摘要
目的分析在儿童重症肺炎诊断中进行血清降钙素原、C反应蛋白、D二聚体及白细胞介素-6(IL-6)联合检测的意义。方法回顾性选取200例儿童重症肺炎患儿进行研究,其中5例死亡患儿作为死亡组,195例好转患儿作为好转组。两组患儿均接受血清降钙素原、C反应蛋白、D二聚体、IL-6检测及痰培养、胸水检测。分析两组病原菌分布情况,比较两组不同时间点(治疗第1、3、7天及转出/死亡当天)C反应蛋白、D二聚体、血清降钙素原、IL-6水平。结果好转组患儿革兰阳性菌占比低于革兰阴性菌,主要致病菌为溶血性葡萄球菌、肺炎克雷伯菌;死亡组患儿革兰阳性菌占比低于革兰阴性菌,主要致病菌为铜绿假单胞菌,真菌较为少见。好转组患儿治疗第1、3、7天及转出当天的C反应蛋白水平分别为(73.15±2.16)、(60.75±0.94)、(43.19±1.06)、(31.02±0.41)mg/L,呈下降趋势,比较差异具有统计学意义(P<0.05);死亡组患儿治疗第1、3、7天及死亡当天的C反应蛋白水平分别为(73.14±2.17)、(90.15±0.16)、(105.13±1.03)、(117.16±0.29)mg/L,呈上升趋势,比较差异具有统计学意义(P<0.05);两组患儿治疗第1天C反应蛋白水平比较差异无统计学意义(P>0.05);好转组患儿治疗第3、7天及转出当天的C反应蛋白水平均低于死亡组,差异具有统计学意义(P<0.05)。好转组患儿治疗第1、3、7天及转出当天的血清降钙素原水平分别为(11.36±0.67)、(7.71±0.42)、(5.64±0.21)、(4.42±0.12)μg/L,呈下降趋势,比较差异具有统计学意义(P<0.05);死亡组患儿治疗第1、3、7天及死亡当天的血清降钙素原水平分别为(11.37±0.66)、(15.74±0.16)、(17.79±0.42)、(19.57±0.15)μg/L,呈上升趋势,比较差异具有统计学意义(P<0.05);两组患儿治疗第1天血清降钙素原水平比较差异无统计学意义(P>0.05);好转组患儿治疗第3、7天及转出当天的血清降钙素原水平均低于死亡组,差异具有统计学意义(P<0.05)。好转组患儿治疗第1、3、7天及转出当天的D二聚体水平分别为(2.74±0.11)、(1.96±0.16)、(1.45±0.11)、(1.11±0.12)mg/L,呈下降趋势,比较差异具有统计学意义(P<0.05);死亡组患儿治疗第1、3、7天及死亡当天的D二聚体水平分别为(2.73±0.12)、(3.13±0.21)、(3.45±0.14)、(3.72±0.11)mg/L,呈上升趋势,比较差异具有统计学意义(P<0.05);两组患儿治疗第1天D二聚体水平比较差异无统计学意义(P>0.05);好转组患儿治疗第3、7天及转出当天的D二聚体水平均低于死亡组,差异具有统计学意义(P<0.05)。好转组患儿治疗第1、3、7天及转出当天的IL-6水平分别为(11.74±0.41)、(7.34±0.12)、(5.45±0.36)、(4.14±0.12)ng/L,呈下降趋势,比较差异具有统计学意义(P<0.05);死亡组患儿治疗第1、3、7天及死亡当天的IL-6水平分别为(12.03±0.12)、(14.56±0.33)、(17.32±0.16)、(18.72±0.11)ng/L,呈上升趋势,比较差异具有统计学意义(P<0.05);两组患儿治疗第1天IL-6水平比较差异无统计学意义(P>0.05);好转组患儿治疗第3、7天及转出当天的IL-6水平均低于死亡组,差异具有统计学意义(P<0.05)。结论重症肺炎患儿病情转归情况与血清降钙素原、C反应蛋白、D二聚体及IL-6指标有直接关系,当重症肺炎患儿病情好转后相关指标不断下降,直到恢复正常值,但病情恶化患儿的各项指标均不断上升。
Objective To analyze the significance of combined detection of serum procalcitonin,C-reactive protein,D-dimer and interleukin-6(IL-6)in the diagnosis of severe pneumonia in children.Methods A retrospective study was conducted on 200 children with severe pneumonia,including 5 dead children as the death group and 195 improved children as the improvement group.Children in both groups received serum procalcitonin,C-reactive protein,D-dimer,IL-6 tests and sputum culture and pleural fluid tests.The distribution of pathogens in the two groups was analyzed,and the levels of C-reactive protein,D-dimer,serum procalcitonin and IL-6 at different time points(day 1,3 and 7 of treatment and the day of transfer out/death)in the two groups were compared.Results The proportion of gram-positive bacteria in the improved group was lower than that of Gram-negative bacteria,and the main pathogens were hemolytic staphylococcus and Klebsiella pneumoniae;the proportion of Gram-positive bacteria in the death group was lower than that of Gram-negative bacteria,and the main pathogens were Pseudomonas aeruginosa,and fungi were rare.The C-reactive protein levels of children in the improved group were(73.15±2.16),(60.75±0.94),(43.19±1.06),and(31.02±0.41)mg/L on day 1,3,and 7 of treatment and on the day of transfer out,showing a decreasing trend,and the differences were statistically significant(P<0.05).The C-reactive protein levels of children in the death group were(73.14±2.17),(90.15±0.16),(105.13±1.03),and(117.16±0.29)mg/L on day 1,3,and 7 of treatment and on the day of transfer out,showing an upward trend,and the differences were statistically significant(P<0.05).On day 1 of treatment,there was no statistically significant difference in C-reactive protein between the two groups(P>0.05).The C-reactive protein levels of children in the improved group were lower than those in the death group on day 3 and 7 of treatment and on the day of transfer out,and the difference was statistically significant(P<0.05).The serum procalcitonin levels of children in the improved group were(11.36±0.67),(7.71±0.42),(5.64±0.21)and(4.42±0.12)μg/L on day 1,3 and 7 of treatment and on the day of transfer out,showing a decreasing trend,and the difference was statistically significant(P<0.05).The serum procalcitonin levels of children in the death group were(11.37±0.66),(15.74±0.16),(17.79±0.42),and(19.57±0.15)μg/L on day 1,3,and 7 of treatment and on the day of death,showing an increasing trend,and the difference was statistically significant(P<0.05).On day 1 of treatment,there was no statistically significant difference in serum procalcitonin between the two groups(P>0.05).The serum procalcitonin of children in the improved group was lower than that of the death group on day 3 and 7 of treatment and on the day of transfer out,and the difference was statistically significant(P<0.05).The D-dimer levels of children in the improved group were(2.74±0.11),(1.96±0.16),(1.45±0.11)and(1.11±0.12)mg/L on day 1,3 and 7 of treatment and on the day of transfer out,showing a decreasing trend,and the difference was statistically significant(P<0.05).The D-dimer levels of children in the death group were(2.73±0.12),(3.13±0.21),(3.45±0.14),and(3.72±0.11)mg/L on day 1,3,and 7 of treatment and on the day of death,showing an increasing trend,and the difference was statistically significant(P<0.05).On day 1 of treatment,there was no statistically significant difference in D-dimer between the two groups(P>0.05).The D-dimer of children in the improved group was lower than that of the death group on day 3 and 7 of treatment and on the day of transfer out,and the difference was statistically significant(P<0.05).The IL-6 levels of children in the improved group were(11.74±0.41),(7.34±0.12),(5.45±0.36)and(4.14±0.12)mg/L on day 1,3 and 7 of treatment and on the day of transfer out,showing a decreasing trend,and the difference was statistically significant(P<0.05).The IL-6 levels of children in the death group were(12.03±0.12),(14.56±0.33),(17.32±0.16),and(18.72±0.11)mg/L on day 1,3,and 7 of treatment and on the day of death,showing an increasing trend,and the difference was statistically significant(P<0.05).On day 1 of treatment,there was no statistically significant difference in IL-6 between the two groups(P>0.05).The IL-6 of children in the improved group was lower than that of the death group on day 3 and 7 of treatment and on the day of transfer out,and the difference was statistically significant(P<0.05).Conclusion The prognosis of children with severe pneumonia is directly related to the indexes of serum procalcitonin,C-reactive protein,D-dimer and IL-6.When the condition of children with severe pneumonia gets better,the relevant indexes continue to decline until they return to the normal value,but the indexes of children with severe pneumonia continue to rise.
作者
曾晓兵
张筱婷
ZENG Xiao-bing;ZHANG Xiao-ting(Department of Pediatrics,Zhangye Second People's Hospital,Zhangye 734000,China)
出处
《中国现代药物应用》
2022年第24期17-21,共5页
Chinese Journal of Modern Drug Application
基金
甘肃省自然科学基金(项目编号:21JR1RG311)。
作者简介
通讯作者:张筱婷。
