摘要
目的探讨不同危重应激状态下血清皮质醇、B型钠尿肽前体(pro-B-type natriuretic peptide,Pro-BNP)和白细胞介素(interleukin,IL)-6水平的变化。方法以2015年5月至2015年12月复旦大学附属儿科医院PICU收治的感染、多发外伤、心肺复苏后患儿为试验组,选取同时间段外科病房收治的无外伤,无感染,无心脏、肾及肾上腺疾病或功能异常,无长期糖皮质激素使用史的患儿为对照组。试验组在入PICU时行小儿危重病例评分(pediatric critical illness score,PCIS),并按照PCIS分为3组:非危重组(PCIS≥90分,n=15)、危重组(PCIS 71~89分,n=26)和极危重组(PCIS≤70分,n=17);另按患儿疾病转归分为存活组(n=39)和死亡组(n=19)。试验组分别于入院当天和病情稳定后、对照组于入院时或外科手术前抽血送检皮质醇、Pro-BNP和IL-6。结果极危重组、危重组及非危重组入院当天血清皮质醇、Pro-BNP和IL-6水平均高于病情稳定后,差异有统计学意义(P<0.05);对照组、非危重组、危重组、极危重组入院当天血清皮质醇、Pro-BNP和IL-6水平依次升高,两两相比差异均有统计学意义(P<0.05);而病情稳定后三组间三个指标的差异无统计学意义(P>0.05)。死亡组患儿Pro-BNP和IL-6水平较存活组明显升高,差异有统计学意义(P<0.05);而血清皮质醇浓度相比,差异无统计学意义(P>0.05)。试验组入院时PCIS与血清皮质醇、Pro-BNP和IL-6水平之间均呈负相关(r值分别为-0.571、-0.661、-0.504,P<0.05)。结论血清皮质醇、Pro-BNP和IL-6水平在危重症患儿显著升高,且与PCIS呈负相关;病情越重,升高越明显,三者可作为评估患儿病情的指标,其中Pro-BNP和IL-6可作为判断预后的指标。
Objective To understand the changes of the levels of serum cortisol, pro-B-type natriuretic peptide(Pro-BNP) and interleukin-6(IL-6) in the critical stress children. Methods The experimental group enrolled the children with severe infection, polytrauma and cardiopulmonary resuscitation admitted in PICU of Children′s Hospital of Fudan University from May 2015 to December 2015.The children admitted to the surgical ward during the same period without trauma, infection, heart, kidney and adrenal diseases or dysfunction, and without a long history of glucocorticoid use were selected as the control group.According to the pediatric critical illness score(PCIS), the experimental group was divided into 3 subgroups: severe critically ill group(PCIS≤70, n=17), critically ill group(PCIS 71-89, n=26), and non-critically ill group(PCIS≥90, n=15). What′s more, the experimental cases were divided into survival group (n=39)and death group(n=19) according to the prognosis.On the day of admission and during the period with stable condition, the peripheral blood sample were collected to detect serum cortisol, Pro-BNP and IL-6.While the control cases were detected the same items on the day of admission or pre-operation. Results The concentrations of serum cortisol, Pro-BNP and IL-6 on the day of admission in severe critically ill group, critically ill group and non-critically ill group were higher than those in the period with stable condition (P<0.05). The concentrations of serum cortisol, Pro-BNP and IL-6 on the day of admission in control group, non-critically ill group, critically ill group and severe critically ill group increased in sequence (P<0.05). While in stable condition, there were no statistically significant differences among severe critically ill group, critically ill group and non-critically ill group(P>0.05). The concentrations of Pro-BNP and IL-6 in death group were significantly higher than those in survival group(P<0.05). While the level of cortisol showed no statistically significant difference between death group and survival group(P>0.05). PCIS was negatively correlated with serum cortisol, Pro-BNP and IL-6 (r=-0.571,-0.661 and -0.504, P<0.05, respectively). Conclusion The levels of serum cortisol, Pro-BNP and IL-6 in critically ill children all significantly increase in acute critically ill period, which are all negatively correlated with PCIS.They can be used as the indicators of severity of illness.Pro-BNP and IL-6 also can be used as the indicators of the prognosis of disease.
作者
王培培
陆铸今
陆国平
Wang Peipei;Lu Zhujin;Lu Guoping(Division of Pediatric Critical Care Medicine,Children's Hospital of Fudan University,Shanghai 201102 ,China)
出处
《中国小儿急救医学》
CAS
2019年第5期358-362,共5页
Chinese Pediatric Emergency Medicine
关键词
危重患儿
应激
皮质醇
B型钠尿肽前体
白细胞介素
Critically ill children
Stress
Cortisol
Pro-B-type natriuretic peptide
Interleukin-6
