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目的探讨血降钙素原(PCT)、乳酸和D-二聚体3种生物标记物评估脓毒血症患儿病情严重程度及预后的临床价值。方法收集2008年1月至2013年1月86例脓毒血症患儿的临床资料,将其按病情严重程度分为早期脓毒症组、严重脓毒症组和脓毒症休克组;回顾性研究则将所有患儿根据预后分为生存组及死亡组。分别比较各组患儿血降钙素原、乳酸、D-二聚体水平和小儿危重病例评分(PCIS),观察血降钙素原、乳酸、D-二聚体3种标记物水平评估病情严重程度及预后的临床价值。结果不同严重程度的脓毒血症的3组患儿中,3种标记物水平及PCIS比较差异均有统计学意义(P<0.05)。生存组患儿血降钙素原、乳酸、D-二聚体水平和PCIS与死亡组比较差异均有统计学意义(P<0.05),且呈负相关关系。结论血降钙素原、乳酸、D-二聚体水平对小儿脓毒血症病情严重程度与预后判断具有指导意义,患儿血降钙素原、乳酸、D-二聚体水平越高,PCIS越低,病情越重,预后越差。
Objective To investigate the clinical value of three biomarkers of blood procalcitonin (PCT), lactic acid and D-dimer in assessing the severity and prognosis of children with sepsis. Methods The clinical data of 86 sepsis children from January 2008 to January 2013 were collected and divided into early sepsis group, severe sepsis group and septic shock group by severity of illness. All patients were divided into survival group and death group according to the prognosis. The levels of plasma procalcitonin, lactate, D-dimer and pediatric critical illness score (PCIS) were compared among the three groups. The levels of three markers, procalcitonin, lactic acid and D-dimer, Severity and prognosis of clinical value. Results Among the three groups of children with sepsis of different severity, the levels of three markers and PCIS were significantly different (P <0.05). There were significant differences in serum procalcitonin, lactate, D-dimer and PCIS between death group and survival group (P <0.05), and there was a negative correlation between them. Conclusion The levels of procalcitonin, lactic acid and D-dimer have guiding significance for the severity and prognosis of sepsis in children. The higher the level of serum procalcitonin, lactic acid and D-dimer, The lower the PCIS, the more severe the disease, the worse the prognosis.