感染患儿(n=16)和行健康体检儿童(n=31)作为对照。用高效液相质谱串联法检测各组血浆内生吗啡浓度。用受试者工作特征曲线(ROC)评估内生吗啡对脓毒症患儿发生休克、死亡及MODS的预测价值。结果健康对照组儿童血浆未检测到内生吗啡,普通感染组仅3例患儿血浆检测到内生吗啡;脓毒症患儿血浆中均检测到内生吗啡。休克组患儿血浆内生吗啡浓度高于非休克组(P<0.05);死亡患儿血浆内生吗啡浓度高于存活患儿(P<0.05);MODS患儿血浆内生吗啡浓度高于非MODS患儿(P<0.05)。ROC结果显示内生吗啡对脓毒症患儿休克、死亡和MODS均有预测价值(P<0.05)。结论脓毒症患儿血浆内生吗啡浓度明显升高,其对脓毒症患儿休克、死亡、MODS风险的发生有较好的预测价值。

Objective To investigate the plasma concentration of endogenous morphine and the value of endogenous morphine in predicting shock, death, and multiple organ dysfunction syndrome（MODS） in children with sepsis. Methods A total of 31 children with sepsis who met the diagnostic criteria were enrolled. According to the presence or absence of shock, they were divided into non-shock group with 19 children and shock group with 12 children. According to the outcome, they were divided into survival group with 22 children and death group with 9 children. According to the presence or absence of MODS, they were divided into non-MODS group with 13 children and MODS group with 18 children. In addition, 16 children with common infection and 31 who underwent physical examination were enrolled as controls. High-performance liquid chromatography-mass spectrometry was used to measure the plasma concentration of endogenous morphine. The receiver operating characteristic（ROC） curve was used to evaluate the value of endogenous morphine in predicting shock, death, and MODS in children with sepsis. Results No endogenous morphine was detected in the healthy control group. Endogenous morphine was detected in 3 children from the common infection group and in all of 31 children with sepsis. The shock group had a significantly higher plasma concentration of endogenous morphine than the non-shock group（P〈0.05）. The death group had a significantly higher plasma concentration of endogenous morphine than the survival group（P〈0.05）. The MODS group had a significantly higher plasma concentration of endogenous morphine than the non-MODS group（P〈0.05）. The ROC curve showed that endogenous morphine had certain value in predicting shock, death, and MODS in children with sepsis（P〈0.05）. Conclusions There is a significant increase in the plasma concentration of endogenous morphine in children with sepsis, and endogenous morphine has a good value in predicting the risk of shock, death, and MODS.