铁蛋白、红细胞参数及血浆D-二聚体与儿童脓毒症的相关性

doi:10.3969/j.issn.1004-583X.2023.01.008

摘要/Abstract

摘要：

目的探讨红细胞参数、血浆D-二聚体(D-dimer,DD)、铁蛋白(serum ferritin, SF)对儿童脓毒症病情及预后的评估价值。方法回顾性分析2015年7月至2022年6月江苏省无锡市儿童医院173例脓毒症患儿的血红蛋白(hemoglobin,Hb)、红细胞体积分布宽度(red blood cell distribution width,RDW)、DD、SF、危重程度及预后,并探讨相互关系和相关机制。结果脓毒症患儿非危重组82例,危重组64例,极危重组27例;随危重程度增加,Hb逐渐降低,RDW、DD、SF逐渐增高,差异均有统计学意义( $P$ <0.01);Hb与RDW、DD、SF均呈负相关( $r$ =-0.527、-0.629、-7.324, $P$ <0.05),RDW与DD正相关( $r$ =0.587, $P$ <0.05),SF与RDW、DD均正相关( $r$ =0.513、0.697, $P$ <0.05)。脓毒症患儿死亡21例,存活152例;死亡组Hb较存活组低,RDW、DD、SF较存活组高,差异均有统计学意义( $P$ <0.01)。脓毒症组124例,脓毒性休克组49例;脓毒症组Hb较脓毒性休克组高,RDW、DD、SF较脓毒性休克组低,差异均有统计学意义( $P$ <0.01)。结论 Hb、RDW、DD、SF对儿童脓毒症的病情及预后评估有一定价值,微循环障碍损伤的红细胞是儿童脓毒症SF的主要来源。

关键词: 脓毒症, 红细胞指数, D-二聚体, 铁蛋白质类

Abstract:

Objective To investigate the evaluation value of erythrocyte parameters, D-dimer (DD) and serum ferritin (SF) on the state and prognosis of sepsis in children, and to explore their relationship. Methods We carried out a retrospective analysis on 173 children with sepsis who visited Wuxi Children's Hospital of Jiangsu Province from July 2015 to June 2022, including Hemoglobin(Hb), red blood cell distribution width(RDW), DD, SF, the severity of illness and the prognosis, and explored its interrelation and related mechanism. Results There were 82 cases in non-severe group, 64 cases in severe group and 27 cases in extremely severe group. Hb was decreased and RDW, DD and SF were increased gradually with increased severity of illness, with statistically significant differences ( $P$ <0.01). Hb was negatively correlated with RDW and DD ( $r$ =-0.527 and -0.629, $P$ <0.05). RDW was positively correlated with DD( $r$ =0.587, $P$ <0.05). SF was negatively correlated with Hb( $r$ =-7.324, $P$ <0.05). SF was positively correlated with RDW and DD ( $r$ =0.513 and 0.697, $P$ <0.05). Among 173 children with sepsis, there were 21cases in death group and 152 cases in survival group. Hb in death group was significantly lower than that in survival group and RDW, DD and SF in death group were significantly higher than those in survival group ( $P$ <0.01). There were 124 children in sepsis group and 49 children in septic shock group. Hb in sepsis group was significantly higher than that in septic shock group, and RDW, and DD and SF were significantly lower than those in septic shock group ( $P$ <0.01). Conclusion Hb, RDW, DD and SF have some evaluation value on the state and prognosis of sepsis in children, and the erythrocytes damaged by microcirculation disturbance may be the main source of SF.

Key words: sepsis, red cell parameters, D-dimer, serum ferritin

中图分类号:

R725

周利娟, 诸彭伟, 曹梅, 程真梅, 吴峤微, 李勇. 铁蛋白、红细胞参数及血浆D-二聚体与儿童脓毒症的相关性[J]. 临床荟萃, 2023, 38(1): 60-63.

Zhou Lijuan, Zhu Pengwei, Cao Mei, Cheng Zhenmei, Wu Qiaowei, Li Yong. Correlation of serum ferritin, erythrocyte parameters and D-dimer with sepsis in children[J]. Clinical Focus, 2023, 38(1): 60-63.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2023.01.008

https://huicui.hebmu.edu.cn/CN/Y2023/V38/I1/60

图/表 3

表1 3组脓毒症患儿第1天指标比较( x -±s)

Tab.1 Comparison of indicators on the first day in three groups( x -±s)

组别	例数	Hb(g/L)	RDW(%)	DD(mg/L)	SF(μg/L)
非危重组	82	104.43±11.25	12.51±2.12	2.125±0.124	182.47±21.26
危重组	64	96.27±3.13	14.23±1.37	4.232±0.093	329.13±37.28
极危重组	27	87.46±2.36	16.86±2.59	6.072±0.186	543.75±50.32
$F$ 值		11.47	19.31	24.17	27.69
$P$ 值		0.00	0.00	0.00	0.00

表1 3组脓毒症患儿第1天指标比较( x -±s)

Tab.1 Comparison of indicators on the first day in three groups( x -±s)

组别	例数	Hb(g/L)	RDW(%)	DD(mg/L)	SF(μg/L)
非危重组	82	104.43±11.25	12.51±2.12	2.125±0.124	182.47±21.26
危重组	64	96.27±3.13	14.23±1.37	4.232±0.093	329.13±37.28
极危重组	27	87.46±2.36	16.86±2.59	6.072±0.186	543.75±50.32
$F$ 值		11.47	19.31	24.17	27.69
$P$ 值		0.00	0.00	0.00	0.00

表2 死亡组与存活组脓毒症患儿指标比较( x -±s)

Tab.2 Comparison of indicators between death group and survival group( x -±s)

组别	例数	Hb(g/L)	RDW(%)	DD(mg/L)	SF(μg/L)
死亡组	21	78.13±5.24	17.19±2.53	5.482±0.812	559.47±42.11
存活组	152	95.47±2.18	13.72±1.66	2.273±0.013	262.51±31.63
$t$ 值		-17.22	18.52	20.03	16.08
$P$ 值		0.00	0.00	0.00	0.00

表2 死亡组与存活组脓毒症患儿指标比较( x -±s)

Tab.2 Comparison of indicators between death group and survival group( x -±s)

组别	例数	Hb(g/L)	RDW(%)	DD(mg/L)	SF(μg/L)
死亡组	21	78.13±5.24	17.19±2.53	5.482±0.812	559.47±42.11
存活组	152	95.47±2.18	13.72±1.66	2.273±0.013	262.51±31.63
$t$ 值		-17.22	18.52	20.03	16.08
$P$ 值		0.00	0.00	0.00	0.00

表3 脓毒症组与脓毒性休克组患儿指标比较( x -±s)

Tab.3 Comparison of indicators between sepsis group and septic shock group( x -±s)

组别	例数	Hb(g/L)	RDW(%)	DD(mg/L)	SF(μg/L)
脓毒症组	124	102.23±4.16	13.41±1.82	2.983±0.018	231.85±42.86
脓毒性休克组	49	89.41±2.95	16.88±3.01	5.972±0.973	513.97±69.43
$t$ 值		15.43	-9.58	-13.97	-19.55
$P$ 值		0.00	0.00	0.00	0.00

表3 脓毒症组与脓毒性休克组患儿指标比较( x -±s)

Tab.3 Comparison of indicators between sepsis group and septic shock group( x -±s)

组别	例数	Hb(g/L)	RDW(%)	DD(mg/L)	SF(μg/L)
脓毒症组	124	102.23±4.16	13.41±1.82	2.983±0.018	231.85±42.86
脓毒性休克组	49	89.41±2.95	16.88±3.01	5.972±0.973	513.97±69.43
$t$ 值		15.43	-9.58	-13.97	-19.55
$P$ 值		0.00	0.00	0.00	0.00

参考文献 16

[1]	Wang TH, Hsu YC. Red cell distribution width as a prognostic factor and its comparison with lactate in patients with sepsis[J]. Diagnostics (Basel), 2021, 11(8):1474.
[2]	Han YQ, Yan L, Zhang L, et al. Performance of D-dimer for predicting sepsis mortality in the intensive care unit[J]. Biochem Med (Zagreb), 2021, 31(2):020709.
[3]	许玉芳, 王艳丽. 血乳酸清除率与 PCIS 评分对危重症患儿预后评估价值的比较[J]. 中国基层医药, 2016: 23(2): 301-303.
[4]	白新凤, 徐梅先, 郭芳, 等. 红细胞及血小板参数对儿童脓毒症严重程度的预测价值[J]. 解放军医学杂志, 2021, 46(9): 917-922.
[5]	Weiss SL, Peters MJ, Alhazzani W, et al. Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children[J]. Pediatr Crit Care Med, 2020, 21(2): e52-e106. doi: 10.1097/PCC.0000000000002198 URL
[6]	朱大年. 生理学[M]., 7版. 北京: 人民卫生出版社, 2008: 149.
[7]	董照刚, 郑喜胜, 冯永利, 等. 血红蛋白与脓毒性休克患者死亡率的相关性[J]. 临床内科杂志, 2021, 38(5): 312-315.
[8]	白新凤, 徐梅先, 郭芳, 等. 红细胞及血小板参数对脓毒症患儿预后的预测价值[J]. 中国急救医学, 2021, 41(8): 693-697.
[9]	茆蓉, 陶千山, 沈元元, 等. 结外NK/T细胞淋巴瘤相关噬血细胞综合征1例[J]. 临床荟萃, 2022, 37(7): 635-639.
[10]	朱金兰, 黄铁栓. 脓毒症患儿血清铁蛋白水平测定的意义及与预后的关系[J]. 检验医学与临床, 2015, (z2): 101-103.
[11]	Nandy A, Mondal T, Datta D, et al. Serum ferritin as a diagnostic biomarker for severity of childhood sepsis[J]. Indian Pediatr, 2021, 58(12): 1143-1146. pmid: 34047717
[12]	高勇, 陈军, 何俊. 血清铁蛋白在恶性血液病诊断与治疗中的价值[J]. 中国保健营养, 2020, 30(19): 273-274.
[13]	王英, 刘佳, 赵婷. 血清铁蛋白在风湿性疾病诊断及治疗中的价值分析[J]. 医药前沿, 2018, 8(11): 205.
[14]	Fernández-Sarmiento J, de Carvalho WB. Bundle for pediatric COVID-19 sepsis[J]. Rev Assoc Med Bras (1992), 2021, 67(Suppl 1): 26-28.
[15]	Semeraro F, Ammollo CT, Caironi P, et al. D-dimer corrected for thrombin and plasmin generation is a strong predictor of mortality in patients with sepsis[J]. Blood Transfus, 2020, 18(4): 304-311.
[16]	盈竞男, 陈彩霞. 儿童嗜血细胞综合征1例[J]. 安徽医药, 2019, 23(3): 507-509.