降钙素原联合C-反应蛋白、白细胞计数检测在儿童创伤中的应用

Application of procalcitonin combined with C-reactive protein and white blood cell count detection in the pediatric trauma

目的探讨降钙素原(PCT)、C-反应蛋白(CRP)、白细胞计数(WBC)在儿童创伤病人中的应用价值。方法回顾性分析2015年1月至2016年6月安徽省立医院儿童重症监护病房的36例创伤患儿,分为死亡+放弃组、存活组,分析创伤原因,并分别比较不同结局患儿、入院当天与入院第3天、发生脓毒症与未发生脓毒症患儿的各项指标情况。结果 (1)死亡+放弃组患儿入院当天PCT、CRP水平分别为(25.38±22.89)μg/L、(45.63±25.67) mg/L,明显高于存活组患儿,差异有统计学意义(t=2.32、2.26,P=0.04、0.04);而两组间的WBC差异无统计学意义(t=-0.21,P=0.84);(2)22例患儿在入院第3天时复查了PCT、CRP、WBC等指标,结果显示PCT水平下降至(3.41±1.56)μg/L,与第1天相比差异有统计学意义(t=5.15,P=0.00);而CRP水平上升至(47.42±18.32) mg/L,与第1天相比差异有统计学意义(t=-2.40,P=0.03),WBC变化则差异无统计学意义(t=-1.61,P=0.13);(3)创伤患儿发生脓毒症(11例)与未发生脓毒症者(25例)入院时PCT、CRP、WBC比较差异无统计学意义(均P>0.05)。结论儿童创伤后PCT、CRP水平与创伤严重程度相关,创伤后PCT水平恢复较快,创伤早期PCT水平对脓毒症的发生可能不具有预测价值。

Objective To explore the application of procalcitonin(PCT),C-reactive protein(CRP)and white blood cell count(WBC)in the pediatric trauma patients.Methods Thirty-six cases of trauma patients admitted to Pediatric Intensive Care Unit in Anhui Provincial Hospital from January 2015 to June 2016 were analyzed retrospectively.Patients were assigned into death+abandonment group and survival group.The causes of trauma were analyzed.PCT,CRP and WBC were compared in children with different outcomes,on the first day of admission and on the third day of admission,and between children with sepsis and without sepsis.Results(1)On the first day of hospitalization,PCT and CRP levels in death+abandonment group were(25.38±22.89)μg/L and(45.63±25.67)mg/L,respectively,which were significantly higher than those in survival group(t=2.32,2.26,respectively,P=0.04,0.04,respectively).There was no difference in the number of WBC between the two groups(t=-0.21,P=0.84).(2)The PCT,CRP,WBC of 22 cases were examined again on the third day of hospitalization.The results showed that PCT level dropped sharply to(3.41±1.56)μg/L,and the difference was statistically significant compared with that on the first day of hospitalization(t=5.15,P=0.00);CRP level rose to(47.42±18.32)mg/L,and the difference was statistically significant compared with the first day of hospitalization(t=-2.40,P=0.03);the difference in the number of WBC was not statistically significant compared with the first day of hospitalization(t=-1.61,P=0.13).(3)There were no significant differences in PCT,CRP,and WBC levels between the patients with traumatic sepsis(11 cases)and those without traumatic sepsis(25 cases)(all P >0.05).Conclusions Post-traumatic PCT and CRP levels were associated with traumatic severity and post-traumatic PCT level restored faster.PCT levels in the early trauma onset did not show predictive value for the occurrence of sepsis.