Objective To investigate the application value of PTX3 in diagnosis and evaluation of sepsis severity and cardiovascular impairment in children.Methods A total of 72 children patients who were admitted and treated in our hospital from February 2015 to February 2017 were divided into three groups according to the degree of infection:n.on sepsis group (n =32),sepsis group (n =28) and severe sepsis group (n =12).According to the PTX3 concentration,these patients redivided in to mildly increase group (n =29),moderate increase group (n =32) and severe increase group (n =12).The plasma levels of PTX3,troponin,brain natriuretic peptide,creatine kinase,white blood cell (WBC),C-reactive protein (CPR) and procalcitonin (PCT) were measured on the first day in intensive care unit.Spearman rank correlation analysis was used to analyze the correlation between the infection degree and increase degree of PTX3 in children with sepsis.The variance analysis was used to determine the changes of myocardial enzymes in children with different levels of PTX3 and to compare the inflammatory indexes in children with different infectious degrees.ROC curve was used to assess the ability of PTX3 and different inflammatory indexes in diagnosis and prognosis prediction.Results There was a correlation between the degree of inflammatory infection and the degree of PTX3 increase (r =0.641,P ＜ 0.01).The levels of PTX3,CRP and PCT in the three groups were increased with the increase of infection degree (P ＜ 0.05),moreover,the ROC curve area of PTX3,PCT,CRP and WBC were 0.729,0.668,0.627 and 0.552,respectively (P ＜ 0.05 or P ＜ 0.01).The differences of cardiac troponin,BNP and creatine kinase were increased with the increase of PTX3,and there were significant differences between groups (P ＜ 0.05).In the aspect of prognosis prediction,the area under ROC curve of PTX3 and BNP was 0.784 (P ＜ 0.01) and 0.618 (P ＞ 0.05),and the specificity and sensitivity of PTX3 in predicting prognosis were higher than those of BNP.Conclusion The plasma levels of PTX3 paly an important role in diagnosis and evaluation of the severity of sepsis,which also has important value in diagnosis and prognosis evaluation of cardiovascular function impairment.%目的 探讨正五聚体蛋白3(PTX3)在诊断和评估小儿脓毒症严重程度及心血管功能损害的价值.方法 选取2015年2月至2017年2月入住的72例患儿,按感染程度分为3组,非脓毒症组32例,脓毒症组28例,严重脓毒症组12例;根据PTX3浓度分组,轻度升高组29例,中度升高组32例,重度升高组12例.收集患儿入住重症监护室第1天血浆PTX3浓度、肌钙蛋白、脑钠肽(BNP)、肌酸激酶、白细胞(WBC)、C-反应蛋白(CPR)、降钙素原(PCT)等实验室指标和预后情况,采用Spearman等级相关分析法分析脓毒症患几感染程度与不同程度PTX3升高组之间的相关性;采用方差分析法判断不同程度PTX3升高组患儿心肌酶变化和不同感染严重程度患儿各炎性指标的比较;PTX3与不同炎性指标诊断疾病和预测预后的能力采用ROC曲线.结果 患儿炎症感染程度与PTX3升高程度存在相关性(r =0.641,P=0.00);3组患儿的FTX3、CRP、PCT等指标随着感染程度的加深而呈升高趋势(P＜0.05);在诊断脓毒血症方面,PTX3、PCT、CRP、WBC在ROC曲线下面积分别为0.729、0.668、0.627、0.552(P=0.001、0.015、0.066、0.451);在不同PTX3升高组之间,心肌酶学评价指标肌钙蛋白、BNP、肌酸激酶等原始值均随着PTX3指标的升高而升高,组间差异均有统计学意义(P＜0.05);在预测脓毒症患儿预后方面,PTX3和BNP在预测预后ROC曲线下面积分别为0.784(P =0.000)和0.618(P=0.110),PTX3在预测预后方面特异度和敏感度方面均高于BNP.结论 脓毒症患儿血浆PTX3水平在诊断和评估疾病严重程度具有重要的意义,且在心血管功能损害的诊断和预后评估也有重要的价值.
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