脓毒血症患儿血清降钙素原和血乳酸水平与病情严重程度和预后的关系

Association of serum levels of procalcitonin and blood lactate with severity and prognosis in children with sepsis

目的探讨脓毒血症患儿血清降钙素原和血乳酸水平与病情严重程度和预后的关系。方法选取2016年1月-2018年8月在贺州市人民医院接受治疗的98例脓毒血症患儿作为观察组,同期体检的健康儿童42例作为对照组。根据病情程度进一步分为脓毒症组,严重脓毒症组,脓毒性休克组。根据预后情况不同分为生存组和死亡组。比较各组血清降钙素原(procalcitonin,PCT)和血乳酸水平,并分析其与病情严重程度和预后的关系。结果 98例患儿,脓毒症34例,严重脓毒症36例,脓毒性休克28例;经规范治疗后,生存72例,死亡26例。与对照组比较,观察组患儿入院时血清PCT和血乳酸水平显著上升(P<0.05)。脓毒性休克组患儿入院时血清PCT和血乳酸水平最高,严重脓毒症组次之,脓毒症最低(P<0.05)。生存组患儿入院时血清PCT和血乳酸水平均低于死亡组(P<0.05);入院时血清PCT和血乳酸水平均与预后呈正相关(P<0.05)。血清PCT及乳酸水平与急性生理和慢性健康状况(acute physiology and chronic health evaluationⅡ,APACHEⅡ)、序贯器官衰竭评分(sequential organ failure assessment,SOFA)评分显著相关,均呈正相关。其中血清PCT水平与APACHEⅡ评分及SOFA评分的相关性较好(P<0.001)。入院时血清PCT的评估脓毒血症的曲线下面积(AUC)和95%CI分别为0.884和(0.854~0.973),当截断点为6.3μg/L时,灵敏度、特异度分别为85.4%和80.5%。血乳酸的评估脓毒血症的AUC和95%CI分别为0.757和(0.617~0.902),当截断点为3.7 mmol/L时,灵敏度、特异度分别为87.9%和83.7%。结论脓毒血症患儿血清降钙素原和血乳酸水平显著上升,与患儿病情严重程度和预后有关,对病情和预后判断有一定的参考价值。

Objective To investigate the relationships between ser um levels of procalcitonin(PCT)and blood lactate on one hand and the severity and prognosis of sepsis in children on the other hand. Methods A total of 98 children with sepsis treated in our hospital between January 2016 and August 2018 were enrolled as the observation group while another 42 healthy children were selected as the control group. According to the severity of disease, the patients were again divided into the sepsis group, severe sepsis group and septic shock group. According to prognosis, they were also divided into the survival group and death group. Ser um procalcitonin(PCT)and blood lactate levels were compared bet ween these g roups and analyzed for their cor relations with the sever it y and prog nosis of the disease. Results There were 34, 36, and 28 patients in the sepsis group, severe sepsis group and septic shock group, respectively, compared with 72 and 26 in the survival group and death group respectively.Compared with the control group, ser um PCT and blood lactate levels were signif icantly increased in the obser vation group(P<0.05). They were the highest in the septic shock group, followed by the severe sepsis group and sepsis group(P<0.05). Ser um PCT and blood lactate levels were lower in the sur vival group than in the death group(P<0.05). Ser um PCT and blood lactate levels were positively correlated with prognosis at admission(P<0.05).Ser um PCT and lactate levels were sig nif icantly cor related with the A PACHEⅡ score and SOFA score, and all were positively cor related. The cor relations between ser um PCT levels and the APACHEⅡ score and SOFA score were good(P<0.001).The area under the curve(AUC)and 95%CI of sepsis were 0.884 and(0.854~0.973), respectively. When the cut-off point was 6.3 μg/L, the sensitivity and specificity were 85.4% and 80.5%, respectively. The AUC and 95%CI of sepsis for blood lactic acid was 0.757 and(0.617~0.902), respectively. When the cut-off point was 3.7 mmol/L, the sensitivity and specificity were 87.9% and 83.7%, respectively. Conclusion Serum procalcitonin and blood lactate levels in children with sepsis are significantly increased, which is related to the severity and prognosis of the disease. This finding is of referential value for the diagnosis of disease and prognosis.