降钙素原和D-二聚体对全身炎症反应综合征患儿病情预后的判断价值

Levels and prognostic significance of serum procalcitonin and D-dimer in children with systemic inflammatory response syndrome

摘要:

目的 探讨降钙素原（PCT）和D-二聚体（D-D）在判断全身炎症反应综合征（SIRS）患儿预后中的价值。方法 采用前瞻性病例对照方法 ，选取PICU住院的SIRS患儿67例，按有无感染灶分为脓毒症组和非脓毒症组，入院24 h内检测血清PCT、D-D、CRP、WBC，并进行小儿危重评分（PCIS）。将有差异指标与PCIS进行相关性分析；随访28 d临床结局；采用受试者工作特征曲线（ROC）下面积（AUC）预测28 d生存效能；多因素logistic回归预测死亡独立危险因素。结果 脓毒症组中血清PCT和D-D水平高于非脓毒症组，PCIS低于非脓毒症组（均P<0.05）；血清PCT和D-D水平与PCIS呈显著负相关（P<0.01）；死亡患儿血清PCT 及D-D水平高于存活患儿，PCIS低于存活患儿（均P<0.05）；PCT、D-D和PCIS预测患儿28 d生存ACU分别为：0.875，0.872及0.863（均P<0.01）；多因素logistic回归分析显示PCT、D-D进入预测危险因素（OR值分别为1.684，1.003，均P<0.01）。结论 SIRS患儿血清PCT有助于早期识别脓毒症和非脓毒症；血清PCT和D-D可作为判断病情预后的重要指标，可能是预测28 d死亡的独立危险因素。

Abstract:

Objective To evaluate the prognostic significance of serum levels of procalcitonin (PCT) and D-dimer in children with systemic inflammatory response syndrome (SIRS). Methods A prospective case control study was conducted on 67 pediatric patients with SIRS who were treated in the pediatric intensive care unit (PICU). Based on the presence or absence of infectious lesions, patients were categorized as sepsis and non-sepsis. Within 24 hours after admission, white blood cell (WBC) count and serum levels of PCT, C-reactive protein (CRP) and D-dimer were determined, and the pediatric critical illness score (PCIS) was calculated. The correlation of PCIS with each of the other measurements was analyzed. On day 28 of follow-up, receiver operator characteristic (ROC) curve was plotted, and the area under ROC (AUC) was calculated. 28-day survival was estimated. Multivariate logistic regression analysis was performed to identify independent risk factors for in-hospital mortality. Results Serum levels of PCT and D-dimer were significantly higher (P<0.05) but PCIS was significantly lower (P<0.05) in patients with sepsis than in those without sepsis. Both PCT and D-dimer were negatively correlated with PCIS (P<0.01). Serum levels of PCT and D-dimer 24 hours after admission were higher (P<0.05) and PCIS was lower (P<0.05) in non-survivors than in survivors on day 28. AUC was 0.875, 0.872 and 0.863 respectively for PCT, D-dimer and PCIS in the prediction of 28-day survival (P<0.01). Logistic regression analysis revealed that PCT and D-dimer were independent prognostic factors (odd ratio: 1.684 and 1.003; P<0.01). Conclusions Serum levels of PCT may be helpful in differentiating sepsis and non-sepsis at early stage of SIRS in children. PCT and D-dimer are independent risk factors for in-hospital mortality in children with SIRS, and thus have a prognostic significance in clinical settings.