SAA、sTREM-1与脓毒症患儿APACHE Ⅱ评分的相关性研究

Relationship between SAA,sTREM-1 and APACHE Ⅱ score in children with sepsis

目的探讨血清淀粉酶样蛋白A(SAA)、可溶性髓系细胞触发受体-1(sTREM-1)与脓毒症患儿急性生理学与慢性健康状况Ⅱ(APACHEⅡ)评分的相关性。方法采用前瞻性研究,选取2018年8月至2020年8月在番禺区何贤纪念医院及广州妇女儿童医疗中心儿童重症监护室治疗的脓毒症患儿85例作为研究组,另选取同期入院的50例患感染性疾病的非脓毒症患儿作为对照组,再根据APACHEⅡ评分将研究组患儿进行分组。测定所有患儿血清SAA、sTREM-1水平并分析其与APACHEⅡ评分的关系,绘制受试者工作特征曲线(ROC)分析血清SAA、sTREM-1对患儿脓毒症的诊断价值。结果研究组患儿血清SAA、sTREM-1水平明显高于对照组(t值分别为123.600、24.693,P<0.05);低、中、高危组脓毒症患儿血清SAA、sTREM-1水平比较差异均有统计学意义(F值分别为32.428、28.571,P<0.05),中危组和高危组患儿血清SAA、sTREM-1水平显著高于低危组(SAA:t值分别为7.979、8.559;sTREM-1:t值分别为10.132、22.233,P<0.05),高危组SAA、sTREM-1水平均显著高于中危组(t值分别为3.863、13.544,P<0.05)。血清SAA、sTREM-1水平均与APACHEⅡ评分呈正相关(相关系数r分别为0.748、0.772,P<0.05)。血清SAA、sTREM-1单独检测及联合检测的曲线下面积分别为0.834、0.791、0.928。结论脓毒症患儿血清SAA、sTREM-1水平与APACHEⅡ评分呈正相关,二者可作为诊断、评估患儿脓毒症的指标。

Objective To investigate the correlation between serum amyloid protein A(SAA),soluble myeloid cell trigger receptor-1(Strem-1) and acute physiology and chronic health status Ⅱ(APACHE Ⅱ) score in children with sepsis.Methods Using a prospective study,85 children with sepsis who were admitted to child intensive care unit of He Xian Memorial Hospital of Panyu District and Guangzhou Women and Children Medical Center from August 2018 to August 2020 were selected as the study group,and 50 children with non-septic diseases with infectious diseases who were admitted to hospital in the same period were selected as the control group.According to the APACHE Ⅱ score,the children in the study group were divided into three groups.The levels of serum SAA,sTREM-1 were detected,the relationship between serum SAA,sTREM-1 level,and neonatal APACHE Ⅱ score was analyzed.The receiver operating characteristic(ROC) curve was drawn to analyze the diagnostic value of serum SAA,sTREM-1 in neonatal sepsis.Results The levels of serum SAA and sTREM-1 in the study group were significantly higher than those in the control group(t=123.600 and 24.693,respectively,both P<0.01).There were significant differences in serum SAA and sTREM-1 in the low,middle,and high-risk groups(F=32.428 and 28.571,respectively,both P<0.05).The levels of serum SAA(t=7.979 and 8.559,respectively,both P<0.05) and sTREM-1(t=10.132 and 22.233,respectively,both P<0.05) in the middle and high-risk groups were significantly higher than those in the low-risk group.The levels of serum SAA and sTREM-1 in the high-risk group were significantly higher than the middle-risk group(t=3.863 and 13.544,respectively,both P<0.05).The level of serum SAA and sTREM-1 were positively correlated with APACHE Ⅱ scores(r=0.748 and 0.772,respectively,both P<0.05).Area under the curve of serum SAA,sTREM-1 level,and combined detection were 0.834,0.791,and 0.928,respectively.Conclusion The level of serum SAA and sTREM-1 in children with sepsis is positively correlated with the APACHE Ⅱ score,which can be used as indicators to diagnose and evaluate sepsis in children.