检索历史 清除

目的:探讨肝素结合蛋白（HBP）联合儿童序贯器官功能衰竭（pSOFA）评分对儿童脓毒症预后的预测价值。方法:选择2021年1月至2022年6月在湖南省人民医院（湖南师范大学附属第一医院）PICU住院的脓毒症患儿为研究组，同期进行腹股沟疝择期手术及性早熟、身材矮小评估的患儿作为对照组。所有脓毒症患儿根据严重程度及预后分为脓毒症组和脓毒性休克组、脓毒症存活组和脓毒症死亡组。研究组在入院第1天、第3天、第7天检测HBP，对照组在入院第1天检测HBP。研究组患儿入院后即刻进行pSOFA评分。比较各组间实验室检查结果及HBP浓度，并联合pSOFA评分建立联合模型评估其对脓毒症预后的预测效能。结果:研究组共纳入50例患儿，其中脓毒症45例，脓毒性休克5例。男27例，女23例，年龄1个月~13岁（中位年龄2岁）。7例患儿死亡，其中脓毒症患儿2例，脓毒性休克患儿5例。研究组第1天HBP浓度显著高于对照组，研究组HBP浓度随住院时间延长呈逐渐下降趋势。脓毒性休克患儿第1天HBP浓度高于脓毒症患儿，差异有统计学意义（ P<0.001）。脓毒症死亡组第1天HBP浓度显著高于脓毒症存活组（ P=0.023）。通过受试者工作特征曲线分析HBP、pSOFA评分对脓毒症患儿死亡均有较好的预测价值，两者的联合模型（75.1×pSOFA-0.1×HBP）对脓毒症患儿死亡的预测效能最佳，但与pSOFA评分差异并不显著。 结论:脓毒症患儿HBP显著增高，随住院时间延长逐渐下降，同时HBP对预测脓毒症患儿死亡结局具有较大价值，联合pSOFA评分能提升其对死亡的预测能力，但并没有优于pSOFA评分。

Objective:To investigate the predictive value of heparin binding protein(HBP) combined with pediatric sequential organ failure assessment(pSOFA) in children with sepsis.Methods:Children with sepsis admitted to PICU of Hunan Provincial People's Hospital (the First Affiliated Hospital of Hunan Normal University) from January 2021 to June 2022 were selected as study group,while those who underwent elective surgery for inguinal hernia and assessment of precocious puberty and short stature during the same period were selected as control group.All children with sepsis were divided into sepsis group and septic shock group according to their severity as well as survival group and death group according to prognosis.The study group was monitored for HBP on the 1st,3rd,and 7th day of admission,while the control group was monitored for HBP on the 1st day of admission.Patients in the sepsis group received pSOFA scores immediately after admission.The laboratory results and HBP concentrations were compared between groups，and a joint model was established in combination with pSOFA to observe its predictive performance in sepsis prognosis.Results:A total of 50 children with sepsis were included in study group，including 45 children with sepsis and five children with septic shock.There were 27 males and 23 females，aged 1 month～13 years（median age two years）.There were 7 deaths in this study，including two patients with sepsis and five patients with septic shock.The HBP concentration in the study group was significantly higher than that in the control group on the 1st day，and the HBP concentration in the group gradually decreased with the prolongation of hospital stay.The concentration of HBP on the first day of septic shock group was higher than that of sepsis group，and the difference was statistically significant（ P<0.001）.The concentration of HBP on the 1st day in the sepsis death group was significantly higher than that in the sepsis survival group（ P=0.023）.The receivor operator characteristic curve analysis showed that HBP and pSOFA had good predictive value for the death of children with sepsis，and the joint model of HBP and pSOFA（75.1×pSOFA-0.1×HBP）had the best predictive performance for the death of children with sepsis，but there was no significant difference with the pSOFA. Conclusion:The HBP level significantly increases in children with sepsis，and gradually decreases with the length of hospital stay，and HBP has great value in predicting the outcome of death in children with sepsis，and the combination of pSOFA could improve its predictive ability of death,but not better than pSOFA.