新生儿脓毒性休克治疗前后血清肌酸激酶同工酶、α-羟丁酸脱氢酶、前白蛋白水平变化及临床意义

张森山; 罗明海; 付扬喜; 程光清; 贺蓉

doi:10.7619/jcmp.201909021

新生儿脓毒性休克治疗前后血清肌酸激酶同工酶、α-羟丁酸脱氢酶、前白蛋白水平变化及临床意义

陕西省安康市中心医院儿童医院儿科, 陕西安康, 725000

基金项目:

陕西省卫生厅科研基金项目 2015JM40237

详细信息

通讯作者:
贺蓉, E-mail: 68828246@qq.com

中图分类号: R722.13
计量
- 文章访问数: 336
- HTML全文浏览量: 226
- PDF下载量: 13
出版历程
- 收稿日期: 2019-03-09
- 录用日期: 2019-04-18
- 网络出版日期: 2020-12-21
- 发布日期: 2019-05-14

Changes of serum levels of creatine kinase isoenzyme, α-hydroxybutyric dehydrogenase, prealbuminafter treatment of neonatal septic shock and their clinical significance

Department of Pediatrics, Children′s Hospital of Ankang Central Hospital, Ankang, Shaanxi, 725000

摘要

摘要:
目的探讨新生儿脓毒性休克治疗前后血清肌酸激酶同工酶(CK-MB)、α-羟丁酸脱氢酶(α-HBDH)、前白蛋白(PA)水平的变化及其临床意义。
方法选取120例脓毒性休克新生儿作为病例组，并选择同期于医院分娩的40例正常健康新生儿作为对照组，病例组入院时及治疗2周后监测血清CK-MB、α-HBDH、PA水平，对照组于入院后测定上述指标，分析血清CK-MB、α-HBDH、PA水平变化与脓毒性休克患儿病情变化的关系及其临床意义。
结果病例组入院时血清CK-MB、α-HBDH水平显著高于对照组, PA水平显著低于对照组(P < 0.05); 轻度脓毒症休克患儿入院时血清CK-MB、α-HBDH水平显著低于重度组，血清PA水平显著高于重度组(P < 0.05); 病例组治疗2周后CK-MB、α-HBDH显著降低，PA水平显著上升，与入院时比较差异有统计学意义(P < 0.05); 重度脓毒症休克新生儿CK-MB恢复时间、α-HBDH恢复时间、PA恢复时间及住院时间均显著长于轻度者(P < 0.05)。
结论脓毒性休克新生儿伴血清CK-MB、α-HBDH明显上调，PA降低，且随脓毒性休克病情的进展，其血清CK-MB、α-HBDH水平逐渐上升, PA逐渐降低，同时，上述指标的变化与治疗反应存在密切关联。
- 脓毒性休克 /
- 新生儿 /
- 肌酸激酶同工酶 /
- α-羟丁酸脱氢酶 /
- 前白蛋白
Abstract:
Objective To explore the changes of serum levels of creatine kinase isoenzyme (CK-MB), α-hydroxybutyrate dehydrogenase (α-HBDH) and prealbumin after treatment of neonatal septic shock and their clinical significance.
Methods A total of 120 neonates with septic shock admitted to the hospital were selected as case group, and another 40 normal healthy neonates who were delivered in the hospital during the same period were selected as control group. Serum levels of CK-MB, α-HBDH and PA before treatment and after 2 weeks of treatment were monitored in case group, and were determined after admission in control group. The relationship between changes of serum levels of CK-MB, α-HBDH, PA and changes of disease in children with septic shock were explored, and their clinical significance were analyzed.
Results The serum levels of CK-MB and α-HBDH in case group were significantly higher after admission while the PA level was lower than that in control group (P < 0.05). Serum levels of CK-MB and α-HBDH in children with mild sepsis shock after admission were higher while serum PA level was lower than those with severe sepsis shock (P < 0.05). The levels of CK-MB and α-HBDH were decreased and the level of PA was increased in case group after 2 weeks of treatment, and there was significant difference compared with before treatment (P < 0.05). The CK-MB recovery time, α-HBDH recovery time, PA recovery time and hospital stay in children with severe sepsis shock were longer than those with mild sepsis shock (P < 0.05).
Conclusion The levels of CK-MB and α-HBDH are obviously up-regulated and the PA level is decreased in neonates with septic shock. With the progression of septic shock, serum CK-MB and α-HBDH levels are gradually increased and PA level gradually decreased. The changes of aboveindexes are closely related to the treatment response.
- septic shock /
- neonates /
- creatine kinase isoenzyme /
- α-hydroxybutyrate dehydrogenase /
- prealbumin

HTML全文

表 1 2组入院时血清CK-MB、α-HBDH、PA水平比较(x±s)

组别	n	CK-MB/(U/L)	α-HBDH/(U/L)	PA/(mg/L)
对照组	40	21.25±5.23	89.25±13.54	156.26±17.71
病例组	120	46.35±7.26^*	526.41±120.36^*	97.23±20.65^*
CK-MB: 肌酸激酶同工酶; α-HBDH: α-羟丁酸脱氢酶; PA: 前白蛋白。与对照组比较, *P < 0.05。

下载: 导出CSV

表 2 病例组不同严重程度患儿入院时血清CK-MB、α-HBDH、PA水平比较(x±s)

组别	n	CK-MB/(U/L)	α-HBDH/(U/L)	PA/(mg/L)
轻度脓毒性休克组	56	34.25±6.78	452.26±60.74	110.23±16.78
重度脓毒性休克组	64	60.25±10.74^*	712.52±110.25^*	79.56±15.66^*
CK-MB: 肌酸激酶同工酶; α-HBDH: α-羟丁酸脱氢酶; PA: 前白蛋白。与轻度脓毒性休克组比较, *P < 0.05。

下载: 导出CSV

表 3 病例组患儿不同时点血清CK-MB、α-HBDH、PA水平比较(x±s)

时点	n	CK-MB/(U/L)	α-HBDH/(U/L)	PA/(mg/L)
入院时	120	46.35±7.26	526.41±120.36	97.23±20.65
治疗2周后	120	22.32±4.79^*	95.26±20.47^*	147.66±23.54^*
CK-MB: 肌酸激酶同工酶; α-HBDH: α-羟丁酸脱氢酶; PA: 前白蛋白。与入院时比较, *P < 0.05。

下载: 导出CSV

表 4 病例组实验室指标恢复时间及住院时间比较(x±s) d

组别	n	CK-MB恢复时间	α-HBDH恢复时间	PA恢复时间	住院时间
轻度脓毒性休克组	56	4.72±1.36	6.72±1.35	4.05±1.23	7.44±1.65
重度脓毒性休克组	64	9.86±1.77^*	12.21±2.36^*	8.41±1.76^*	15.11±2.45^*
CK-MB: 肌酸激酶同工酶; α-HBDH: α-羟丁酸脱氢酶; PA: 前白蛋白。与轻度脓毒性休克组比较, *P < 0.05。

下载: 导出CSV

参考文献(20)

[1]	王春源, 李肖肖, 丁静, 等. cTnⅠ、CK-MB及乳酸联合检测对急诊老年严重脓毒症及脓毒症休克患者预后的评估[J]. 中国实验诊断学, 2017, 21(5): 774-777. doi: 10.3969/j.issn.1007-4287.2017.05.004
[2]	LANDESBERG G, JAFFE A S, GILON D, et al. Troponin elevation in severe sepsis and septic shock: the role of left ventricular diastolic dysfunction and right ventricular dilatation[J]. Critical Care Medicine, 2014, 42(4): 790-800. doi: 10.1097/CCM.0000000000000107
[3]	李敏, 李寒春. 脓毒症患儿心肌损害与胰岛素抵抗相关性研究[J]. 西部医学, 2016, 28(2): 228-230. doi: 10.3969/j.issn.1672-3511.2016.02.024
[4]	陈矛, 姜悦, 黄樱菲, 等. 严重脓毒症及脓毒性休克患者SV、ScVO₂、乳酸清除率、心肌酶学的相关性研究[J]. 海南医学, 2016, 27(4): 551-553. doi: 10.3969/j.issn.1003-6350.2016.04.012
[5]	SHARAWY N, LEHMANN C. New directions for sepsis and septic shock research[J]. Journal of Surgical Research, 2015, 194(2): 520-527. doi: 10.1016/j.jss.2014.12.014
[6]	凌萍, 陈建丽, 周茉, 等. 脓毒症、严重脓毒症危重患儿血清降钙素原水平变化及临床意义[J]. 贵州医药, 2016, 40(8): 810-813. doi: 10.3969/j.issn.1000-744X.2016.08.009
[7]	高戈, 冯喆, 常志刚, 等. 2012国际严重脓毒症及脓毒性休克诊疗指南[J]. 中华危重病急救医学, 2013, 25(8): 501-505. doi: 10.3760/cma.j.issn.2095-4352.2013.08.016
[8]	中华医学会重症医学分会. 中国严重脓毒症/脓毒性休克治疗指南(2014)[J]. 中华内科杂志, 2015, 54(6): 401-426. https://www.cnki.com.cn/Article/CJFDTOTAL-QKYL201504002.htm
[9]	ZHU Y, WU H, WU Y, et al. Beneficial Effect of Intermedin 1-53 in Septic Shock Rats: Contributions of RHO Kinase and BKCA Pathway-Mediated Improvement in Cardiac Function[J]. Shock, 2016, 46(5): 557-565. doi: 10.1097/SHK.0000000000000639
[10]	刘威, 段美丽, 李昂. 脓毒性休克微循环改变相关研究进展[J]. 山东医药, 2013, 53(48): 85-88. https://www.cnki.com.cn/Article/CJFDTOTAL-SDYY201348036.htm
[11]	王宾, 王超, 王红. 脓毒症早期诊断生物标志的研究进展[J]. 临床和实验医学杂志, 2016, 15(7): 718-720. doi: 10.3969/j.issn.1671-4695.2016.07.036
[12]	SANTIAGO M B, VIEIRA A A, ELIAS L L, et al. Neurohypophyseal response to fluid resuscitation with hypertonic saline during septic shock in rats[J]. Experimental Physiology, 2013, 98(2): 556-563. doi: 10.1113/expphysiol.2012.066241
[13]	徐菱阳. 脓毒性休克患儿血液氧代谢指标变化及其临床意义[J]. 中国当代儿科杂志, 2017, 19(10): 1124-1128. doi: 10.7499/j.issn.1008-8830.2017.10.018
[14]	谢友军, 莫武桂, 韦跃. 不同呼气末正压对脓毒性休克合并急性呼吸窘迫综合征婴幼儿预后的影响[J]. 中国小儿急救医学, 2014, 21(11): 693-696. doi: 10.3760/cma.j.issn.1673-4912.2014.11.004
[15]	张志忠, 王国兴, 杨立沛. 休克指数对急诊严重脓毒症和脓毒性休克预后评估的意义[J]. 中华急诊医学杂志, 2015, 24(2): 147-150. doi: 10.3760/cma.j.issn.1671-0282.2015.02.007
[16]	霍习敏, 王晓冬, 康磊. 小儿脓毒性休克容量复苏应用的临床研究[J]. 中华危重病急救医学, 2014, 26(4): 253-257. doi: 10.3760/cma.j.issn.2095-4352.2014.04.011
[17]	罗运山, 罗君, 刘易林, 等. 脓毒性休克预后因素分析[J]. 重庆医学, 2017, 46(19): 2715-2717. doi: 10.3969/j.issn.1671-8348.2017.19.039
[18]	KOCH L, BOSK A, SASSE M, et al. Managing Neonatal Severe Sepsis in Germany: A Preliminary Survey of Current Practices[J]. Klinische Padiatrie, 2015, 227(1): 23-27. doi: 10.1055/s-0034-1389975
[19]	王龙廷, 周荣斌. 脓毒性休克预后相关生物学指标的研究进展[J]. 中国全科医学, 2016, 19(4): 492-496. doi: 10.3969/j.issn.1007-9572.2016.04.030
[20]	肖政辉, 刘萍萍, 卢秀兰, 等. 脓毒症/严重脓毒症/脓毒性休克患儿高尿酸血症与预后关系的研究[J]. 中华急诊医学杂志, 2015, 24(9): 1031-1034. doi: 10.3760/cma.j.issn.1671-0282.2015.09.023

施引文献

资源附件(0)

表(4)

计量

文章访问数: 336
HTML全文浏览量: 226
PDF下载量: 13
被引次数: 0

新生儿脓毒性休克治疗前后血清肌酸激酶同工酶、α-羟丁酸脱氢酶、前白蛋白水平变化及临床意义

通讯作者: 贺蓉, E-mail: 68828246@qq.com

计量

出版历程

Changes of serum levels of creatine kinase isoenzyme, α-hydroxybutyric dehydrogenase, prealbuminafter treatment of neonatal septic shock and their clinical significance

计量

出版历程

目录

通讯作者:
贺蓉, E-mail: 68828246@qq.com