血清神經炎癥因子水平和意識狀態與兒童膿毒癥相關性腦病的相關性研究

【摘要】 目的：探究血清神經炎癥因子水平和意識狀態與兒童膿毒癥相關性腦病（SAE）的關聯性。方法：選擇2020年5月1日—2023年1月31日在江西省兒童醫院入住兒童重癥監護室/急診重癥監護室并診斷為膿毒癥/膿毒癥休克患兒75例，根據是否存在SAE將患兒分為觀察組（41例）和對照組（34例）。檢測患兒入院時血清Tau蛋白、C反應蛋白（CRP）、S100B、神經元特異性烯醇化酶（NSE）、降鈣素原（PCT）指標和格拉斯哥昏迷評分（GCS），以受試者操作特征（ROC）曲線分析各指標對兒童SAE的診斷價值，以logistic回歸分析各指標與兒童SAE的關系；隨訪兩組28 d的死亡率和3個月后格拉斯哥預后評分（GOS）等級；分析各指標與預后的關系。結果：觀察組Tau蛋白、PCT、CRP、S100B、NSE指標均顯著高于對照組（Plt;0.05），GCS評分、GOS評分等級均顯著低于對照組（Plt;0.05）；觀察組28 d死亡率顯著高于對照組（Plt;0.05）；ROC曲線分析結果顯示Tau蛋白、PCT、S100B、NSE、GCS評分的曲線下面積分別為0.709、0.746、0.686、0.725、0.783；logistic回歸分析結果顯示Tau蛋白≥7.238 pg/mL、

PCT≥4.299 ng/mL、S100B≥1.002 ng/mL、GCSlt;8.467分是SAE發生的獨立影響因素（Plt;0.05），

logit（P）=-1.241+2.320×Tau蛋白+2.243×PCT+1.727×S100B-2.296×GCS；存活患兒體內Tau蛋白、PCT、S100B指標均顯著低于死亡患兒（Plt;0.05），GCS評分顯著高于死亡患兒（Plt;0.05）；Spearman相關性分析結果顯示Tau蛋白、PCT、S100B指標與GOS評分等級呈負相關關系（rs=-0.764，Plt;0.05；rs=-0.658，Plt;0.05；rs=-0.598，Plt;0.05），GCS評分與GOS評分等級呈正相關關系（rs=0.524，Plt;0.05）。結論：患兒血清Tau蛋白、PCT、S100B指標及GCS評分對兒童膿毒癥相關性腦病有較高的診斷價值，并且患兒Tau蛋白、PCT、S100B指標及GCS評分與預后結局具有一定相關性。

【關鍵詞】 Tau蛋白 膿毒癥相關性腦病 格拉斯哥預后評分

Correlation between Serum Neuroinflammatory Factor Levels， Consciousness Status and Sepsis Associated Encephalopathy in Children/WU Jiali， WU Tao， LIU Hong， CHEN Kai， XU Fangfei. //Medical Innovation of China， 2023， 20（31）： -148

[Abstract] Objective： To explore the correlation between serum neuroinflammatory factor levels， consciousness status and sepsis associated encephalopathy （SAE） in children. Method： A total of 75 children with sepsis/septic shock who were admitted to the Pediatric Intensive Care Unit/Emergency Intensive Care Unit of Jiangxi Provincial Children's Hospital were enrolled from May 1st， 2020 to January 31st， 2023. According to the presence or absence of SAE， they were divided into the observation group （41 cases） and the control group （34 cases）. Serum Tau protein， C reactive protein （CRP）， S100B， NSE， procalcitonin （PCT） and Glasgow coma scale （GCS） were detected at admission. The diagnostic value of the above indexes for SAE was analyzed by receiver operating characteristic （ROC） curves， and logistic regression was used to analyze the relationship between each index and SAE in children. The 28 d mortality and Glasgow outcome scale （GOS） scores grade at 3 months after surgery in both groups were followed up， the relationship between each index and prognosis was analyzed. Result： The indexes of Tau protein， PCT， CRP， S100B and NSE in the observation group were significantly higher than those in the control group （Plt;0.05）， while GCS scores and GOS scores grade were significantly lower than those in the control group （Plt;0.05）. The 28 d mortality in the observation group was significantly higher than that in the control group （Plt;0.05）. The results of ROC curves analysis showed that area under the curve values of Tau protein， PCT， S100B， NSE and GCS scores were 0.709， 0.746， 0.686， 0.725 and 0.783， respectively. The results of logistic regression analysis showed that Tau protein ≥7.238 pg/mL， PCT ≥4.299 ng/mL， S100B ≥1.002 ng/mL and GCS score lt;8.467 points were independent influencing factors of SAE （Plt;0.05）. Logit（P）=-1.241+2.320×Tau+2.243×PCT+1.727×S100B-2.296×GCS. The indexes of Tau protein， PCT and S100B in the survival children were significantly lower than those in the death children （Plt;0.05）， while GCS score was significantly higher than that in the death children （Plt;0.05）. The results of Spearman correlation analysis showed that indexes of Tau protein， PCT and S100B were negatively correlated with GOS score grade （rs=-0.764， Plt;0.05; rs=-0.658， Plt;0.05; rs=-0.598， Plt;0.05）， while GCS score grade was positively correlated with GOS score grade （rs=0.524， Plt;0.05）. Conclusion： Serum Tau protein， PCT， S100B indexe and GCS score have high diagnostic value for SAE in children. And serum Tau protein， PCT， S100B indexe and GCS score have certain correlation with prognosis of children.

[Key words] Tau protein Sepsis associated encephalopathy Glasgow outcome scale score

First-author's address： Jiangxi Provincial Children's Hospital， Nanchang 330000， China

doi：10.3969/j.issn.1674-4985.2023.31.033

膿毒癥及其并發癥是兒科重癥監護病房最常見的危重癥之一。在膿毒癥進展過程中，大腦不僅參與免疫調節，也是易受累器官之一[1]。膿毒癥相關性腦病（sepsis associated encephalopathy，SAE）為排除中樞神經系統感染、其他類型腦病（如肝、腎、代謝性腦病）所發生的彌散性腦功能障礙。……