血清降钙素原在儿童急性病毒性腹泻病中的临床价值探讨

目的：探讨急性病毒性腹泻病患儿血清降钙素原( PCT)的表达水平及临床意义。方法回顾性分析2013年9月至2015年9月在我院住院治疗的186例急性病毒性腹泻患儿,男107例,女79例,其中轮状病毒感染171例,诺如病毒感染15例。平均年龄(1.29±0.89)岁。所有患儿血培养、粪培养均阴性。按照患儿脱水程度和是否伴有器官功能障碍分为重症组(包括重度脱水、休克、多器官功能障碍)33例、轻-中度脱水组68例和无脱水组85例。8例死亡。选取35例健康同龄儿童作为健康对照组。腹泻患儿入院后2 h内分别留取血标本检测血清PCT水平,同时检查血常规、超敏CRP。结果急性病毒性腹泻患儿血清 PCT水平升高73例,其中>100 ng/ml 8例,5~100 ng/ml 21例,0.5~5.0 ng/ml 44例。急性病毒性腹泻患儿血清PCT(ng/ml)[0.36(0.14,1.67)]、超敏CRP(mg/L)[3.50(0.70,14.83)]、WBC(×109/L)[9.06(6.79,12.50)]水平均较健康对照组儿童[0.09(0.05,0.13)；1.00(0.40,2.50)；6.90(5.90,8.20)]升高(P<0.05)。合并脱水者PCT水平较无脱水者升高[0.54(0.19,7.83)vs.0.26(0.11,0.55)](P<0.05)；重症组患儿PCT水平[13.69(3.41,60.30)]较轻-中度脱水组[0.33(0.13,0.89)]和无脱水组[0.26(0.11,0.55)]升高(均P<0.017),超敏CRP、WBC水平各组无差异(P>0.05)。结论急性病毒性腹泻患儿血清PCT也可以升高,尤其是合并重度脱水、休克及多器官功能障碍者更高。持续较高的PCT水平提示病情危重,预后差。 PCT可以指导评估急性病毒性腹泻病患儿病情的严重程度及预后。

The clinical value of serum procalcitonin in children with acute viral diarrhea

Objective To discuss the expression level of serum procalcitonin( PCT) and clinical val-ue in acute viral diarrhea patients. Methods A total of 186 patients with acute viral diarrhea treated in our hospital from September 2013 to September 2015 were retrospectively reviewed. One hundred and seven were male and 79 were female,of which 171 cases were infected by rotavirus and 15 cases infected by norovirus. The average age was ( 1. 29 ± 0. 89 ) years old. All patients′ blood and stool cultures were negative. The patients were divided into three groups according to the degree of dehydration and whether complicated with multiple organ dysfunction or not:severe group( complicated with severe dehydration,shock or multiple organ dysfunction,n=33),mild-moderate dehydration group(n=68) and no dehydration group(n=85). Thirty-five healthy children with the same age were enrolled as the control group. Serum PCT levels,high sensitivity CRP(hs CRP) and blood routine were detected. Results The serum PCT levels increased in 73 patients with acute viral diarrhea,8 cases>100 ng/ml,21 cases 5 to 100 ng/ml and 44 cases 0. 5 to 5. 0 ng/ml. PCT( ng/ml)[0. 36(0. 14,1. 67),hsCRP(mg/L)[3. 50(0. 70,14. 83)] and WBC( × 109/L)[9. 06(6. 79,12. 50)] levels increased in the diarrhea patients compared with those in the healthy group[0. 09(0. 05,0. 13);1. 00 (0.40,2.50);6.90(5.90,8.20)](all P < 0.05). The level of PCT in patients with dehydration [0.54 (0. 19,7. 83)]was higher than that without dehydration[ 0. 26(0. 11,0. 55)](P<0. 05) and increased in severe group[13. 69(3. 41,60. 30)] compared with in those the mild-moderate group[0. 33(0. 13,0. 89)] and no dehydration group[0. 26(0. 11,0. 55)](all P<0. 017),but there was no difference among groups in hsCRP and WBC levels ( P>0. 05 ) . Conclusion PCT can increase in pediatric patients with acute viral diarrhea,especially in those with severe dehydration,shock and organ dysfunction. Continued high levels of PCT indicates critical condition and has poor prognosis. PCT can be used as a good indicator to evaluate the severity of disease and the prognosis.