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目的了解降钙素原(PCT)在全身炎症反应综合征(SIRS)发病中的变化及其与病情危重程度的关系;探讨PCT的生物学机制及在SIRS发病中的作用。方法选择2004-01—2004-12河北医科大学第四医院儿科SIRS患儿60例,依据SIRS诊断评分标准分为:S2组21例、S3组22例、S4组17例。并将此60例依据简化PCIS评分分为3组:非危重组54例、危重组4例、极危重组2例。并选择同期健康体检儿童20例,作为对照组。采用免疫化学发光法、酶联免疫吸附法(ELISA)检测患儿血清PCT、肿瘤坏死因子-α(TNF-α)、白介素-1β(IL-1β)及白介素-10(IL-10)的质量浓度。结果SIRS患儿急性期血清PCT质量浓度[(0·57±0·35)ng/mL]明显高于对照组[(0·18±0·17)ng/mL](P<0·01)。细菌感染组血清PCT质量浓度[(0·73±0·37)ng/mL]明显高于病毒感染组[(0·37±0·21)ng/mL]及非感染性疾病组[(0·43±0·28)ng/mL](P<0·05)。SIRS评分与血清PCT水平变化:S4组PCT质量浓度[(0·73±0·49)ng/mL]明显高于S2组[(0·46±0·27)ng/mL](P<0·05),S2组与S3组,S3组与S4组比较,差异均无显著性意义(P>0·05)。SIRS患儿血清PCT质量浓度与简化PCIS评分呈显著负相关(r=-0·306,P<0·05)。血清PCT水平与TNF-α、IL-10水平呈显著正相关(r值分别为0·259和0·268,均P<0·05);与IL-1β无显著相关性(r=0·029,P>0·05)。结论PCT有助于诊断、判断病情及鉴别不同病因所致SIRS。PCT水平的高低可反映病情的危重状态。PCT作为一种炎症介质参与SIRS的病理过程,并在SIRS的发生发展进程中和致炎因子与抑炎因子相互促进、相互拮抗,参与炎症反应。
Objective To investigate the changes of procalcitonin (PCT) in the pathogenesis of systemic inflammatory response syndrome (SIRS) and its relationship with the severity of the disease. To investigate the biological mechanism of PCT and its role in the pathogenesis of SIRS. Methods Sixty children with SIRS in pediatric department of the Fourth Hospital of Hebei Medical University from January 2004 to December 2004 were divided into 21 cases in group S2, 22 cases in group S3 and 17 cases in group S4 according to SIRS diagnostic criteria. Sixty patients were divided into three groups based on the simplified PCIS score: 54 in the non-critically ill group, 4 in the critically ill group and 2 in the critically ill group. And select the same period healthy children 20 cases of physical examination, as a control group. The levels of serum PCT, TNF-α, IL-1β and IL-10 in children were measured by immunochemical chemiluminescence and enzyme-linked immunosorbent assay (ELISA) concentration. Results The serum PCT concentration in acute stage of SIRS patients was significantly higher than that of control group [(0.57 ± 0.35) ng / mL vs (0.18 ± 0.17) ng / mL] (P <0.01) . The serum PCT concentration in bacterial infection group was significantly higher than that in virus-infected group [(0.73 ± 0.37) ng / mL [(0 · 37 ± 0.21) ng / mL and (0 · 43 ± 0 · 28) ng / mL] (P <0.05). SIRS score and serum PCT level: The PCT concentration in S4 group was significantly higher than that in S2 group [(0.46 ± 0.27) ng / mL] (P <0. 73 ± 0.49 ng / mL] · 05), there was no significant difference between S2 group and S3 group, S3 group and S4 group (P> 0.05). There was a significant negative correlation between serum PCT concentration and the simplified PCIS score in children with SIRS (r = -0 · 306, P <0.05). Serum PCT levels were positively correlated with TNF-α and IL-10 levels (r = 0.259 and 0.268, respectively, P <0.05), but no significant correlation with serum IL-1β 029, P> 0.05). Conclusions The PCT is helpful in diagnosis, judgment of illness and identification of SIRS caused by different etiologies. The level of PCT can reflect the critical condition of the disease. As an inflammatory mediator, PCT participates in the pathological process of SIRS. In the process of occurrence and development of SIRS, PCT promotes the interaction between proinflammatory cytokines and proinflammatory cytokines, antagonizes each other and participates in the inflammatory reaction.