摘要
目的探究儿童脓毒症血栓弹力图(thromboelastography,TEG)指标、黏附分子与多器官功能障碍综合征(multiple organ dysfunction syndrome,MODS)及预后的关系。方法选取2017年4月至2020年4月湖北省妇幼保健院收治的脓毒症患儿187例为研究对象,根据是否并发MODS将其分为MODS组(73例)和非MODS组(114例);根据入院后28 d脓毒症患儿预后将其分为生存组(145例)和死亡组(42例)。收集患儿临床资料、TEG指标(K值、R值、MA值、α角)、黏附分子[细胞间黏附分子-1(intercelluar adhesion molecule-1,ICAM-1)、血管细胞黏附分子-1(vascular cell adhesion molecule-1,VCAM-1)]水平;绘制受试者操作特征曲线(receiver operating characteristic curve,ROC曲线)评估TEG指标和黏附分子对脓毒症患儿并发MODS的预测价值,采用多因素Logistic回归分析探讨脓毒症患儿死亡的影响因素。结果MODS组患儿K值、R值均显著长于非MODS组(均P<0.05),MA值、α角均显著小于非MODS组(均P<0.05),血清ICAM-1、VCAM-1水平均显著高于非MODS组(均P<0.05)。ROC曲线显示,K值、R值、MA值、α角、ICAM-1、VCAM-1预测脓毒症患儿并发MODS的曲线下面积(area under the curve,AUC)分别为0.782、0.685、0.788、0.784、0.709、0.678,六项联合的AUC为0.930,灵敏度为91.8%,特异度为84.2%。多因素Logistic回归分析结果显示,K值和R值延长、ICAM-1和VCAM-1水平升高、并发MODS均是脓毒症患儿入院后28 d死亡的危险因素(均P<0.05);而MA值升高、α角增大均是脓毒症患儿入院后28 d死亡的保护因素(均P<0.05)。结论TEG指标与ICAM-1、VCAM-1联合检测对儿童脓毒症并发MODS具有较高预测价值,监测以上指标有利于判断脓毒症患儿短期预后。
Objective To explore the relationship between thromboelastography(TEG)indicators,adhesion molecules,multiple organ dysfunction syndrome(MODS)and prognosis in children with sepsis.Method From April 2017 to April 2020,187 children with sepsis admitted to Maternal and Child Health Hospital of Hubei Province were selected.According to whether or not concurrent MODS,they were divided into MODS group(73 cases)and non-MODS group(114 cases);according to the prognosis of 28 days after admission,they were divided into survival group(145 cases)and death group(42 cases).Collect clinical data of children and TEG indicators(K value,R value,MA value,αangle),adhesion molecule[intercellular adhesion molecule-1(ICAM-1),vascular cell adhesion molecule-1(VCAM-1)]level.Draw receiver operating characteristic curve(ROC curve)to evaluate the predictive value of TEG indicators and adhesion molecules in children with sepsis complicated by MODS,and use multivariate Logistic regression analysis to explore the influencing factors of death in children with sepsis.Result The K value and R value of children in MODS group were significantly longer than those in non-MODS group(all P<0.05),the MA value andαangle were significantly lower than those in non-MODS group(all P<0.05),and the serum ICAM-1 and VCAM-1 levels were significantly higher than those in non-MODS group(all P<0.05).The ROC curve shows that the K value,R value,MA value,αangle,ICAM-1,VCAM-1 predict the area under the curve(AUC)of children with sepsis complicated by MODS were 0.782,0.685,0.788,0.784,0.709,0.678,respectively,the AUC of the six combinations was 0.930,the sensitivity was 91.8%,and the specificity was 84.2%.The results of multivariate Logistic regression analysis showed that K value,R value extended,ICAM-1,VCAM-1 increased,and concurrent MODS were all the risks factors of death 28 days after admission to the hospital for sepsis children(all P<0.05);while the MA value increased andαangle increased were protective factors for death of children with sepsis at 28 days after admission(all P<0.05).Conclusion The combined monitoring of TEG indicators,ICAM-1 and VCAM-1 has a high predictive value for children with sepsis complicated by MODS.Monitoring the above indicators is helpful to judge the short-term prognosis of children with sepsis.
作者
汤文
许慧
黄成姣
李勇
肖书娜
石步云
夏治
Tang Wen;Xu Hui;Huang Chengjiao;Li Yong;Xiao Shuna;Shi Buyun;Xia Zhi(Department of Pediatric Intensive Care Unit,Maternal and Child Health Hospital of Hubei Province,Wuhan 430070,China)
出处
《中国医学前沿杂志（电子版）》
2021年第11期81-86,共6页
Chinese Journal of the Frontiers of Medical Science(Electronic Version)
基金
湖北省自然科学基金一般面上项目(ZRMS2018001671)。
关键词
脓毒症
儿童
血栓弹力图
黏附分子
多器官功能障碍综合征
预后
Sepsis
Children
Thromboelastography
Adhesion molecule
Multiple organ dysfunction syndrome
Prognosis
