血清PCT、BNP、DD与PCIS评分对重症肺部感染儿童的评估效果

Effect of serum PCT, BNP, DD and PCIS scores on children with severe pulmonary infection

目的探究血清降钙素原(procalcitonin,PCT)、脑钠肽(brain natriuretic peptide,BNP)、D-二聚体(D-dimer,DD)与小儿危重病例评分(pediatric critical illness score,PCIS评分)对重症肺部感染儿童临床结局的评估效果。方法选取2015年1月-2017年1月简阳市人民医院收治的重症肺部感染患儿102例,根据患儿的临床结局状况将所有患儿分为治愈组55例和预后不良组47例。统计患儿进入重症监护病房24 h内的DD、血清PCT、BNP结果以及PCIS评分分值,分别绘制以上指标的受试者工作特征(receiver operation characteristic,ROC)曲线并比较曲线下面积(Area Under Curve,AUC);结合以上四项指标绘制ROC曲线,将其与各指标的AUC分别比较来评价血清PCT、BNP、DD与PCIS评分对重症肺部感染患者临床结局的评估价值。结果治愈组患者BNP、血清PCT、DD水平均较预后不良组低,PCIS评分较预后不良组高(P<0.05);患者进入重症监护病房24 h内的BNP、血清PCT、DD以及PCIS评分的AUC范围均在0.7~0.9之间,四个指标联合应用的AUC为0.931,特异度和灵敏度均较单独应用有所提升。结论血清PCT、BNP、DD与PCIS评分联合应用对重症肺部感染儿童的诊断和病情判断具有较高的价值,可以提高此类患者的预后判断的准确率。

OBJECTIVE To explore the evaluation effect of serum procalcitonin(PCT), brain natriuretic peptide(BNP), D-dimer(DD) and pediatric critical illness score(PCIS) scores on the clinical outcomes of children with severe pulmonary infection. METHODS Totally 102 patients with severe pulmonary infection treated in our hospital from Jan. 2015 to Jan. 2017 were selected. All patients were divided into the cured group(n=65) and the poor prognosis group(n=47) according to the clinical outcome of the patient. DD, serum PCT, BNP results and PCIS scores within 24 hours after admission to the intensive care unit were recorded, the receiver operating characteristic(ROC) curves of the above indicators were plotted and the area under the curve(AUC) was compared. The ROC curve was drawn by combining the above four indicators, and it was compared with the AUC of each index to evaluate the value of serum PCT, BNP, DD and PCIS scores in the evaluation of clinical outcomes in patients with severe pulmonary infection. RESULTS The BNP, serum PCT, and DD levels in the cured group were significantly lower than those in the poor prognosis group, and the PCIS score was significantly higher than the poor prognosis group(P<0.05). The AUC range of BNP, serum PCT, DD, and PCIS score obtained within 24 hours after admission to the intensive care unitwas all between 0.7 and 0.9, and the AUC of the four indicators in combined use was 0.931. The specificity and sensitivity were both improved compared with single application. CONCLUSION The combination of serum PCT, BNP, DD and PCIS scores has certain value in the diagnosis and judgment of children with severe pulmonary infection, which can improve the accuracy of prognosis judgment of such patients.