脓毒症患儿血清SAA、PCT、CRP水平与预后的关系及其诊断价值分析

摘要 目的：探讨脓毒症患儿血清淀粉样蛋白A（SAA）、降钙素原（PCT）、C反应蛋白（CRP）与预后的关系，并分析三者对脓毒症的诊断价值。方法：纳入我院于2016年8月～2020年6月期间收治的脓毒症患儿60例开展回顾性研究，作为脓毒症组，选取同期于我院进行体检的健康儿童40例作为对照组，比较两组血清SAA、PCT、CRP水平。根据脓毒症患儿1个月内的生存、死亡情况，分成生存组（n=42）、死亡组（n=18），比较两组临床资料及血清SAA、PCT、CRP水平，经COX回归模型分析脓毒症患儿死亡的危险因素。绘制受试者工作特征（ROC）曲线分析血清SAA、PCT、CRP对脓毒症的诊断价值。结果：脓毒症组血清SAA、PCT、CRP水平显著高于对照组（P＜0.05）。死亡组器官障碍数量＞2个、脓毒性休克患儿占比分别为55.56%、44.44%，显著高于生存组的19.05%、9.52%（P＜0.05）；死亡组入院后1 h内使用抗菌治疗患儿占比为38.89%，显著低于生存组的69.05%（P＜0.05）；死亡组血清SAA、PCT、CRP水平高于生存组（P＜0.05）。COX多因素分析结果显示，器官障碍数量＞2、脓毒性休克及血清SAA、PCT、CRP水平升高是脓毒症患儿死亡的危险因素（P＜0.05），而入院后1 h内使用抗菌治疗是脓毒症患儿死亡风险的保护性因素（P＜0.05）。血清SAA、PCT、CRP单独及三者联合诊断脓毒症的曲线下面积（AUC）分别为0.808、0.780、0.761、0.912。结论：脓毒症患儿血清SAA、PCT、CRP明显升高，三者升高均为脓毒症患儿死亡的危险因素，且对脓毒症具有一定诊断价值。

Relationship between Serum SAA, PCT, CRP Levels and Prognosis in Children with Sepsis and Analysis of Its Diagnostic Value

ABSTRACT Objective: To explore the relationship between serum amyloid A (SAA), procalcitonin (PCT), C-reactive protein (CRP) and prognosis in children with sepsis, and analyze the diagnostic value of the three for sepsis. Methods: A retrospective study was carried out on 60 children with sepsis who were admitted to our hospital from August 2016 to June 2020 as the sepsis group, 40 healthy children who received physical examination in our hospital during the same period were selected as the control group. The serum SAA, PCT and CRP levels were compared between the two groups. According to the survival and death of children with sepsis within 1 month, they were divided into survival group (n=42) and death group (n=18). The clinical data and serum SAA, PCT, CRP levels were compared between the two groups, and the risk factors for the death of children with sepsis were analyzed by COX regression model. Draw receiver operating characteristic curve(ROC) to analyze the diagnostic value of serum SAA, PCT and CRP for sepsis. Results: The serum SAA, PCT and CRP levels in the sepsis group were significantly higher than those in the control group (P<0.05). The number of organ disorders in the death group was more than 2, and the children with septic shock were 55.56% and 44.44% respectively, which were significantly higher than 19.05% and 9.52% in the survival group(P<0.05). The proportion of antibiotic treatment within 1 h after admission in death group was 38.89%, which was significantly lower than 69.05% in survival group (P<0.05). Serum SAA, PCT and CRP levels in the death group were higher than those in the survival group(P<0.05). COX multivariate analysis suggested that the number of organ disorders, septic shock, and increased serum SAA, PCT, and CRP levels were risk factors for the death of children with sepsis (P<0.05), the use of antibiotic treatment within 1 h after admission was a protective factor to control the risk of death in children with sepsis (P<0.05). The area under the curve(AUC) of serum SAA, PCT, CRP alone or in combination with the three were 0.808, 0.780, 0.761, 0.912, respectively. Conclusion: Serum SAA, PCT and CRP in children with sepsis are significantly increased, which are risk factors of death in children with sepsis, and has a certain diagnostic value for sepsis.