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目的 探讨不同程度全身炎症反应综合征 (SIRS)患儿血管性假血友病因子 (VW因子 )、D 二聚体 (D D)及C 反应蛋白 (CRP)的变化 ,与病情危重程度的关系。 方法 符合SIRS一项诊断标准评一分 ,按SIRS评分将患儿分为SIRS2、SIRS3及SIRS4三组 ,每组各 2 0例。于急性期和恢复期抽血用ELISA法测定VW因子和D D ,免疫比浊法测定CRP ,并与非SIRS患儿进行比较。同时对SIRS患儿行危重症评分分为危重症组和非危重症组。 结果 SIRS患儿急性期血VW因子、D D及CRP含量均增高 ,且随SIRS评分增加 ,升高程度更显著 ;三者在危重症组也明显高于非危重症组 (P均 <0 0 5 )。SIRS4组符合危重症标准及发生MODS的例数均高于SIRS3和SIRS2组 (SIRS4与SIRS2比较 ,P <0 0 5 )。 结论 SIRS时血浆VW因子和D D明显升高 ,提示血管内皮细胞受到损伤 ,凝血功能出现紊乱 ,当SIRS程度加重、病情恶化时 ,升高的程度更显著。CRP水平可反映SIRS患儿体内炎症反应的程度 ,并与病情的危重程度密切相关。SIRS评分可作为临床判定患儿病情轻重的简便易行的指标 ,SIRS评分越高 ,提示病情越重 ,若结合血VW因子、D D或CRP水平可更准确地判定病情的危重程度。
Objective To investigate the changes of VW, D D and C reactive protein (CRP) in children with systemic inflammatory response syndrome (SIRS) and their relationship with severity of illness. Methods According to a diagnostic criteria of SIRS, the patients were divided into three groups according to SIRS score: SIRS2, SIRS3 and SIRS4, with 20 cases in each group. VW and D D were measured by ELISA in acute phase and recovery phase. CRP was measured by immunoturbidimetry and compared with non-SIRS. At the same time, critically ill patients with SIRS were divided into critically ill patients and non-critically ill patients. Results The levels of VW, DD and CRP in acute stage of SIRS children were all higher than those in non-critically ill group (P <0.05). ). The number of critically ill patients with MODS in SIRS4 group was higher than those in SIRS3 and SIRS2 patients (SIRS4 vs SIRS2, P <0.05). Conclusions The plasma levels of VW and D D are significantly increased during SIRS, suggesting that vascular endothelial cells may be impaired and blood coagulation may be disturbed. When SIRS is increased, the severity of the disease is more pronounced. The level of CRP reflects the degree of inflammatory reaction in children with SIRS and is closely related to the severity of the disease. The SIRS score can be used as a simple and easy indicator for judging the severity of the illness in children. The higher the SIRS score, the more serious the disease is. If combined with the blood VW factor, D D or CRP level, the severity of the illness can be more accurately determined.