血清PCT、CRP、GPBB、HMGB1与脓毒症患儿心肌损伤指标的相关性及与预后的关系.docx
血清PCT、CRP、GPBB、HMGBl与脓毒症患儿心肌损伤指标的相关性及与预后的关系杨瑞利1、郭晓波2、贾秦亮3、韩双4#1 .西安经开妇幼医院检验科陕西西安7100212 .西安市中心医院血液研究所陕西西安7100043 .西北妇女儿童医院检验科陕西西安7100614 .长安医院检验科陕西西安710016摘要目的探讨血清降钙素原(PCT)、C反应蛋白(CRP)>糖原磷酸化酶脑型(GPBB).高迁移率族蛋白Bl(HMGBI)水平与脓毒症患儿心肌损伤以及预后的关系。方法选择2019年3月至2022年3月我院儿科收治的271例脓毒症心肌损伤患儿(心肌损伤组)和同期我院收治的227例脓毒症感染性疾病但未发生心肌损伤患儿(对照组)。入院第Id采集两组患儿静脉血5mL,检测血清PCT、CRP、GPBBHMGBl水平以及心肌损伤指标水平。应用PearSOn相关系数分析血清PCT、CRP>GPBB>HMGBI与心肌损伤指标之间的相关性。根据心肌损伤组患儿28d的预后情况分为死亡组和存活组，通过单因素和多因素Logistic回归分析脓毒症心肌损伤患儿死亡的危险因素。结果心肌损伤组血清PCT(0.99±0.16)ngmkCRP(21.07+2.01)mg/L、GPBB(24.41±2.83)ng/mL、HMGBl(152.63±29.18)pg/mL、肌红蛋白(Mb)(99.58±13.25)gL、心肌肌钙蛋白I(CTnD(0.25±0.03)gL>肌酸激酶同工酶(CK-MB)(23.22±5.48)U/L水平均高于对照组(0.69+0.08)ng/mk(6.49±1.78)mg/L、(9.79±2.03)ng/mL、(137.18±24.37)pgmL>(30.98±8.93)gg/L、(0.10+0.02)gL(13.19±4.74)U/L(P<0.05)。血清PCT、CRP、GPBBHMGBl水平均与血清Mb、CK-MB、CTnI水平呈正相关(r=0.462,P=0.000;r=O.313,P=0.000;r=0.469,P=0.000:r=0.509,P=0.000:r=0.492,P=0.000;r=O.518,P=0.000:r=0.362,P=0.000;r=0.306,P=0.000;r=0.485,P=0.000:r=0.321,P=0.000;r=0.309,P=0.0;r=0.562,P=0.000)(P<0.05)。死亡组脓毒症休克比例(35.19%)、APACHEII评分(23.98±5.35)分、SOFA评分(11.36±1.97)分、尿素氮(12.16±2.97)mmolL>血肌Sf(129.68±14.23)molL血清PCT(1.23±0.08)ngmL>CRP(25.61±1.82)mg/L、GPBB(27.62±1.45)ng/mL、HMGBl(175.96±13.52)pg/mL水平高于存活组(9.68%)、(16.54±3.83)分、(7.42±1.76)分、(7.98±1.86)mmol/L、(91.67+12.37)molL(0.93±0.09)ng/mL、(19.94±1.93)mg/L(23.61±0.94)ng/mL、(146.82±10.37)pgmL(PV0.05)。前白蛋白(153.49±12.46)mgL低于存活组(168.94±11.37)mg/L(PV0.05)。多因素LOgiStiC回归分析结果显示，高APACHEII评分、存在脓毒症休克、高PCT、高CRP、高GPBB、高HMGBI、高CTnl是脓毒症患儿预后的危险因素(PV0.05)o结论脓毒症心肌损伤患儿血清PCT、CRP.GPBB、HMGBl水平均增高，且与预后不良有关。关键词：脓毒症；预后；降钙素原；C反应蛋白；糖原磷酸化酶脑型；高迁移率族蛋白Bl中图分类号：R720.597,文献标识码：A作者简介：杨瑞利(1980-)女，汉族，陕西渭南人，本科，副主任技师，研究方向：临床检验及诊断，邮箱：。#通讯作者：韩双(1985-),女，汉族，陕西省咸阳市人，本科，主任技师，研究方向：临床检验及诊断,邮箱：。CorrelationofserumPCT,CRP,GPBBandHMGBlandmyocardialinjuryindexesandrelationshipwithprognosisinchildrenwithsepsisYangRui-Ii1,GuoXiao-bo2,JiaQin-Iiang3,HanShuang4*1.DepartmentofClinicalLaboratory,Xi'anEconomicDevelopmentHospitalforWomenandChildren,Xi'an,Shaanxi,7100212.BIoodResearchInstitute,Xi'anCentralHospital,Xi'an,Shaanxi,7100043 .DepartmentofClinicalLaboratory,NorthwestWomen'sandChildren'sHospital,Xi'an,Shaanxi,7100614 .DepartmentofClinicalLaboratory,Chang'anHospital,Xi'an,Shaanxi,710016Abstract:ObjectiveTbinvestigatetherelationshipbetweenserumlevelsofprocalcitonin(PCT),C-reactiveprotein(CRP),glycogenphosphorylaseisoenzymeBB(GPBB)andhighmobilitygroupproteinBl(HMGBl)andmyocardialinjuryandprognosisinchildrenwithsepsis.Methods271childrenwithsepsismyocardialinjury(myocardialinjurygroup)whowereadmittedtoourpediatrichospitalfromMarch2019toMarch2022and227childrenwithsepsisinfectiousdiseasesandwithoutmyocardialinjury(controlgroup)whowereadmittedtoourhospitalduringthesameperiodwereselected.OntheIdofadmission,5mLofvenousbloodwascollectedfromthetwogroups,thelevelsofserumPCT,CRP,GPBB,HMGBlandmyocardialinjuryindexesweredetected.PearsoncorrelationcoefficientwasusedtoanalyzethecorrelationbetweenserumPCT,CRP,GPBB,HMGBlandmyocardialinjuryindexes.Accordingtotheprognosisofchildrenwithmyocardialinjuryat28d,thechildreninthemyocardialinjurygroupweredividedintothedeathgroupandthesurvivalgroup,andtheriskfactorsofdeathinchildrenwithmyocardialinjuryofsepsiswereanalyzedbyunivariateandmultivariateLogisticregression.ResultsThelevelsofserumPCT(0.99±0.16)ngml,CRP(21.07±2.01)mgL,GPBB(24.41±2.83)ngmL,HMGBl(152.63±29.18)pgmL,myoglobin(Mb)(99.58±13.25)gL,cardiactroponinI(cTnI)(0.25±0.03)gL,andcreatinekinaseisoenzyme(CK-MB)(23.22±5.48)U/Linthemyocardialinjurygroupwerehigherthanthoseinthecontrolgroup(0.69±0.08)ngml,(6.49±1.78)mgL,(9.79±2.03)ngmL,(137.18±24.37)pgmL,(30.98±8.93)gL,(0.10±0.02)gL,(13.19±4.74)U/L(P<0.05).ThelevelsofserumPCT,CRP,GPBBandHMGBlwerepositivelycorrelatedwithMB,CK-MBandcTnl(r=0.462,P=0.000.r=0.313,P=0.000.r=0.469,P=0.000.r=0.509,P=0.000.r=0.492,P=0.000.r=0.518,P=0.000.r=0.362,P=0.000.r=0.306,P=0.000.r=0.485,P=0.000.r=0.321,P=0.000.r=0.309,P=0.000.r=0.562,P=0.000)(P<0.05).Theproportionofsepticshock(35.19%),APACHEIIscore(23.98±5.35)score,SOFAscore(11.36±1.97)score,ureanitrogen(12.16±2.97)mmolL,andserumcreatinine(129.68±14.23)molL,ThelevelsofserumPCT(1.23±0.08)ngmL,CRP(25.61±1.82)mgL,GPBB(27.62±1.45)ngmL,andHMGBl(175.96±13.52)pg/mLinthedeathgroupwerehigherthanthoseinthesurvivalgroup(9.68%),(16.54÷3.83)score,(7.42±1.76)score,(7.98±1.86)mmolL,(9i.67±12.37)molL,(0.93±0.09)ngmL,(19.94±1.93)mgL,(23.61±0.94)ngmL,(146.82±10.37)pg/mL(P<0.05).Theprealbumin(153.49±12.46)mg/Lwaslowerthanthatofsurvivalgroup(168.94±11.37)mg/L(P<0.05).MultivariateLogisticregressionanalysisshowedthathighAPACHEIIscore,presenceofsepticshock,highPCT,highCRRhighGPBB,highHMGBlandhighcTnlwereriskfactorsforprognosisofchildrenwithsepsis(P<0.05).ConclusionThelevelsofserumPCT,CRRGPBBandHMGBlinchildrenwithsepsismyocardialinjuryincreasedonaverage,whicharerelatedtopoorprognosis.Keywords:Sepsis;Prognosis;Procalcitonin;C-reactiveprotein;GlycogenphosphorylaseisoenzymeBB:Highmobility
