本文選題：膿毒癥 + 兒童�。� 參考：《昆明醫(yī)科大學》2017年碩士論文

【摘要】：[目的]研究膿毒癥患兒急性期血清鐵、血磷、T淋巴細胞亞群水平變化特點,并探討對膿毒癥的早期預(yù)警價值,為膿毒癥的早期診斷及早期干預(yù)提供理論依據(jù)。[方法]采用前瞻性的研究方法,收集2015年4月至2016年10月在昆明醫(yī)科大學第二附屬醫(yī)院兒科住院部診斷為膿毒癥的患兒35例、感染的患兒45例及同期住院的非感染患兒24例為研究對象。所有的患兒于入院后24小時內(nèi)抽血,送檢本院檢驗科,采用TPTZ法檢測血清鐵,磷鉬酸鹽法檢測血磷,流式細胞儀法檢測T淋巴細胞亞群,分組比較血清鐵、血磷、T淋巴細胞亞群的變化。[結(jié)果]1.膿毒癥組、一般感染組、非感染組年齡、性別的比較:膿毒癥組、一般感染組、非感染組年齡M (P25, P75)分別為4. 0(2. 0,6. 2)歲、4. 5 (2. 3, 9. 3)歲、7. 6(3. 3,10. 9)歲,三組比較X2為5. 235,P=0. 073,差異無統(tǒng)計學意義(P0. 05)。性別(男%、女%)分別為 21 (60.0%)、14 (40.0%),29 (64.4%)、16 (35. 6%),11 (45.8%)、13 (54.2%),三組比較X2為2. 275, P=0. 321,差異無統(tǒng)計學意義(P0.05)。2.膿毒癥組、一般感染組、非感染組血清鐵、血磷水平的比較:膿毒癥組、一般感染組、非感染組血清鐵M(P25,P75)分別為2. 7(2. 0, 5. 1)、8. 8(4. 7,12. 2)、15. 8(11. 8,18. 1)umol/L,膿毒癥組急性期血清鐵水平明顯低于一般感染組和非感染組,一般感染組患兒血清鐵水平明顯低于非感染組,X2值為44. 922, P=0. 000,差異有統(tǒng)計學意義(P0.05);血磷M (P25,P75)分別為1.49(1.29,1.61)、1. 71 (1. 56,1. 86)、1. 84 (1. 55, 1.86) mmol/L,膿毒癥組急性期血磷水平明顯低于一般感染組和非感染組,差異有統(tǒng)計學意義(P0. 05)。3.膿毒癥組、一般感染組、非感染組T淋巴細胞亞群水平的比較:膿毒癥組、一般感染組、非感染組 CD3 (%)分別為 59. 7(53. 7, 66. 7)、62. 9(56. 5, 69.0)、67. 8(63. 7, 71.1),CD4 (%)分別為 28. 7(24.6, 35. 3)、32. 1(27. 5, 39.2)、36.4(31.8,40.3),進行兩兩比較,膿毒癥組CD3、CD4較非感染組明顯減低,差異有統(tǒng)計學意義(P0. 017)。膿毒癥組、一般感染組、非感染組CD8 (%)分別為 21. 4(16. 8,26. 1)、23.2(19. 6, 26. 5)、23. 5(19.6,25.95),CD4/CD8 分別為 1,34(1. 07, 1.74)、1.41(1.13,1.8)、1.58(1.27,1.81),三組間進行比較差異無統(tǒng)計學意義(P0. 05)。4.嚴重膿毒癥組、普通膿毒癥組血清鐵、血磷水平的比較:嚴重膿毒癥組、普通膿毒癥組血清鐵分別為2. 2 (1.9, 3.0)、4.3 (2. 3, 7.3) umol/L,兩組比較Z為-2.197, P=0. 027,差異有統(tǒng)計學意義(P0. 05)。嚴重膿毒癥組、普通膿毒癥組血磷分別為1.5(1. 28,1.62)、1.48(1. 31,1. 6)mmol/L,兩組比較Z為-0.066, P=0. 961,差異無統(tǒng)計學意義(P0. 05)。5.嚴重膿毒癥組、普通膿毒癥組T淋巴細胞亞群水平的比較:嚴重膿毒癥組與普通膿毒癥組 CD3 (%)分別為 56. 6 (49. 9, 64. 2)、61. 1 (57. 3, 70. 5), CD4(%)分別為 26. 7 (21.8,30.4)、31.9 (26. 3, 38.1),嚴重膿毒癥組 CD3、CD4 明顯低于普通膿毒癥組,兩組比較Z值分別為-2. 212、-2.113, P值分別為0.027、0.035,差異有統(tǒng)計學意義(P0. 05);嚴重膿毒癥組、普通膿毒癥組CD8 (%)分別為 22.1(19. 5, 25. 8)、21.4(16. 7,27.1), CD4/CD8 分別為 1.3(1.1,1.54)、1.4 (1.0, 2. 0),兩組比較Z值分別為-0. 413和-0. 924,P值分別為0. 68和0. 369,差異無統(tǒng)計學意義(P0. 05)。6.血清鐵、血磷、CD3、CD4四項指標單項檢測及聯(lián)合檢測的ROC曲線分析:血清鐵、血磷、CD3、CD4、聯(lián)合檢測預(yù)測變量PRE-1的ROC曲線下面積分別為:0. 859、0. 767、0. 638、0. 655、0. 881,均有明顯統(tǒng)計學意義(P0. 05)。[結(jié)論]1.膿毒癥患兒血清鐵較一般感染患兒明顯減低,對指導早期預(yù)警膿毒癥有臨床意義。2.血清鐵減低程度與膿毒癥的嚴重程度成正比,血清鐵越低,預(yù)示著膿毒癥患兒的病情越重。3.膿毒癥患兒CD3、CD4較非感染患兒明顯減低,可能存在感染所致的免疫抑制。4.血清鐵、血磷、CD3、CD4各項檢測對膿毒癥均有診斷價值,聯(lián)合檢測優(yōu)于單項檢測,其中血清鐵是診斷膿毒癥較好的單項檢測指標。
[Abstract]:[Objective] to study the changes of serum iron, blood phosphorus and T lymphocyte subsets in acute phase of children with sepsis, and to explore the early warning value of sepsis to provide theoretical basis for early diagnosis and early intervention of sepsis. [Methods] a prospective study method was used to collect the second attachment of Kunming Medical University from April 2015 to October 2016. 35 children diagnosed with sepsis were diagnosed as sepsis in the hospital department of hospital, 45 cases of infected children and 24 cases of non infected children in the same period were studied. All the children were collected from the hospital within 24 hours after admission to the hospital. The serum iron was detected by TPTZ method, phosphommolybdate method was used to test the blood phosphorus, and the flow cytometry was used to detect the T lymphocyte subgroup. The changes in serum iron, blood phosphorus and T lymphocyte subsets were compared. [results the age and sex of]1. sepsis group, general infection group, non infection group: 4 (2. 0,6. 2) years, 4.5 (2.3, 9.3) years old, 7.6 (3. 3,10. 9) years old, 7.6 (3. 3,10. 9) years, and three groups compared X2 to 5.235, P=0. 073, difference) No statistical significance (P0. 05). Sex (male, female%) were 21 (60%), 14 (40%), 29 (64.4%), 16 (35.6%), 11 (45.8%), 13 (54.2%), and the differences were compared with X2. The difference was not statistically significant (P0.05).2. sepsis group, general infection group, non infected group, serum iron, blood phosphorus levels: sepsis, general infection, non sense The serum iron M (P25, P75) was 2.7 (2, 5.1), 8.8 (4. 7,12. 2) and 15.8 (11. 8,18. 1) umol/L respectively. The serum iron level of the sepsis group was significantly lower than that of the general infection group and the non infected group. The serum iron level of the children in the general infection group was significantly lower than that in the non sensitive group, and the X2 value was 44.922, P=0. 000, and the difference was statistically significant (P0.05); the blood phosphorus M was statistically significant (P0.05). (P25, P75) were 1.49 (1.29,1.61), 1.71 (1. 56,1. 86), 1.84 (1.55, 1.86) mmol/L. The level of phosphorus in the acute phase of sepsis was significantly lower than that in the general infection group and the non infected group. The difference was statistically significant (P0. 05).3. sepsis group, the general infection group, the non infected group, and the comparison of the T lymphocyte subsets in the non infected group: the sepsis group, the general infection group, The non infected group CD3 (53.7, 66.7), 62.9 (56.5, 69), 67.8 (63.7, 71.1), and CD4 (%) were 28.7 (24.6, 35.3), 32.1 (27.5, 31.8,40.3), CD3 in sepsis group, CD4 compared with non infection group, the difference was statistically significant (P0.). The sepsis group, general infection group, non infection Group CD8 (16. 8,26. 1), 23.2 (19.6, 26.5), 23.5 (19.6,25.95), CD4/CD8 were 1,34 (1.07, 1.74), 1.41 (1.13,1.8), 1.58 (1.27,1.81). There was no statistically significant difference between the three groups (P0. 05) in.4. severe sepsis group, and the comparison of serum iron and blood phosphorus levels in common sepsis group: severe sepsis group, common sepsis. The serum iron of the disease group was 2.2 (1.9, 3), 4.3 (2.3, 7.3) umol/L, and the two group was Z -2.197, P=0. 027, the difference was statistically significant (P0. 05). The blood phosphorus in the severe sepsis group and the common sepsis group were 1.5 (1. 28,1.62), 1.48 (1. 31,1. 6) mmol/L, and the Z was -0.066, P=0., and the difference was not statistically significant (P0.) was serious pus Comparison of T lymphocyte subsets in toxic and common sepsis group: 56.6 (49.9, 64.2), 61.1 (57.3, 70.5), 26.7 (21.8,30.4), 31.9 (26.3, 38.1), 26.7 (21.8,30.4), 31.9 (26.3, 38.1) in severe sepsis and common sepsis group, 26.7 (21.8,30.4), 31.9 (26.3, 38.1), CD3 in severe sepsis group, CD4 significantly lower than that of common sepsis group, and in group two, Z values were respectively compared. The values of -2. 212, -2.113 and P were 0.027,0.035, and the difference was statistically significant (P0. 05). The CD8 (%) in the severe sepsis group and the common sepsis group were 22.1 (19.5, 25.8), 21.4 (16. 7,27.1), CD4/CD8 1.3 (1.1,1.54), 1.4 (1, 2) respectively. The Z values of the two groups were -0. 413 and -0. 924 respectively, and the differences were not statistically different. The study significance (P0. 05).6. serum iron, blood phosphorus, CD3, CD4 of the single test and the combined detection of the ROC curve analysis: serum iron, blood phosphorus, CD3, CD4, the joint detection predictive variable PRE-1 ROC curve area is: 0. 859,0. 767,0. 638,0. 881, there are significant statistical significance (05). [Conclusion serum iron of children with sepsis is more than one The lower level of serum iron reduction was proportional to the severity of sepsis, the lower the serum iron, the lower the serum iron, the lower the serum iron, the greater the severity of the disease in children with sepsis, the lower the serum iron, the lower the serum iron, the more CD3 of the children with sepsis, the lower the CD4 than the non infected children, and the possible presence of the immunosuppressed.4. serum iron caused by infection,.2.. Blood phosphorus, CD3 and CD4 are all diagnostic values for sepsis. Joint detection is better than single detection, and serum iron is a better single index for diagnosis of sepsis.

【學位授予單位】：昆明醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R720.597

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