摘要
目的探讨小剂量糖皮质激素对小儿脓毒症血清可溶性髓系细胞触发受体1(sTREM-1)、降钙素原(PCT)、CD64的影响。方法选取2014年3月~2016年3月中国石油中心医院儿科住院收治66例脓毒症患儿,采用随机数字表法分成两组,每组33例。均予原发病和退热等对症治疗,对照组予脓毒症集束化(抗生素、强化胰岛素、营养支持等)治疗,研究组在上述基础上再予小剂量注射用甲泼尼龙琥珀酸钠静脉滴注,治疗7 d。检测外周血T淋巴细胞、炎症指标PCT、C反应蛋白(CRP)、白介素-8(IL-8)和sTREM-1、可溶性细胞间黏附因子-1(sICAM-1)以及可溶性血管细胞黏附分子-1(sVCAM-1)水平。评估小儿危重病例评分标准(PCIS)及急性生理学及慢性健康状况评分系统Ⅱ(APACHEⅡ)评分,比较治疗效果。结果与治疗前比较,两组治疗后CD3~+、CD4~+及CD8~+升高(P<0.01),CD64~+降低(P<0.01),PCT、CRP、IL-8降低(P<0.01),sTREM-1、sICAM-1、sVCAM-1降低(P<0.01),PCIS评分升高(P<0.01),APACHEⅡ评分降低(P<0.01);与对照组比较,研究组CD3~+、CD4~+及CD8~+较高(P<0.01),CD64~+较低(P<0.01),PCT、CRP、IL-8较低(P<0.01),sTREM-1、sICAM-1、sVCAM-1较低(P<0.01),PCIS评分较高(P<0.05),APACHEⅡ评分较低(P<0.01),总有效率较高(P<0.05)。结论小剂量糖皮质激素能有效降低脓毒症患儿血清sTREM-1、PCT、CD64~+水平,具有重要临床价值。
Objective To explore the influence of small doses of hormones on serum sTREM-1, PCT, CD64 in pediatric sepsis.Methods 66 cases of children with sepsis treated in Pediatrics Department of CNPC Central Hospital from March 2014 to March 2016 were selected as research objects.They were divided into two groups according to random number table method, 33 cases in each group.All pateints were given symptomatic treatment.Patients in the control group were given bundle of treatment, inculding antibiotics, intensive insulin, nutritional support.On the basis of the control gorup, patients in the study group were given small dose Methylprednisolone Sodium Succinate for Injection for7 d.The levels of peripheral blood T lymphocyte, inflammatory index(PCT, CRP, IL-8) and sTREM-1, sICAM-1 and sVCAM-1 were detected.The scores of PCIS and APACHE Ⅱ were evaluated.The therapeutic effect was compared between the two groups.Results Compared with before treatment, after treatment two groups of CD3~+, CD4~+and CD8~+increased(P < 0.01), CD64~+decreased(P < 0.01), levels of PCT, CRP, IL-8 decreased(P < 0.01), levels of sTREM-1,sICAM-1, sVCAM-1 decreased(P < 0.01), PCIS score increased(P < 0.01), APACHE Ⅱ score decreased(P < 0.01).Compared with the control group, the study group had higher CD3~+, CD4~+and CD8~+(P < 0.01), lower CD64~+(P < 0.01),lower levels of PCT, CRP, IL-8 and sTREM-1、sICAM-1、sVCAM-1(P < 0.01), higher PCIS score(P < 0.05), lower APACHE Ⅱ score(P < 0.01), and higher total effective rate(P < 0.05).Conclusion Small doses of glucocorticoid can effectively reduce serum sTREM-1, PCT, CD64~+ levels of sepsis patients, which has important clinical value.
引文
[1]姜建渝,王玲.小儿脓毒症血流感染致各种并发症的诊治分析[J].中国小儿急救医学,2016,23(1):62-63.
[2]上海ICU脓毒症诊治情况调查协作组.上海市四家儿童医院重症监护病房304例脓毒症诊治调查分析[J].中华儿科杂志,2012,50(3):172-177.
[3]周小勤,涂丹娜,夏治.儿童脓毒症患病现状调查及死亡危险因素分析[J].实用医学杂志,2013,29(4):606-608.
[4]陈建丽,黄莉,徐艳霞,等.儿童重症医学科脓毒症发病及死亡相关危险因素临床分析[J].贵州医药,2013,37(3):201-205.
[5]王雯,王东,方明明,等.小剂量糖皮质激素治疗脓毒血症疗效的Meta分析[J].国际流行病学传染病学杂志,2015,42(2):110-114.
[6]Goldstein B,Giroir B,Randolph A,et al.Interna tional pediatric sepsis consensus conference:definitions for sepsis and organ dysfunction in pediatrics[J].Pediatr Crit Care Med,2005,6(1):2-8.
[7]Dellinger RP,Levy MM,Carlet JM,et al.Surviving Sepsis Campaign:intermational guidelines for management of severe sepsis and septic shoch:2008[J].Crit Care Med,2008,(1):296-327.
[8]陆文峰,王丽杰,刘春峰,等.几种重症评分在儿科的临床应用[J].中国小儿急救医学,2015,22(10):714-717.
[9]袁晓宇,袁菊萍,王艳,等.D-二聚体、急诊脓毒症病死率评分及急性生理学与慢性健康状况评价系统Ⅱ评分对急诊脓毒症患者预后的预测价值[J].实用心脑肺血管病杂志,2016,24(5):96-99.
[10]肖为,杨明施.脓毒症治疗的现状与新进展[J].医学综述,2014,20(8):1425-1429.
[11]韩松勇,郭伟,李宏.糖皮质激素治疗脓毒症的临床研究进展[J].中国中西医结合急救杂志,2013,20(1):60-61.
[12]许东,肖淼淼.糖皮质激素治疗脓毒血症的策略[J].医学与哲学,2014,35(8):88-90.
[13]袁远宏,肖政辉,张慧,等.小儿脓毒症T细胞亚群变化分析及临床意义[J].中国当代儿科杂志,2013,15(3):216-218.
[14]阮莉莉,杜俊君,林艳,等.CD64指数在新生儿脓毒症早期诊断中的意义[J].上海交通大学学报:医学版,2014,34(10):1503.
[15]Venet F,Lepapr A,Monmeret G,et al.Clinical review:flow cytometry perspectives in the ICU-form diagnosis of infection to monitoring of injury-induced immune dysfunctions[J].Crit Care,2011,15(5):231.
[16]何勤,樊省廉,韦丽仁.动态监测肺部感染相关脓毒症患儿血清降钙素原水平的临床意义[J].中国医刊,2015,50(8):102-104.
[17]熊凡,冯姗.血清降钙素原检测在小儿脓毒症中的临床价值[J].临床医药实践,2016,25(7):515-517.
[18]谢剑锋,杨毅.生物标记物在全身性感染中的诊断价值[J].实用医院临床杂志,2012,9(6):27-29.
[19]李玖军,张涛.C反应蛋白及降钙素原在小儿脓毒症血流感染及其他部位感染性疾病中的诊断价值[J].中国当代儿科杂志,2013,15(3):212-215.
[20]陈晨,吕艳琪,金志鹏,等.小儿脓毒症早期血乳酸及乳酸清除率的临床意义[J].中国医药科学,2015,5(8):59-61.
[21]赵安玲.脓毒血症儿童血清降钙素原与炎症因子的相关性[J].儿科药学杂志,2013,19(8):5-7.
