小儿危重病例评分联合D-二聚体和降钙素原检测对儿童感染病情的早期评判价值

摘要

目的 小儿危重病例评分(PCIS)联合D-二聚体(D-D)及降钙素原(PCT)检测用于儿童感染病情的早期评判的价值.方法 选取ICU收治的感染性疾病重症患儿86例,根据PCIS结果分为危重组患儿43例(评分70~80),极危重组患儿43例(评分低于70分),对2组患者入院后24 h内血清PCT、D-D及PCIS评分比较.采用Pearson相关系数分析PCIS与PCT及D-D之间关系,并对影响患儿死亡因素进行logistic回归分析,随访28 d预后,ROC曲线分析,PCIS、PCT及D-D对预测28 d患儿生存情况.结果 极危重组患儿血清PCT和D-D水平明显高于危重组患儿(P<0.05);血清PCT和D-D水平均与PCIS呈显著负相关(P<0.05);Logistic回归分析显示PCT、D-D、PCIS均为影响患儿死亡的独立危险因素;PCT、D-D和PCIS预测患儿28 d生存ROC曲线下面积为分别为0.875、0.872及0.863(P<0.01).结论 儿童感染危重患者的血清PCT和D-D是判断病情预后的重要指标,联合使用小儿危重病例评分对预后判断具有指导意义.%Objective To investigate the early prediction and discriminant value of pediatric critical illness scores (PCIS) combined with the detection of D-dimer ( D-D) and procalcitonin ( PCT) for the severity of pediatric infection condition.Methods Eighty-six children patients with severe infectious disease who were treated in ICU of our hospital from October 2014 to September 2015 were enrolled in the study.According to pediatric critical cases scores ( PCIS), these children patients were divided into critical case group ( n =43,PCIS score:70 ~80),extremely critical case group ( n =43, PCIS score:under 70 points).The PCIS,serum levels of D-D and PCT were observed and compared between two groups .The correlation between PCIS and PCT as well as D-D was analyzed by means of Pearson correlation coefficient analysis ,moreover, the influencing factors on patient's death were analyzed by means of Logistic regression analysis .After 28-day follow-up, ROC curve analysis was used to analyze the prediction value of PCIS ,D-D and PCT for 28-day survival condition of patients .Results The serum levels of D-D and PCT in extremely critical case group were significantly higher than those in critical case group ( P <0.05).The serum levels of PCT and D-D were negatively correlated to PCIS ( P <0.05).Logistic regression analysis showed that PCT,D-D,PCIS were independent risk factors influencing patient's death.The area under ROC curve of PCT,D-D and PCIS in predicting 28-day survival condition of patients was 0.875,0.872 and 0.863,respectively ( P <0.01). Conclusion The serum levels of PCT and D-D in children patients with severe infection are important indexes to evaluate prognosis of disease condition ,which combined with PCIS has important guidance significance to evaluate prognosis of patients .