血清降钙素原在早期判断婴儿捂热综合征严重程度中的价值

Clinical value of serum procalcitonin in evaluating severity of infant muggy syndrome

摘要:

目的 探讨血清降钙素原(PCT)在早期评估婴儿捂热综合征(IMS)病情严重程度和发生多器官功能障碍综合征(MODS)中的预测价值。方法 50 例IMS 患儿,根据是否发生MODS 分为MODS 组(n=29)和非MODS 组(n=21);根据患儿随访30 d 是否存活分为存活组(n=36)和死亡组(n=14)。记录患儿入院后24 h 内生命体征、动脉血气分析、血常规、C 反应蛋白(CRP)、肝肾功能、心肌酶谱等指标及小儿危重病例评分(PCIS)和转归。采用半定量胶体金免疫色谱法床旁检测血清PCT 水平。结果 50例IMS患儿中,47 例(94%)入院时血清PCT ≥0.5 ng/mL;死亡组中血清PCT 水平及MODS 发生率明显高于存活组,PCIS 评分明显降低(P<0.05);血清PCT 水平与PCIS 评分呈显著负相关(r=-0.84,P<0.05)。MODS 组患儿血清PCT 明显高于非MODS 组(P<0.01)。以发病24 h 内血清PCT 值为10.6 ng/mL作为截断点,预测发生MODS 的敏感性和特异性分别79.3% 和90.5%,AUC 为0.924(P<0.01)。结论 PCT 作为一项炎症指标,入院时其血清水平与IMS患儿病情严重程度密切相关,且可早期预测MODS的发生。

Abstract:

Objective To study the correlation between serum procalcitonin (PCT) level and severity of infant muggy syndrome (IMS) and the predictive value of PCT in the development of multiple organ dysfunction syndrome (MODS) in children with IMS.Methods Fifty children with IMS were classified into two groups according to the presence of MODS:MODS (n=29) and non-MODS (n=21). According to a 30-day follow-up result, they were classified into survival (n=36) and deceased groups (n=14). Vital signs, routine biological measurements (arterial blood gas, blood routine, CRP, liver and kidney functions, myocardial enzyme and so on) and the disease severity evaluated by the Pediatric Critical Illness Score (PCIS) within 24 hours of admission were recorded. Serum levels were measured using the semi-quantitative PCT-Q test within 24 hours of admission.Results Forty-seven children (94%) had elevated serum PCT levels (≥0.5 ng/mL) at admission. There were lower PCIS scores, higher rates of MODS and higher levels of serum PCT in deceased patients than survivors (P<0.05). There was a significant negative correlation between serum PCT levels and PCIS scores (r=-0.84, P<0.05). Serum PCT levels in the MODS group were significantly higher than in the non-MODS group (P<0.01). Receiver operating characteristic curve showed that, if the cut-off point of serum PCT level was 10.6 ng/mL, the sensitivity and specificity of PCT were 79.3% and 90.5% respectively, in predicting MODS, with the area under the curve of 0.924 (P<0.01).Conclusions Serum PCT level at admission is correlated with the severity of IMS and it may be an early predictive marker of MODS.