降钙素原联合心脏相关标志物评估脓毒症患儿病情意义

摘要

Objectives To explore the clinical value of procalcitonin (PCT) in conjunction with heart-related markers in assessment of the severity of sepsis. Methods The clinical data of 147 children with sepsis (88 cases of sepsis and 59 cases of severe sepsis) admitted to pediatric intensive care unit (PICU) from September 2013 to April 2014 were retrospectively analyzed. The levels of procalcitonin and heart-related markers at different stages of sepsis were compared. Results The levels of PCT, CK-MB, NT-proBNP, and cTnT-hs in severe sepsis group were signiifcantly higher than those in sepsis group (P<0.01). However, there was no signiifcant difference in WBC and CRP between the two groups (P>0.05). Compared with surviving patients, the levels of PCT, CK-MB, cTnT-hs, and NT-proBNP were signiifcantly higher in dead patients (P<0.05). The area under the curve (AUC) of PCT, CK-MB, NT-proBNP, and cTnT-hs in assessment of the severity of sepsis was 0.838, 0.811, 0.854 and 0.713, respectively. The AUC of PCT, CK-MB, NT-proBNP, and cTnT-hs in predicting survival situation was 0.766, 0.715, 0.778 and 0.609, respectively. A binary logistic regression equation was established based on the results of procalcitonin and heart-related indicators:logt(P)=2.668×NT-proBNP+1.083×PCT+1.620×CK-MB+0.864×cTnT-hs–11.461. The AUC of logt (P) in assess-ment of the severity of sepsis and in predicting survival situation was 0.928 and 0.807. Conclusions Individual indicator of PCT, CK-MB, NT-proBNP, and cTnT-hs can be independently used to evaluate the severity of sepsis in children, and in comparison with single index, the assessment value is higher when four indicators are combined. The severity of sepsis in children is closely related to myocardial injury and cardiac dysfunction.%目的：探讨降钙素原(PCT)联合心脏相关标志物评估脓毒症患儿病情的临床价值。方法回顾性分析2013年9月至2014年4月儿童重症监护病房(PICU)收治的147例脓毒症患儿(脓毒症88例、严重脓毒症59例)的临床资料，分析比较不同程度脓毒症患儿PCT及心脏相关标志物水平的差异。结果严重脓毒症患儿PCT、肌酸激酶同工酶(CK-MB)、氨基末端脑钠肽前体(NT-proBNP)、超敏肌钙蛋白T(cTnT-hs)水平均显著高于脓毒症患儿，差异有统计学意义(P均<0.01)；白细胞(WBC)、C-反应蛋白(CRP)的差异无统计学意义(P均>0.05)。死亡患儿的PCT、CK-MB、cTnT-hs、NT-proBNP水平高于存活患儿，差异有统计学意义(P均<0.05)。PCT、CK-MB、NT-proBNP、cTnT-hs评估脓毒症严重程度曲线下面积(AUC)分别为0.838、0.811、0.854、0.713；预测存亡情况AUC分别为0.766、0.715、0.778、0.609，优于其他脏器相关指标。以PCT及心脏相关指标建立二分类logistic回归方程：logt(P)=2.668×NT-pro BNP+1.083×PCT+1.620×CK-MB+0.864×cTnT-hs–11.461；新变量log t(P)值评估脓毒症患儿病情、存亡情况AUC分别为0.928、0.807。结论 PCT、CK-MB、NT-proBNP、cTnT-hs可单独用于判断脓毒症患儿病情，4项指标联合检测的评估价值优于各单项指标。脓毒症患儿病情严重程度与心肌损伤、心功能障碍密切相关。