Clinical Atudy Of Pentraxin3 In Sepsis And Cardiovascular Function Of Children

Background and Objective: Pentraxin 3 is a kind of local inflammation factors for he cardiovascular system, it produced and released from many different types of cells, mainly are the damage of myocardial cells[1],activatly endothelial cells and neutrophils. In recent years, many foreign workers’ study suggests: PTX3 have closely related with the severity and prognosis of sepsis.Method: A total of 178 patients who were older than 28 days,getting acute infection of respiratory or neurological, excluding having chronic or special disease,and admitted to the PICU of Hu Nan Children’ Hospital from October 1, 2013 to April 30,2014 were enrolled, including 102 male cases and 76 female cases. The ages spanning between 1 month to 13 years and 1 month. 78 cases of them are less than 1 year old; 58 cases are between 1 to 3 years old; 42 cases are above 3 years old. 101 cases are diagnoses respiratory system diseases, 77 cases are nervous system diseases. Detecting PTX3 by ELISA method within 24 h after enrolled、at 3 days and 7days, meanwhile, measureing troponin, myocardial enzyme, BNP, CRP, PCT and WBC etc. According to the plasma PTX3 value which measured within 24 h after enrolled devided them into three groups: mildly elevated group(< 44μg/L) 41 cases; Moderately elevated group(44 ~ < 132μg/L) in 66 cases; Severely elevated group 71 cases(132μg/L or higher); Those 178 patients were devided into 3 groups according to the degree of infection: un-sepsis group(78 cases), sepsis( 70 cases), severe sepsis group(30 cases), and in each group, those with heart failure are respectively for 19 cases, 28 cases, 17 cases.;Analysis of the plasma PTX3 expression changes at different clinical manifestations、different condition、different degrees of Organ damages and prognosis for the patient. The continuous variables were analyzed with t-test, F-test, H-test,the categorical variables were analyzed with Chi-squared test, and the correlation analysis was calculated using Pearson coefficients.Result:(1) The PTX3 value measured within 24 h after enrolled are increasing with the degree of infection [50.4(35.2,70.4)μg/L;175.8(99.6,309.9) μg/L;419.9(168.3,468.6) μg/L;H=88.345,P=0.000]. The level of PTX3 are gradually declined(the PTX3 value for within 24 h after enrolled、after 3days 、7days are respectively by:167.5(48.8,258.6)μg/L;112.1(32.7,154.6) μg/L;72.6(25.3,65.3) μg/L;H=69.077,P=0.000)(p<0.05);(2) The area under the ROC curve of Plasma PTX3 was larger than other inflammatory markers such as CRP and PCT, white blood cells and neutrophils in the diagnosis of sepsis; while the former three are PTX3, PCT and CRP(the sensitivity and specificity respectively by 0.77, 0.68; 0.66, 0.6; 0.47, 0.55);(3) The PTX3 value of the severely elevated group was obviously higher than the mildly and moderatly(P < 0.05); The proportion of having 3 or more than 3 organs failure are increased as the PTX3 rising among the groups of mildly elevated group、Moderately elevated group、Severely elevated group [1(2.4%)、4(6.1%)、14(19.7%)χ2=16.16,P=0.000];and in each group, the proportion of having good or bad prognosis or dead for this three groups are differents [33(80.5%),7(17.1%),1(2.4%);35(53%),26(37.9%),6(9.1%);28(39.4%),33(46.5%),10(14.1%),χ2=18.059,P=0.001],The K-M curve for this three groups have statistically significance(χ2=7.086,P=0.029, Picture 2).(4) PTX3 value increases with myocardial enzymology’s(troponin, creatine kinase isoenzyme, BNP) rising. In the diagnosis of heart failure, the area under the ROC curve are respectively PTX3 0.824; BNP 0.772; CM-KB 0.643; CNTI0.671, the sensitivity and specificity are PTX3 0.8,0.58; CK-MB 0.56,0.79; CTNI 0.60,0.69; BNP 0.73,0.58. At the aspect of predicting the prognosis of the patients with heart failure complications, the PTX3 value’s area under ROC curve is larger than the BNP(respectively 0.844, 0.472). Those with heart failure have higher PTX3 value than those with non-heart failure at the same degree of infection. Here are the description of each group: non-sepsis group(U=-3.446,P=0.001); sepsis group(U=-4.586,P=0.000); severe sepsis group(U=-2.408,P=0.016).(5) PTX3 compared with the molecular markers which are standing for organ lesioned, we found that the glutamic oxalacetic transaminase and lactic acid are rising with plasma PTX3(p=0.009,0035).Conclusion: The PTX3 is an objective biochemical markers in diagnosis of sepsis; it is helpful in assessment of severity and prognosis of sepsis; it’s also has a certain clinical value in the aspect of sepsis cardiovascular function damage: PTX3’s value increases with myocardial enzymology’s(troponin, creatine kinase isoenzyme, BNP) rising, in the diagnosis of heart failure, the sensitivity and specificity for PTX3 was better than others; it’s also can predicting the prognosis of sepsis with heart failure.