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目的通过观察小儿脓毒症和严重脓毒症患者体内血浆和肽素(Copeptin)水平的改变,探讨其在病情分层中的临床意义。方法入选住院脓毒症患儿48例,严重脓毒症患儿16例;另选取健康儿童30例作为正常对照组。同时检测两组患儿未经治疗时和对照组血浆中Copeptin、白细胞计数(WBC)、中性粒细胞计数(N)、C-反应蛋白(CRP)、降钙素原(PCT)及血清钠水平。结果脓毒症和严重脓毒症患儿体内血浆Copeptin及PCT均显著高于对照组(P<0.01),同时脓毒症和严重脓毒症间比较差异也有统计学意义(P<0.05);组间CRP及血清钠水平比较差异未见统计学意义(P>0.05),脓毒症与严重脓毒症组WBC、N比较差异未见统计学意义(P>0.05)。各组外周血浆Copeptin与PCT有一定相关性(r=0.563,P<0.01),尚不能认为与余各炎症指标(WBC、N、CRP)和血清钠相关(r<0.50或P>0.05)。脓毒症患儿Copeptin和PCT受试者工作特征曲线(ROC曲线)分析显示,Copeptin对严重脓毒症有显著诊断价值[曲线下面积=0.872,95%可信区间(95%CI):0.744~1.001,P=0.001],优于PCT(AUC=0.694)。取截点Copeptin>0.91 ng/ml,对诊断有80.00%的敏感度和83.33%的特异度。结论检测脓毒症患儿体内血浆Copeptin和PCT水平有助于患儿病情及其严重程度分层判断,且Copeptin优于后者。
Objective To observe the clinical significance of plasma Copeptin levels in children with sepsis and severe sepsis and to explore its clinical significance in stratification. Methods Forty-eight children with sepsis and 16 children with severe sepsis were enrolled in this study. Thirty healthy children were selected as normal control group. The levels of Copeptin, WBC, neutrophil count (N), C-reactive protein (CRP), procalcitonin (PCT) and serum sodium Level. Results The plasma Copeptin and PCT in children with sepsis and severe sepsis were significantly higher than those in the control group (P <0.01). There was also significant difference between sepsis and severe sepsis (P <0.05). There were no significant differences in CRP and serum sodium between the two groups (P> 0.05). There was no significant difference in WBC and N between sepsis and severe sepsis (P> 0.05). Peripheral blood plasma Copeptin had a certain correlation with PCT (r = 0.563, P <0.01), but it was not considered to be associated with the remaining inflammatory markers (WBC, N, CRP) and serum sodium (r <0.50 or P> 0.05). Analysis of Copeptin and PCT subjects’ working characteristic curves (ROC curves) in sepsis children showed a significant diagnostic value of Copeptin for severe sepsis [area under the curve = 0.872, 95% confidence interval (95% CI): 0.744 ~ 1.001, P = 0.001], better than PCT (AUC = 0.694). Take the cut-off point Copeptin> 0.91 ng / ml, the diagnosis of 80.00% sensitivity and 83.33% specificity. Conclusion Detection of plasma Copeptin and PCT levels in children with sepsis is helpful to stratify the severity and severity of the disease in children and Copeptin is superior to the latter.