摘要
目的探讨PICU中葡萄糖-6-碗酸脱氢酶(glucose-6-phosphate dehydrogenase,G6PD)缺陷患儿细菌感染炎症因子的临床意义.方法采用前瞻性队列研究方法,将2014年6月至2017年12月小儿危重病例评分<80分、入住PICU的符合细菌感染患儿77例为研究对象,排除本次发病前存在除了G6PD缺陷外其他基础性疾病、有大剂量糖皮质激素使用史及24 h内出院或者死亡病例,按有无G6PD缺陷分为36例G6PD缺乏患儿组(观察组)及41例无G6PD缺乏患儿组(对照组),两组患儿分别于住院入科时、治疗12 h及24 h取静脉血用酶联免疫吸附法检测血清肿瘤坏死因子(TNF-α)、白介素6(IL-6)、白介素10(IL-10)、C反应蛋白(CRP)炎症因子变化,用成组t检验、χ^2检验及Hsher确切检验对炎症因子变化、并发症、预后情况、PICU天数及住院费用等进行统计分析结果观察组较对照组在入科时炎症因子水平明显增高,TNF-α分别为(67.25±26.17)pg/mL和(56.31±21.04)pg/mL;IL-6分别为(100.86±26.23)pg/mL和(89.04±24.12)pg/mL;IL-10分别为(89.93±26.10)pg/mL和(78.03±25.35)pg/mL;CRP分别是(65.59±26.21)mg/L和(52.07±28.70)mg/L,差异均有统计学意义(均P<0.05);治疗后12 h及24 h G6PD缺陷组细胞因子及CRP在不同时间点均高于无G6PD缺陷组(P<0.05);治疗过程中两组炎症因子变化速度差异无统计学意义;观察组住PICU天数更长[(7.98±6.55)d和(5.01±6.21)d]及住院费用更高[(36634.09±11876.67)元和(31571.42±10245.80)元],差异均有统计学意义(P<0.05);观察组严重脓毒症、脓毒性休克、MODS发生率增高及治愈好转率降低,差异均有统计学意义(P<0.05);结论G6PD缺陷患儿细菌感染时炎症反应严重、预后差及治疗费用更高,更需要警惕严重脓毒症、脓毒性休克和MODS的发生.
Objective To investigate the clinical significance of inflammatory factors in bacterial infection children with glucose-6-phosphate dehydrogenase(G6PD)deficiency in PICU.Methods A prospective cohort study was carried out from June 2014 to December 2017.77 bacterial infection children with pediatric critical illness score less than 80 who were admitted to the PICU,were recruit in the study.The patient diagnosed as other basic diseases,with history of high-dose glucocorticoid use,discharged or died within 24 hours were excluded.The recruited patients were divided into G6PD deficiency group(observation group with 36 cases)and non-G6PD deficiency group(control group with 41 cases)according to the presence or absence of G6PD deflciency.Blood samples were taken at admission,12 hand 24 h after hospitalization to detect the concentrations of tumor necrosis factor(TNF-α),interleukin 6(IL-6),interleukin 10(IL-10)andC-reactive protein(CRP).T test,χ^2test and Fisher exact test were used to analyze the changes of the above inflammatory factors,complications,prognosis,PICU stay time and hospitalization costs.Results The levels of inflammatory factors in the observation group were significantly higher than those in the control group at admission,12 and 24 hours after hospitalization,the differences were statistically significant(all P<0.05).There was no statistically significant difference in thechangerate of inflammatory factors between the two groups during treatment;The PICU stay time of observation group was longer[(7.98±6.55)vs(5.01±6.21)]and the hospitalization cost(yuan)was higher[(36634.09±11876.67)vs(31571.42±10245.80)],P<0.05;Compared to the control group,the incidence ofsevere sepsis,septic shock,MODS increased significantly,and the curative rate decreasedsignificantly in observation group(P<0.05).Conclusions G6PD-deficient children with bacterial infections had serious inflammatory reactions with poor prognosis and higher hospitalization costs and were susceptible to the occurrence of severe sepsis,septic shoc
作者
莫武桂
唐育鹏
韦蓉
谢友军
黄维真
付君
卢功志
莫致荣
王莹
宁铂涛
Mo Wugui;Tang Yupeng;Wei Rong;Xie Youjun;Huang Weizhen;Fu Jun;Lu Gongzhi;Mo Zhirong;Wang Ying;Ning Botao(Department of Intensive Medicine,Guangxi Zhuang Autonomous Region Maternal and Child Health Hospital,Nanning 530003;Department of Laboratory of Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region,Nanning 530003;Department of Intensive Medicine,Shanghai Children’s Medical Center,Affiliated to the Medical College of Shanghai Jiaotong University,Shanghai 200127)
出处
《中华急诊医学杂志》
CAS
CSCD
北大核心
2020年第6期793-798,共6页
Chinese Journal of Emergency Medicine
基金
广西医疗卫生适宜技术与开发课题(S201405-04)。
