可溶性髓样细胞触发受体-1和降钙素原在儿童脓毒症中的应用价值

目的 探讨sTREM-1和PCT在儿童脓毒症诊断及严重程度评估方面的价值。方法 选取2016年1月1日—12月31日张家口市第一医院儿科收治的脓毒症儿童78例、普通感染儿童23例和健康体检儿童25例为研究对象,比较三组患儿sTREM-1、PCT、IL-6和CRP水平;采用受试者工作曲线分析四项指标诊断儿童脓毒症的价值。根据脓毒症的严重程度把脓毒症组分为一般脓毒症、严重脓毒症和脓毒症休克三组,比较亚组间患儿sTREM-1、PCT、IL-6、CRP和SOFA评分;并分析sTREM-1、PCT、IL-6、CRP和SOFA评分的相关性。结果 脓毒症组sTREM-1、PCT和IL-6水平均高于普通感染组和健康对照组,差异具有统计学意义（P均<0.05）。比较诊断脓毒症的曲线下面积sTREM-1最大为0.88（95%CI：0.78~0.98）,PCT次之为0.81（95%CI：0.70~0.93）;当sTREM-1取最佳临界值69.08 pg/mL时,灵敏度最高为83.33%,特异度为84.00%,稍低于PCT取1.93 ng/mL时的特异度88.00%。脓毒症各亚组间sTREM-1、PCT和SOFA评分有差异,脓毒症休克组最高,一般脓毒症组最低（P均<0.05）,三组间IL-6和CRP水平差异没有统计学意义（P均>0.05）。相关性分析显示sTREM-1、PCT与SOFA评分呈正相关（P均<0.05）;而IL-6和CRP水平与SOFA评分不相关（P均>0.05）。结论 sTREM-1和PCT水平不仅有助于儿童脓毒症的早期诊断,而且还可以评估病情的严重程度。

The application value of soluble triggering receptor expresses on myeloid cells-1 and procalcitonin in children′s sepsis

Objective To investigate the value of sTREM-1 and PCT in the diagnosis and severity assessment of children's sepsis. Methods Select 78 children with sepsis, 23 children with normal infection and 25 healthy children who were from the Number One Hospital of Zhangjiakou from January 1 to December 31, 2016, and compare the levels of sTREM-1, PCT, IL-6 and CRP among the three groups; Analyze the value of four indicators in the diagnosis of children's sepsis by the subjects' work curve. According to the severity of sepsis, divide the sepsis group into three groups: general sepsis, severe sepsis and septic shock, and compare the levels of sTREM-1, PCT, IL-6, CRP and the scores of SOFA among the subgroups; and analyze the correlation of sTREM-1, PCT, IL-6, CRP and SOFA scores. Results In the sepsis group, the levels of sTREM-1, PCT and IL-6 were higher than those in the common infection group and the healthy control group, and the difference was statistically significant (P all <0.05). Comparison of the area under the working curve of the subjects, the maximum sTREM-1 was 0.88 (95%CI: 0.78-0.98), and 0.81 (95%CI: 0.70-0.93) in PCT; When the optimal cutoff value of sTREM-1 was 69.08 pg/mL, the sensitivity was the highest (83.33%), and the specificity was 84.00% lower than that (88.00%) of PCT with 1.93 ng/mL. The levels of sTREM-1, PCT and the scores of SOFA in sepsis subgroups were significantly different;The septic shock group was the highest and the lowest in the sepsis group (P all <0.05);But there was no significant difference in the level of IL-6 and CRP among the three groups (P both >0.05). Correlation analysis showed that sTREM-1 and PCT were positively correlated with SOFA scores (P<0.05), while IL-6 and CRP levels were not related with SOFA score (P>0.05). Conclusions TREM-1 and PCT levels are not only helpful to the early diagnosis of children's sepsis, but also to assess the severity of the disease.