动态监测血清PCT、SAA、IgE对ICU脓毒症急性肾损伤患儿病情程度的评估价值及临床意义

Evaluation Value and Clinical Significance of Dynamic Monitoring of Serum PCT,SAA and IgE in ICU Sepsis in Children with Septic Acute Kidney Injury

目的 观察血清降钙素原(PCT)、淀粉样蛋白A(SAA)、免疫球蛋白E(IgE)动态水平对ICU脓毒症急性肾损伤(AKI)患儿病情程度的评估价值及临床意义。方法 回顾性选取2022年3月至2023年3月河南省儿童医院重症监护室(ICU)收治的180例脓毒症患儿,根据是否发生AKI,分为AKI组(112例)、非AKI组(68例)。比较两组一般临床资料[性别、年龄、诱因、感染部位、急性生理学及慢性健康Ⅱ(APACHEⅡ)评分、序贯器官衰竭评估(SOFA)评分],比较两组血清PCT、SAA、IgE水平,分析脓毒症患儿发生AKI的影响因素,ROC分析血清PCT、SAA、IgE水平联合检测对发生AKI的预测价值。结果 AKI组APACHEⅡ、SOFA评分高于非AKI组(P<0.05);两组不同时间点血清PCT、SAA、IgE水平比较,AKI组高于非AKI组,入院第1天>入院第3天>入院第7天,且各指标水平与APACHEⅡ评分、SOFA评分呈正相关(P<0.05);APACHEⅡ评分、SOFA评分、入院第7天血清PCT、SAA、IgE水平是脓毒症患儿发生AKI的危险因素(OR>1,P<0.05),且入院第7天血清各指标水平联合预测脓毒症患儿发生AKI的AUC为0.859。结论 血清PCT、SAA、IgE水平与AKI病情严重程度密切相关,各指标联合检测对脓毒症患儿发生AKI具有较高预测价值,可作为临床判断病情、预测是否发生AKI的有效指标。

Objective To observe the evaluation value and clinical significance of dynamic levels of serum procalcitonin(PCT),amyloid A(SAA),and immunoglobulin E(IgE)in evaluating the severity of acute kidney injury(AKI)in children with sepsis in the ICU.Methods A retrospective selection was conducted on 180 children with sepsis admitted to the intensive care unit(ICU)of Henan Children’s Hospital from March 2022 to March 2023.According to the occurrence of AKI,they were divided into AKI group(112 cases)and non AKI group(68 cases).General clinical data(gender,age,underlying disease,site of infection,acute physiology and chronic healthⅡ(APACHEⅡ)score,sequential organ failure assessment(SOFA)score of the two groups were compared,serum PCT,SAA,IgE levels of the two groups were compared,and the influencing factors of AKI in sepsis in children were analyzed.ROC analysis of the combined detection of serum PCT,SAA and IgE levels in the prediction of AKI.Results The scores of APACHEⅡand SOFA in AKI group were higher than those in non-AKI group(P<0.05).Comparison of serum PCT,SAA and IgE levels between the two groups at different time points,AKI group was higher than non-AKI group,the 1st day after admission>the 3rd day after admission>the 7th day after admission,and each index level was positively correlated with APACHEⅡscore and SOFA score(P<0.05).APACHEⅡscore,SOFA score,serum PCT,SAA and IgE levels on the 7th day after admission were the risk factors for AKI in sepsis in children(OR>1,P<0.05),and the AUC of serum indexes combined to predict AKI in sepsis in children on the 7th day after admission was 0.859.Conclusion Serum PCT,SAA and IgE levels are closely related to the severity of AKI,and the combined detection of all indicators has high predictive value for the occurrence of AKI in sepsis in children,and can be used as an effective indicator for clinical judgment and prediction of AKI.