动态监测社区获得性肺炎患儿血清铁蛋白水平变化及其临床意义

Dynamic monitoring of serum ferritin in children with community-acquired pneumonia and its clinical significance

目的:探讨动态监测社区获得性肺炎(community-acquired pneumonia,CAP)患儿血清铁蛋白(serum ferritin,SF)水平对评估病情严重程度及预后的临床意义。方法:随机选取2018-09-01~2019-11-30我院儿科确诊为CAP的168例患儿为研究对象,根据诊断标准分为CAP组(n=93)和SCAP组(n=75),SCAP组根据相应评分标准分为非危重组、危重组和极危重组3个亚组。另选同期健康体检合格的86例儿童为对照组。检测各组入院时SF、C反应蛋白(C-reactive protein,CRP)、降钙素原(procalcitonin,PCT)和白细胞(white blood cell,WBC)水平;SCAP组治疗第7天复查SF水平,根据第7天的SF水平将SCAP患儿分为SF升高组和SF正常组,比较两组的入住重症监护室(intensive care unit,ICU)时间、总住院时间、气管插管率和病死率。结果:SCAP组的SF、CRP、PCT和WBC均明显高于CAP组和对照组(P<0.01),CAP组的CRP、PCT和WBC高于对照组(P<0.01),SF稍高于对照组,但差异无统计学意义(P>0.05);SCAP各亚组间比较,非危重组、危重组和极危重组SF水平依次升高,危重组SF水平明显高于非危重组(P<0.01);极危重组SF水平明显高于危重组(P<0.01);SF升高组入住ICU时间、总住院时间、气管插管率和病死率均明显高于SF正常组(P<0.01)。结论:SCAP患儿急性期SF明显升高且与病情严重程度有关,恢复期SF降至正常范围;动态监测SF水平有助于评估肺炎患儿的病情及预后。

Objective:To investigate the clinical significance of dynamic monitoring serum ferritin(SF)in children with community-acquired pneumonia(CAP).Methods:A total of 168 children diagnosed with CAP in our hospital from September 2018 to November 2019 were randomly selected as the subjects.These subjects were divided into CAP group(n=93)and SCAP group(n=75).SCAP group were further divided into non-critical group,critical group and extremely critical group.And 86 children who underwent physical examination during the same period were enrolled as the control group.The levels of SF,C-reactive protein(CRP),procalcitonin(PCT)and white blood cell(WBC)were measured at admission in all children,and the levels of SF were measured on the 7th day of treatment and at discharge for the SCAP group.According to the SF level on the 7th day of treatment,the children with severe pneumonia were divided into SF increasing group and normal SF group,and the length of intensive care unit(ICU)stay,length of hospital stay,tracheal intubation rate and mortality were compared between the two groups.Results:The SF,CRP,PCT and WBC levels in SCAP group were significantly higher than those in the CAP group and the control group(P<0.01),the CRP,PCT and WBC levels in CAP group were significantly higher than those in control group(P<0.01),the SF level in CAP group was slightly higher than that in control group,but the difference was not statistically significant(P>0.05).The SF levels in children with critical pneumonia were significantly higher than that in non-critical group(P<0.01),the SF levels in children with the extremely critical pneumonia were significantly higher than that in critical group(P<0.01).There were significant differences in length of hospital stay,length of ICU stay,tracheal intubation rate and mortality between SF increasing group and normal group(P<0.01).Conclusion:The level of SF in children with SCAP is significantly increased in acute phase which was correlated with the severity of the disease,and the level of SF decreased to the normal range in the recovery period.Dynamic monitoring of SF level is helpful to evaluate the disease status and prognosis of children with pneumonia.