血清PCT、CD64和sTREM-1在儿童细菌性脓毒症诊断及病情预测中的应用价值

目的探讨儿童细菌性脓毒症患儿外周血中降钙素原(PCT)、中性粒细胞表面CD64指数及可溶性触发受体表达因子1(sTREM-1)在诊断及判断病情严重程度方面的意义。方法根据血培养阳性结果选取2020年10月至2022年9月本院收治脓毒症患儿62例为脓毒症组,43例同期住院非脓毒症患儿为对照组,选取本院健康体检儿童人群33例为健康对照组,检测血清PCT及CD64指数,收集脓毒症患儿入院当天的首次参数计算pSOFA评分。结果细菌性脓毒症组患儿外周血CD64指数、sTREM-1、PCT水平均高于对照组患儿(P<0.05);sTREM-1及CD64指数在不同病原菌感染患儿的差异无统计学意义(P>0.05);PCT水平在G-杆菌和混合感染患儿中明显高于G+球菌患儿(P<0.05);CD64指数、sTREM-1、PCT水平均与pSOFA评分呈正相关,相关系数(r)分别为0.358、0.394、0.522;三者联合检测诊断患儿细菌性脓毒症的灵敏度(88.9%)及特异度(92.6%)均高于单一指标检测。结论儿童细菌性脓毒症患者外周血中PCT、CD64指数及sTREM-1水平升高,并随病情加重而增高,具有较高的诊断及预后判断价值。

Objective To explore the significance of procalcitonin(PCT),neutrophil surface CD64 index and soluble triggering receptor expressed on myeloid cells-1(sTREM-1)in the diagnosis and severity of bacterial sepsis in children.Methods 62 children with sepsis and the positive blood culture results admitted to our hospital from October 2020 to September 2022 were selected as the sepsis group,and 43 children hospitalized in general infection group(non-septic children as the control group).33 children undergoing health examinations in our hospital were selected as the healthy control group.Serum PCT,sTREM-1 levels and CD64 index were detected,and the first parameters of children with sepsis on the day of admission were collected to calculate the pSOFA score.Results The CD64 index,sTREM-1 and PCT levels of children in the bacterial sepsis group were higher than those in the control group(P<0.05).There was no significant difference in sTREM-1 and CD64 indexes in children with different pathogen infections(P>0.05).The PCT level was significantly higher in children with Gram-negative bacilli and mixed infections than those with Gram-positive cocci(P<0.05).CD64 index,sTREM-1,PCT levels were positively correlated with pSOFA scores,and the correlation coefficients were 0.358,0.394,0.522,respectively.The sensitivity(88.9%)and specificity(92.6%)of the combined detection in children with bacterial sepsis are higher than the single index detection.Conclusion The levels of PCT,CD64 index and sTREM-1 in peripheral blood of children with bacterial sepsis increase and continue to rise with the worsening of the disease,demonstrating high diagnostic and prognostic significance.