儿童脓毒症及严重脓毒症患儿血液sCD 163变化及其意义

摘要

Objective To investigate the changes of serum soluble CD 163 (sCD 163) level,to assess the severity of critical illness and to evaluate the immune status of sepsis or severe sepsis in children.Method A prospective study was conducted. The sCD 163 was determined in 50 cases with sepsis or severe sepsis in pediatric intensive care unit (PICU) and 23 cases of age- and gender-matched healthy children were enrolled as control during the period from April 2010 to March 2011. Double-antibody sandwich ELISA was used for sCD 163 measurement. The relationship with sCD 163 level and disease severity score ( pediatric critical illness score,PCIS; and pediatric risk of mortality Ⅲ,PRISM Ⅲ ),lymphocyte subsets,C-reactive protein (CRP),tumor necrosis factor α (TNFα) were analyzed.Result The sCD 163 in sepsis/severe sepsis groups ( 171.04 ± 177.85) mg/L was significantly higher than that in control group (44.19 ±86.48) mg/L ( P ＜0.01 ).sCD 163 in sepsis group [ ( 105.32 ± 145.87) mg/L] was significantly lower than that of severe sepsis group[ (233.32 ± 171.78) mg/L] (P ＜ 0.05 ).sCD 163 level was significantly higher in lower PCIS score patients.( P ＜0.01 ).The sCD 163 levels was higher in PRISM Ⅲ ≥ 10 than the PRISM Ⅲ ＜ 10 group.The sCD 163 levels were higher in death group than the survival group.The sCD163 was negatively correlated with CD4 +,CD4 + /CD8 + (R =- 0.820,P＜0.05;R=-0.839,P ＜0.01 ).Conclusion Detection of sCD 163 was helpful in predicting the severity of sepsis and severe sepsis,and sCD 163 may reflect the immune status of critically ill children with sepsis.%目的 探讨脓毒症及严重脓毒症患儿血液可溶性CD 163(sCD 163)水平,评估其在病情严重程度及脓毒症免疫状态判断中的价值.方法 前瞻性实验,采用双抗体夹心ELISA方法,测定入住本院儿童重症医学科(PICU)50例脓毒症/严重脓毒症患儿血清sCD 163含量,同期选择23例健康检查儿童作为对照；分析sCD 163与病情严重程度评分(pediatric critical illness score,PCIS；pediatric risk of mortalityⅢ,PRISMⅢ)、淋巴细胞亚群、C反应蛋白(CRP)、肿瘤坏死因子α(TNFα)之间的关系.研究方案经医院伦理委员会批准,签转家长知情同意书.结果 实验组患儿与健康组儿童血清sCD 163分别为(171.04±177.85) mg/L和(44.19 ± 86.48) mg/L,差异有统计学意义(P＜0.01).脓毒症与严重脓毒症患儿sCD 163分别为(105.32±145.87) mg/L和(233.32±171.78) mg/L,差异有统计学意义(P＜0.05).PCIS分值≥90、70 ～ 89及＜70患儿中,PCIS分值越低,sCD 163水平越高,三组差异有统计学意义(P＜0.01).PRISMⅢ≥10组血清sCD 163浓度明显高于PRISMⅢ＜ 10组(P＜0.01).死亡组sCD 163水平高于生存组,差异有统计学意义.sCD 163与CD4+、CD4+/CD8+呈负相关(R=-0.820,P＜0.05,R=-0.839,P＜0.01).结论 血清sCD 163测定有助于预测脓毒症患儿病情严重程度,是脓毒症患儿免疫状态判断参考指标之一.