脓毒症患儿血清胆碱酯酶、前白蛋白和C反应蛋白变化及预后的关系

目的了解脓毒症（sepsis）患儿血清胆碱酯酶（CHE）、前白蛋白（PA）和超敏c反应蛋白（hsCRP）和c反应蛋白（CRP）变化特点及临床意义，探讨CHE、PA、hsCRP和CRP变化及对脓毒症患儿预后的影响。方法对2007-01—2009—02住院的59例符合脓毒症诊断标准患儿，经治疗原发病和应用呼吸支持、液体复苏、血管活性药物、抗感染、对症治疗等处理后，依据疾病转归情况将患儿分为未愈／死亡组18例和治愈／存活组41例，全部于人组当天及第3天检测血清CHE、hsCRP、CRP、肝功能等其他各项指标，49例同时检测血清PA，设同龄普通肺炎对照组患儿30例。结果脓毒症患儿未愈／死亡组与治愈／存活组比较：人组当天及第3天血清CHE、PA均明显降低（均分别为P〈0．05和P〈0．01）；hsCRP及CRP人组当天及第3天均明显增高（分别为P〈0．05和P〈0．01）。两组分别与正常儿童比较：血清CHE、PA、均明显降低（P均〈0．01）；hsCRP未愈／死亡组较对照组增高（P〈0．01）；CRP治愈／存活组及未愈／死亡组较对照组均明显增高（P均〈0．05）。结论脓毒症患儿存在不同程度血清CHE、PA降低，hsCRP及CRP增高，血清CHE、PA、hsCRP及CRP在一定程度上体现脓毒症患儿病情的危重程度，对判断脓毒症患儿预后有参考价值。

Relationship between prognosis and changes of serum choUnesterase,prealbumin and reactive protein C in children with sepsis

Objective To understand the characteristics of changes of the serum cholinesterase（CHE） ,prealbumin（PA） ,supersensitive reactive protein C （hsCRP） and reactive protein C （CRP） in the children with sepsis and their clinical significances, and to approach the changes and their effects on the prognosis of the sepsis in chil- dren. Methods From January, 2007 to February, 2009, 59 cases of sepsis in accord with diagnostic criteria under- went treatment of primary affection, respiratory sustentation, fluid anabiosis, vasoactive agent, anti - infection and symptomatic treatment, etc. And according to prognosis of disease, the cases were classified into one not - yet - recovered / expired group of 18 cases and one cured / survived group of 41. In all of the cases, on the day when into the groups and the third day, their serum CHE, hsCRP, CRP and indexes of liver function were detected. Serum PA of 49 cases was detected simultaneously, and a control group of 30 cases of the same age with pneumonia was set up. Results Compared with the levels of the serums CHE and PA of the cured / survived group, those of the not - yet - recovered / expired group with sepsis dropped remarkably （ respectively P 〈 0. 05 and P 〈 0. 01 ） on the day entering the group and the third day, while the hsCRP and CRP rose remarkably（ respectively P 〈 0. 05 and P 〈 0. 01 ）. Com- pared with the serum CHE and PA of unimpaired children, those of the two groups both dropped remarkably （ P 〈 0. 01 ） ; hsCRP of the not - yet - recovered / expired group increased more than the control group （P 〈0. 01 ） ; CRP of the cured / survived group and the not - yet - recovered / expired increased more than the control group（ both P 〈 0. 05）. Conclusion There are differently lower levels of serums CHE and PA and higher hsCRP and CRP in the im- paired children with sepsis. Serums CHE, PA, hsCRP and CRP are indicative of the severity of the patient＇ s condi- tion with sepsis, which are of referred value to the prognosis of the child with sepsis.