血浆Th1/Th2细胞、ET、PTA、PCT与脓毒症患儿病情严重程度及转归的关系分析

Analysis of the relationship between plasma Th1/Th2 cells,ET,PTA,PCT and the severity and outcome of sepsis in children

目的探究血浆辅助性T细胞1(help T cell 1,Th1)/辅助性T细胞2(help T cell 2,Th2)细胞、内毒素(endotoxin,ET)、凝血酶原活动度(prothrombin activity,PTA)、降钙素原(procalcitonin,PCT)与脓毒症患儿病情严重程度及转归的关系。方法选取我院脓毒症患儿96例,通过小儿危重症评分(pediatric critical illness score,PCIS)评估病情严重程度,分为非危重组(PCIS分值>80分,n=39)、危重组(PCIS分值71~80分,n=32)、极危重组(PCIS分值≤70分,n=25),比较3组一般资料、入院时血浆Th1/Th2细胞、ET、PTA、PCT水平,分析血浆各指标与脓毒症患儿PCIS分值的关系,并统计脓毒症患儿28 d预后情况,比较不同预后患儿入院时血浆Th1/Th2细胞、ET、PTA、PCT水平,分析血浆各指标与脓毒症患儿预后的关系及预测脓毒症患儿预后的价值。结果极危重组血浆Th1/Th2细胞、PTA水平低于危重组、非危重组,且危重组低于非危重组;极危重组血浆ET、PCT水平高于危重组、非危重组,且危重组高于非危重组,差异有统计学意义(P<0.05)。血浆Th1/Th2细胞、PTA水平与脓毒症患儿PCIS分值呈正相关,血浆ET、PCT水平与脓毒症患儿PCIS分值呈负相关(P<0.05);死亡患儿入院时血浆Th1/Th2细胞、PTA水平均低于存活患儿,血浆ET、PCT水平均高于存活患儿(P<0.05);血浆Th1/Th2细胞、PTA水平与预后呈正相关,血浆ET、PCT水平与预后呈负相关(P<0.05);入院时血浆Th1/Th2细胞、ET、PTA、PCT预测预后为死亡的曲线下面积(area under the curve,AUC)分别为0.808、0.836、0.720、0.748,联合预测的AUC最大,为0.933。结论脓毒症患儿血浆Th1/Th2细胞、PTA水平与病情密切相关,血浆ET、PCT水平与病情严重程度呈负相关,且与患儿预后密切相关,早期联合检测各指标水平可辅助临床预测患儿预后转归。

Objective To investigate the relationship between plasma helper T cell 1(Th1)/helper T cell 2(Th2)cells,endotoxin(ET),prothrombin activity(PTA)and procalcitonin(PCT)and the severity and outcome of sepsis in children.Methods Ninety-six children with sepsis in our hospital were selected,and the severity of sepsis was assessed by the Pediatric Critical Care Score(PCIS)and classified into non-critical group(PCIS score>80,n=39),critical group(PCIS score 71-80,n=32),and very critical group(PCIS score≤70,n=25).The three groups were compared in terms of general data,plasma Th1/Th2 cells,ET,PTA,and PCT levels at admission,and the relationship between plasma indicators and PCIS scores of children with sepsis was analyzed.The 28 d prognosis of children with sepsis was recorded,and plasma Th1/Th2 cells,ET,PTA,and PCT levels at admission in children with different prognosis were compared,and the relationship between plasma indicators and the prognosis of children with sepsis as well as the value of plasma indicators in predicting the prognosis of children with sepsis was analyzed.Results The level of Th1/Th2 cells and PTA in very critical group was lower than that in critical group and non-critical group,and lower in critical group than in non-critical group.The levels of ET and PCT in very critical group were higher than those in critical group and non-critical group,and higher in critical group than in non-critical group,and the difference was statistically significant(P<0.05).Plasma Th1/Th2 cells and PTA levels were positively correlated with PCIS scores of children with sepsis,and plasma ET and PCT levels were negatively correlated with PCIS scores of children with sepsis(P<0.05).Plasma Th1/Th2 cells and PTA levels at admission were lower in deceased children than in surviving children,and plasma ET and PCT levels were higher than in surviving children(P<0.05).Plasma Th1/Th2 cells and PTA levels were positively correlated with the prognosis of children with sepsis,and plasma ET and PCT levels were negatively correlated with the prognosis of children with sepsis(P<0.05).The area under the curve(AUC)of Th1/Th2 cells,ET,PTA,and PCT in predicting the prognosis of children with sepsis as death was 0.808,0.836,0.720,and 0.748,respectively,and the combined prediction had the largest AUC of 0.933.Conclusion The levels of plasma Th1/Th2 cells and PTA were closely associated with the severity of sepsis in children,and the levels of plasma ET and PCT were negatively correlated with the severity of the disease and closely correlated with the prognosis of the children.The early combined detection of the levels of each index can assist in clinical prediction of the prognosis of the children.