肝素结合蛋白对儿童重症感染诊断价值的前瞻性研究

Value of heparin-binding protein in the diagnosis of severe infection in children: a prospective study

摘要:

目的 探讨肝素结合蛋白（heparin-binding protein，HBP）对儿童重症感染的诊断价值。 方法 该研究系前瞻性观察研究。收集2019年1月到2020年1月因感染入住儿童重症监护室患儿的临床资料，按照严重脓毒症与脓毒症诊断标准分为严重脓毒症组（49例）、脓毒症组（82例）和非重症感染组（33例），比较3组血浆HBP、血清C-反应蛋白、血清降钙素原及血小板计数等生物标志物水平的差异。并通过受试者工作特征曲线评估血浆HBP水平对重症感染（包括严重脓毒症组和脓毒症）的诊断价值。 结果 严重脓毒症组与脓毒症组入院时的血浆HBP水平均显著高于非重症感染组（P<0.05）。严重脓毒症组血清C-反应蛋白和降钙素原水平显著高于脓毒症组及非重症感染组（P<0.05）。严重脓毒症组血小板计数明显低于脓毒症组及非重症感染组（P<0.05）。血浆HBP水平诊断是否为重症感染的曲线下面积为0.590，灵敏度为38.0%，特异度为82.4%，具有统计学意义（P<0.05）。 结论 血浆HBP水平在重症感染儿童中增高，其诊断重症感染的灵敏度较低，但特异度较高，可作为儿童重症感染判断的标志物之一。

Abstract:

Objective To study the value of heparin-binding protein (HBP) in the diagnosis of severe infection in children. Methods This study was a prospective observational study. The medical data of children who were admitted to the pediatric intensive care unit due to infection from January 2019 to January 2020 were collected. According to the diagnostic criteria for severe sepsis and sepsis, the children were divided into a severe sepsis group with 49 children, a sepsis group with 82 children, and a non-severe infection group with 33 children. The three groups were compared in terms of related biomarkers such as plasma HBP, serum C-reactive protein, serum procalcitonin, and platelet count. The receiver operating characteristic (ROC) curve was plotted to investigate the value of plasma HBP level in the diagnosis of severe infection (including severe sepsis and sepsis). Results The severe sepsis and sepsis groups had a significantly higher plasma HBP level on admission than the non-severe infection group (P<0.05). Compared with the sepsis and non-severe groups, the severe sepsis group had significantly higher serum levels of C-reactive protein and procalcitonin and a significantly lower platelet count (P<0.05). Plasma HBP level had an area under the ROC curve of 0.590 in determining severe infection, with a sensitivity of 38.0% and a specificity of 82.4% (P<0.05). Conclusions There is an increase in plasma HBP level in children with severe infection, and plasma HBP level has a lower sensitivity but a higher specificity in the diagnosis of severe infection and can thus be used as one of the markers for the judgment of severe infection in children.