胰石蛋白对脓毒症患儿病情评估的价值

Value of pancreatic stone protein/regenerating protein in severity evaluation and prognosis prediction for children with sepsis

摘要:

目的 探讨胰石蛋白(PSP/reg)判断脓毒症患儿病情及预后的价值。方法 采用前瞻性病例对照研究,收集159例脓毒症患儿(脓毒症组106例;严重脓毒症组53例,其中脓毒性休克12例)及同期20例非脓毒症患儿(对照组)的临床资料,采用ELISA检测患儿入住PICU后第1、3、7天血浆PSP/reg浓度。血浆PSP/reg水平与血清降钙素原(PCT)、CRP、WBC计数、小儿危重病例评分(PCIS)的相关性进行Spearman相关分析,并采用受试者工作特征曲线下面积(AUC)评估各指标判断脓毒症患儿病情严重程度及预后的价值。结果 脓毒症组、严重脓毒症组入住PICU后第1天血浆PSP/reg水平高于对照组(P<0.05);严重脓毒症组血浆PSP/reg水平高于脓毒症组(P<0.05)。死亡患儿(n=27)入住PICU后第1天血浆PSP/reg水平高于存活患儿(n=132)(P<0.05)。脓毒症患儿第1天血浆PSP/reg水平与WBC计数及血清PCT水平呈正相关(分别r_s=0.212、0.548;P<0.05),与PCIS评分呈负相关(r_s=-0.373,P<0.05)。血浆PSP/reg、血清PCT判断脓毒症患儿是否为严重脓毒症、脓毒性休克及结局为死亡的AUC均大于0.7(P<0.05)。结论 PSP/reg与感染密切相关,对脓毒症危险分层及预后评估有一定的临床价值。

Abstract:

Objective To evaluate the value of pancreatic stone protein/regenerating protein (PSP/reg) in severity evaluation and prognosis prediction for children with sepsis. Methods In this prospective case-control study, 159 children with sepsis (106 cases in the sepsis group; 53 cases in the severe sepsis group, including 12 cases of septic shock) and 20 children without sepsis (control group) were enrolled. ELISA was applied to measure plasma PSP/reg levels on days 1, 3, and 7 of admission to the PICU. The Spearman rank correlation test was applied to assess the correlations between plasma PSP/reg level and serum procalcitonin (PCT), CRP, WBC count, and pediatric critical illness score (PCIS). The area under the receiver operating characteristic curve (AUC) was used to assess the value of each index in determining severity and predicting prognosis for children with sepsis. Results On day 1 of admission to the PICU, plasma PSP/reg levels in the sepsis and severe sepsis groups were significantly higher than in the control group (P<0.05), and the severe sepsis group had a significantly higher plasma PSP/reg level than the sepsis group (P<0.05). On day 1 of admission to the PICU, the survival group (n=132) had a significantly lower plasma PSP/reg level than the non-survival group (n=27) (P<0.05). On day 1 of admission to the PICU, plasma PSP/reg level in children with sepsis was positively correlated with WBC count and serum PCT level (r_s=0.212 and 0.548, respectively; both P<0.05), and negatively correlated with PCIS score (r_s=-0.373; P<0.05). The AUCs of plasma PSP/reg level and serum PCT for determination of severe sepsis, septic shock, and death were higher than 0.7 (P<0.05). Conclusions PSP/reg is closely related to infection, and has a certain clinical value in risk stratification of sepsis and prognosis evaluation.