小儿全身炎症反应综合征血清降钙素原水平动态变化及价值

目的 探讨小儿全身炎症反应综合征(SIRS)血清降钙素原(PCT)水平及临床价值.方法 以2006年1月至12月收住郑州市儿童医院重症监护室(ICU)、小儿危重症评分≤70分的SIRS患儿96例作为观察对象,其中感染性SIRS 54例,原发病包括重症肺炎、化脓性脑膜炎、败血症、中毒性痢疾.非感染性SIRS 42例,原发病包括颅内出血、药物中毒、一氧化碳中毒、捂热综合征、溺水、脊髓肿瘤、小脑肿瘤.观察两组PCT、IL-6、IL-8、CRP、WBC水平及动态变化.结果 感染性SIRS组血清PCT水平高于非感染性SIRS组(P＜0.001);脓毒症发展成多器官功能障碍综合征(MODS)时72 h血清PCT水平进行性升高(P＜0.001).脓毒症患儿IL-6、IL-8水平高于严重脓毒症和MODS患儿(P＜0.05);严重脓毒症与MODS患儿之间差异无显著性(P＞0.05).在感染性SIRS脓毒症发展成MODS的患儿中,72 h的CRP、WBC无明显变化(P＞0.05).结论 PCT可作为小儿细菌感染和判断预后的重要参考指标,敏感性、特异性优于传统指标.

The dynamic change and value of serum Per in children with systemic inflammatory response syndrome

Objective To explore the level and clinical value of serum PCT in children with systemic inflammatory response syndrome(SIRS).Methods Ninety-six children with SIRS and critical score below seventy in Zhengzhou Children's Hospital Intensive Critical Unit(ICU)were admitted from January 2006 to December 2006.Severe pneumonia,toxic dysentery,bacterial meningitis,septicemia were the major underlying diseases of fifty-four children with infectious SIRS.Intracranial hemorrhage,infant muggy syndrome,poisoning,anthracemia,drowning,tumor were the major underlying diseases of forty-two children with non-infectious SIRS.PCT,IL-6,IL-8,CRP and WBC were compared between the two groups.Results The levels of semm PCT,CRP and WBC in infectious SIRS group was higher than non-infectious SIRS group(P＜0.001).Dynamic observation of serum PCT level in children developing from sepsis to MODS confirmed that serum PCT concentration at seventy-two hour stably increased.IL-6 and IL-8 showed no significant difference between the two groups(P＞O.05).IL-6 and IL-8 concentration in sepsis group was higher than that in severe sepsis and MODS group(P＜0.05).But CRP and WBC had no significant difference(P＞0.05).Conclusion PCT concentration in serum has important value in differential diagnosis and prognosis assessment,and has more sensitivity and specificity than conventional inflammatory parameters.