血清D-D、LDH及PGE2评估脓毒症血流感染患儿预后的临床价值

Clinical value of serum D-D,LDH and PGE2 in assessing prognosis of children with sepsis and bloodstream infection

目的 探讨血清D-二聚体(D-D)、乳酸脱氢酶(LDH)及前列腺素E2(PGE2)评估脓毒症血流感染患儿预后的临床价值。方法 选取2018年8月至2020年8月榆林市第一医院收治的158例脓毒症血流感染患儿为研究组,另选取50例同期招募来本院体检的健康儿童为对照组,检测对照组入院当日及研究组入院当日、入院48h后的血清D-D、LDH、PGE2水平;研究组患儿随访治疗28d,采用受试者工作特征(ROC)曲线及曲线下面积(AUC)评估血清D-D、LDH及PGE2指标的预测价值。结果 研究组患儿入院时血清D-D、LDH及PGE2水平均高于对照组,差异有统计学意义(t值分别为22.072、16.740、35.737,P<0.05);研究组随访28d内有41例(35.04%)患儿治疗无效,治疗有效组患儿在入院时、48h后的血清D-D、LDH及PGE2水平均低于同期治疗无效组,差异有统计学意义(t值介于2.401~8.409之间,P<0.05);入院48h后血清D-D、LDH、PGE2及三者联合指标用于预测脓毒症血流感染患儿预后的AUC分别为0.679、0.822、0.855、0.950。结论 脓毒症血流感染患儿的血清D-D、LDH及PGE2水平均高于健康人员水平,监测上述指标对于评估脓毒症血流感染患儿预后具有重要意义。

Objective To explore the clinical value of serum D-dimer(D-D),lactate dehydrogenase(LDH) and prostaglandin E2(PGE2) in assessing prognosis of patients with sepsis and bloodstream infection.Methods A total of 158 children with sepsis and bloodstream infection admitted to Yulin First Hospital between August 2018 and August 2020 were enrolled as the study group, while other 50 healthy children undergoing physical examination during the same period were enrolled as the control group.The levels of serum D-D,LDH and PGE2 on the day of admission in the control group, on the day of admission and at 48 h after admission in the study group were detected.The children in the study group were followed up for 28 d.The predictive value of serum D-D,LDH and PGE2 was evaluated by area under receiver operating characteristic(ROC) curves(AUC) values.Results The levels of serum D-D,LDH and PGE2 in the study group were higher than those in the control group at admission, and the differences were statistically significant(t=22.072,16.740 and 35.737,respectively, P<0.05).Within 28 d of follow-up, there were 41 cases(35.04%) with ineffective treatment in the study group.At admission and 48 h after admission, levels of serum D-D,LDH and PGE2 in the effective treatment group were lower than those in the ineffective treatment group, and the differences were statistically significant(t=2.401-8.409,respectively, P<0.05).At 48 h after admission, AUC values of serum D-D,LDH,PGE2 and combined detection for predicting prognosis of patients with sepsis and bloodstream infection were 0.679,0.822,0.855 and 0.950,respectively.Conclusion The levels of serum D-D,LDH and PGE2 in children with sepsis and bloodstream infection are higher than those in healthy people.Monitoring the above indexes is of great significance for assessing prognosis of children with sepsis and bloodstream infection.