外周血SAA、WBC、s-Pselectin对重症感染患儿血液净化疗效及生存预测分析

The Effect of Peripheral Blood SAA,WBC and s-Pselectin on Blood Purification in Severely Infected Children and Its Survival Prediction

目的通过外周血SAA、WBC、s-Pselectin水平变化,探究其与重症感染患儿血液净化疗效关系及预测生存的价值。方法选取2016年5月1日-2019年5月30日某院收治的73例重症感染患儿作为研究对象,根据血液净化效果分为有效组(n=46)和无效组(n=27)。对比2组治疗前后外周血SAA、WBC、s-Pselectin水平、APACHE-Ⅱ及SOFA评分,Pearson、多元线性回归分析外周血各指标与APACHE Ⅱ、SOFA评分及疗效关系,对比生存及死亡患儿治疗前后外周血各指标变化,绘制受试者工作曲线(ROC曲线)分析外周血各指标预测死亡的价值,并采用K-M曲线分析患儿生存状况。结果治疗后有效组外周血SAA、WBC、s-Pselectin水平及APACHE Ⅱ、SOFA评分低于无效组(P<0.05);治疗前外周血SAA、WBC、s-Pselectin与APACHE Ⅱ评分、SOFA评分呈正相关(P<0.05);治疗后生存患儿外周血SAA、WBC、s-Pselectin水平低于死亡患儿,差值高于死亡患儿(P<0.05);外周血SAA、WBC、s-Pselectin与生存状况显著相关(P<0.05);SAA差值预测重症感染患儿死亡价值的AUC最大,其次为s-Pselectin差值、WBC差值,SAA、WBC、s-Pselectin高危组生存率低于低危组(P<0.05)。结论重症感染患儿外周血SAA、WBC、s-Pselectin水平变化与病情有关,其中血液净化治疗前后SAA差值是影响生存状况的主要因素,可作为临床评估预后及完善治疗方案的参考依据。

Objectives To explore the relationship between SAA,WBC and s-Pselectin levels in peripheral blood and the efficacy of blood purification in children with severe infections and the value of survival prediction.Methods From May 1st,2016 to May 30th,2019,73 severely infected children admitted to a hospital were selected as the research objects.And they were divided into an effective group(n=46)and an ineffective group(n=27)according to the blood purification effect.The peripheral blood SAA,WBC,s-Pselectin levels,APACHE-Ⅱand SOFA scores were compared between the two groups before and after treatment.Pearson and multiple linear regression were used to analyze the relationship between peripheral blood indicators and APACHE Ⅱ,SOFA scores and efficacy,and the changes in peripheral blood indicators before and after treatment in children with survival and death were compared.The receiver operating curve(ROC curve)was drawn to analyze the value of the peripheral blood indicators in predicting death,and the K-M curve was used to analyze the survival status of children.Results After treatment,the SAA,WBC,s-Pselectin levels,APACHE Ⅱ,and SOFA scores in the effective group were lower than those in the ineffective group(P<0.05);before treatment,peripheral blood SAA,WBC,s-Pselectin were positively correlated with APACHE Ⅱ score and SOFA score(P<P<0.05);the levels of SAA,WBC,and s-Pselectin in peripheral blood of surviving children after treatment were lower than those of dead children,and the difference was higher than that of dead children(P<0.05);peripheral blood SAA,WBC and s-Pselectin were significantly correlated with survival status(P<0.05);The AUC value of SAA difference in predicting the death of children with severe infection was the largest,followed by the s-Pselectin difference and WBC difference,the survival rate of SAA,WBC,s-Pselectin high-risk group was lower than that of low-risk group(P<0.05).Conclusions The changes of peripheral blood SAA,WBC and s-Pselectin levels in children with severe infection were related to the condition.Among them,the difference of SAA before and after blood purification treatment was the main factor affecting the survival status,which could be used as a reference basis for clinical evaluation of prognosis and perfect treatment plan.