血清学指标水平变化对儿童急性骨关节感染继发脓毒症的早期预测价值分析

The value of changes in serological index levels in early prediction of sepsis secondary to acute osteoarticular infection in children

目的探讨血清学指标C反应蛋白(C-reactive protein,CRP)、血沉(erythrocyte sedimentation rate,ESR)、降钙素原(procalcitonin,PCT)、白细胞介素6(interleukin-6,IL-6)及D-二聚体变化对儿童急性骨关节感染继发脓毒症的早期预测价值分析。方法选取急性骨关节感染患儿149例为研究对象,定义为骨关节感染组,并根据是否继发脓毒症将急性骨关节感染组分为普通感染组(108例)和脓毒症组(41例),另外选择同期正常儿童71例为对照组,所有患儿均检测CRP、ESR、PCT、IL-6及D-二聚体并进行相关比较。结果急性骨关节感染组CRP、ESR、PCT、IL-6、D-二聚体水平均高于正常对照组(P<0.05),普通感染组CRP、ESR、PCT、IL-6、D-二聚体水平均低脓毒症组(P<0.05),多因素Logistic回归分析,结果显示CRP、ESR、PCT、IL-6及D-二聚体升高是急性骨关节感染继发脓毒症的独立危险因素,5项联合检测的AUC大于单独检测,其敏感度和特异度也高于单独检测,分别为95.43%、94.53%。结论CRP、ESR、PCT、IL-6、D-二聚体检测在儿童急性骨关节感染中明显升高,是急性骨关节感染继发脓毒症的独立危险因素;5项联合检测对预测价值更高,对继发脓毒症的早期诊断具有一定价值。

Objective To explore the value of serological indexes C-reactive protein(CRP),erythrocyte sedimentation rate(ESR),procalcitonin(PCT),interleukin-6(IL-6)and D-dimer(D-D)in early prediction of sepsis secondary to acute osteoarticular infection(AOI)in children.Methods A total of 149 children with AOI were enrolled as AOI group.According to presence or absence of secondary sepsis,they were divided into general infection group(n=108)and sepsis group(n=41).In addition,71 healthy children in the same period were selected as control group.CRP,ESR,PCT,IL-6 and D-D were measured in all patients.Results The levels of CRP,ESR,PCT,IL-6 and D-D in the AOI group were higher than those in the normal control group(P<0.05),and the levels of CRP,ESR,PCT,IL-6 and D-D in the general infection group were lower than those in the sepsis group(P<0.05).Multivariate logistic regression analysis showed that the increase of CRP,ESR,PCT,IL-6 and D-D was an independent risk factor for sepsis secondary to AOI(P<0.05).The AUC of combined detection of the five indicators was greater than that of the single detection,and the sensitivity and specificity were higher,which were 95.43%and 94.53%respectively.Conclusion The levels of CRP,ESR,PCT,IL-6 and D-D were significantly higher in children with AOI.Combined detection of the five indicators have a higher value in prediction and early diagnosis of secondary sepsis.