脓毒症患儿早期血清白介素1受体1和活性蛋白C及降钙素原表达水平及其临床意义研究

摘要

Objective To investigate the clinical value of serum interleukin-1 receptor 1(IL-1R1),active protein C(APC),and procalcitonin(PCT) for evaluating the severity of pediatric sepsis.Methods Sixty-six children,38 with sepsis and 28 with severe sepsis,treated in the ICU of the Children's Hospital of Hebei province in 2015 were included.Thirty healthy children who presented for routine examinations during the study period were the control group.Serum IL-1R1,APC,and PCT were assayed in patients within 24 hours of admission and in controls on enrollment.Receiver operating characteristic(ROC) curve were used to evaluate the significance of IL-1R1,APC,and PCT as markers of sepsis severity.Results There were significant differences in the IL-1R1,APC,and PCT concentrations(all P<0.05).IL-1R1 and PCT were higher in the sepsis group than in the control group,and APC was significantly lower(P<0.05).IL-1R1 was higher,and APC was lower,in the severe sepsis group than in the control group(P<0.05).APC was higher in the severe sepsis group than in sepsis group(P<0.05). PCT was higher in the severe sepsis group than in both sepsis and control groups(P<0.05).The area under the ROC curve (AUC) of the IL-1R1 concentration for diagnosing severe sepsis was 0.597,which was not significantly different from 0.500 (P=0.198).The corresponding AUCs of APC and PCT were 0.686 and 0.817,respectively(both > 0.500;P=0.013 for APC and P<0.001 for PCT).The AUC of the three combined markers was 0.834,which was significantly higher than 0.500(P<0.001). Conclusion Elevated serum PCT and the three biomarkers combined were relatively accurate in evaluating the severity of sepsis and have potential clinical value as a reference of severity.%目的 测定脓毒症患儿白介素1受体1(IL-1R1)、活性蛋白C(APC)、降钙素原(PCT)表达水平,探讨其判断脓毒症严重程度的临床价值.方法 选取2015年河北省儿童医院重症监护室收治的脓毒症患儿66例,根据诊断标准,其中脓毒症38例(脓毒症组),严重脓毒症28例(严重脓毒症组).另选取同期体检健康儿童30例作为对照组.检测比较脓毒症组及严重脓毒症组入院24 h时、对照组体检时血清IL-1R1、APC、PCT表达水平;并采用受试者工作特征(ROC)曲线评价入院24 h时IL-1R1、APC、PCT判断脓毒症严重程度的价值.结果 3组入院24 h时IL-1R1、APC、PCT表达水平比较,差异均有统计学意义(P<0.05);其中脓毒症组IL-1R1、PCT水平高于对照组, APC水平低于对照组;严重脓毒症组IL-1R1水平高于对照组,APC水平低于对照组,高于脓毒症组,PCT水平高于对照组和脓毒症组(P<0.05).入院24 h IL-1R1判断脓毒症患儿发生严重脓毒症的ROC曲线下面积(AUC)为0.597,与AUC=0.500比较,差异无统计学意义(P=0.198);入院24 h APC判断脓毒症患儿发生严重脓毒症的AUC为0.686,与AUC=0.500比较,差异有统计学意义(P=0.013);入院24 h PCT判断脓毒症患儿发生严重脓毒症的AUC为0.817,与AUC=0.500比较,差异有统计学意义(P<0.001).入院24 h三者联合判断脓毒症患儿发生严重脓毒症的AUC为0.834,与AUC=0.500比较,差异有统计学意义(P<0.001).结论 脓毒症及严重脓毒症患儿血清IL-1R1、PCT、APC水平较正常儿童存在差异.PCT及三者联合判断脓毒症严重程度的价值较高,可以作为判断病情的参考指标.