血清降钙素原、白蛋白、可溶性髓样细胞触发受体-1对脓毒症患儿的临床诊断价值

Clinical diagnostic value of serum procalcitonin, albumin and soluble myeloid cell trigger receptor-1 in children with sepsis

目的探讨血清降钙素原(PCT)、白蛋白(Alb)、可溶性髓样细胞触发受体-1(s TREM-1)对脓毒症患儿的临床诊断价值。方法选取2015年10月~2017年8月于湖南省妇幼保健院确诊的脓毒症患儿140例(脓毒症组)及非感染全身炎症反应综合征患儿(对照组)60例为研究对象。比较两组患儿血清PCT、Alb及s TREM-1水平,并根据病情将脓毒症组患儿分为一般脓毒症组(79例)、严重脓毒症组(43例)、脓毒症休克组(18例)进行亚组分析。采用受试者工作曲线分析血清PCT、Alb、sTREM-1单独及联合应用在脓毒症鉴别诊断中的应用价值。结果脓毒症组患儿的血清PCT、sTREM-1均显著高于对照组(P<0.05);脓毒症组患儿的血清Alb和小儿危重病例评分(PCIS)均显著低于对照组(P<0.05);一般脓毒症组、严重脓毒症组、脓毒症休克组患儿的血清PCT、sTREM-1比较差异均有统计学意义(P<0.05),无逐渐升高趋势。一般脓毒症组、严重脓毒症组及脓毒症休克组患儿的血清Alb和PCIS评分比较差异均有统计学意义(P<0.05),无逐渐降低趋势。PCT+Alb+s TREM-1断脓毒症、炎症反应综合征患儿的灵敏度为91.96%、特异度为95.72%、AUC值为0.956,高于三者单独检测。结论 PCT+Alb+s TREM-1联合应用诊断脓毒症患儿较单一检测具有更高的临床价值。

Objective To investigate the clinical value of serum procalcitonin（PCT）, albumin（Alb） and soluble myeloid cell triggering receptor-1（sTREM-1） in the diagnosis of children with sepsis. Methods From October 2015 to August2017, 140 children with sepsis（sepsis group） and 60 cases of non-infectious children with systemic inflammatory response syndrome（control group） in Hu＇nan Provincial Maternal and Child Health Care Hospital were selected as the study objects. Levels of serum PCT, Alb, and sTREM-1 were compared between two groups, and according to the condition of illness, children of the sepsis group were divided into general sepsis group（79 cases）, severe sepsis group（43 cases）and septic shock group（18 cases） for subgroup analysis. The value of serum PCT, Alb, and sTREM-1 alone or in combination in the diagnosis of sepsis was analyzed by using the subjects＇ work curve. Results The levels of serum PCT and sTREM-1 of the sepsis group were significantly higher than those of the control group（P〈0.05）; level of serum Alb and PCIS score of the sepsis group were significantly lower than those of the control group（P〈0.05）; the differences of serum PCT, sTREM-1 in general sepsis group, severe sepsis group and septic shock group were statistically significant（P〈0.05）, without gradual increasing trend; the differences of serum Alb, PCIS score among groups were statistically significant（P〈0.05）, without gradual decreasing trend. The sensitivity, specificity and AUC value of PCT＋Alb＋sTREM-1 were 91.96%, 95.72% and 0.956 respectively in the diagnosis of children with sepsis and inflammatory response syndrome. Conclusion PCT＋Alb＋sTREM-1 combined diagnosis has higher clinical value in children with sepsis.