探讨早期鉴别诊断脓毒症与川崎病的生物标志物。

选择2017年1月1日至2018年2月28日，于四川大学华西第二医院出院时确诊为脓毒症及川崎病的患儿为研究对象，并分别纳入脓毒症组(n＝286)和川崎病组(n＝326)。采用Mann-Whitney U秩和检验对2组患儿的白细胞计数(WBC)、中性粒细胞百分比、中性粒细胞绝对计数(ANC)、C反应蛋白(CRP)、血小板计数(PLT)、血红蛋白(Hb)，红细胞沉降率(ESR)、降钙素原(PCT)、血小板平均体积(MPV)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)，天冬氨酸氨基转移酶(AST)、丙氨酸转移酶(ALT)、乳酸脱氢酶(LDH)、白蛋白、血尿素氮(BUN)、血清肌酐(SCr)、D-二聚体(DD)、纤维蛋白原降解物(FDP)、国际正常化比率(INR)、肌钙蛋白I(cTnI)、肌红蛋白(Mb)、N端脑钠肽(NTBNP)、纤维蛋白原(Fg)，动脉血氧分压(PaO₂)、吸入氧气分数(FiO₂)、Na^＋、K^＋、Ca^2＋、Cl^－等指标进行统计学分析。采用χ²检验或连续性校正χ²检验对2组患儿病死率、冠状动脉扩张发生率等进行统计学分析。2组患儿的性别构成比比较，差异无统计学意义(P>0.05)。本研究遵循的程序符合2013年修订的《世界医学协会赫尔辛基宣言》的要求。

①脓毒症组患儿年龄小于川崎病组，入院前发热时间短于川崎病组，2组比较，差异均有统计学意义(P<0.05)。②脓毒症组患儿PCT水平高于川崎病组，而中性粒细胞百分比、ANC和ESR水平低于川崎病组，2组分别比较，差异均有统计学意义(P<0.05)。此外，脓毒症组患儿PCT值>0.5 ng/mL及PCT值>2 ng/mL者占比，均高于川崎病组，而CRP水平>30 mg/L、ESR>40 mm/h者占比，均低于川崎病组，2组分别比较，差异均有统计学意义(P<0.05)。③脓毒症组患儿的MPV、AST、LDH、BUN、SCr、Cl^－、DD、FDP、cTnI、Mb水平，均高于川崎病组，而Hb、PLT、ALT、Fg水平，均低于川崎病组，并且差异亦均有统计学意义(P<0.05)。④2组患儿呼吸系统功能损伤、循环系统功能损伤、消化系统功能损伤、泌尿系统功能损伤、凝血功能异常、血电解质异常、贫血及血小板增多者所占比例比较，差异均有统计学意义(P<0.05)。⑤脓毒症组与川崎病组住院期间患儿死亡率分别为5.2%(15例)与0，并且差异有统计学意义(χ²＝17.527，P<0.001)。

儿童脓毒症和川崎病在早期难以鉴别，易被误诊和漏诊。二者虽然很多实验室检查结果类似，但亦有部分实验室结果存在差异。脓毒症患儿的脏器损伤更严重、预后更差。

To explore biomarkers for early differential diagnosis of sepsis and Kawasaki disease.

Children diagnosed with sepsis and Kawasaki disease at the discharge from West China Second Hospital, Sichuan University from January 1, 2017 to February 28, 2018 were selected into this study, and they were included into sepsis group (n=286) and Kawasaki disease group (n=326), respectively. The levels of white blood cell count (WBC), absolute neutrophil count (ANC), C-reactive protein (CRP), platelet count (PLT), erythrocyte sedimentation rate (ESR), hemoglobin (Hb), mean platelet volume (MPV), aspartate aminotransferase (AST), alanine transferase (ALT), lactate dehydrogenase (LDH), blood urea nitrogen (BUN), serum creatinine (SCr), D-dimer (DD), fibrinogen degradation (FDP), troponin I (cTnI), myoglobin (Mb), hemoglobin (Hb), fibrinogen (Fg), partial pressure of oxygen in artery (PaO₂), fraction of inspired oxygen (FiO₂), activated partial thromboplastin time (APTT), international normalized ratio (INR), and other laboratory indexes between two groups were statistically analyzed by Mann-Whitney U rank sum test. The mortality and the incidence of coronary artery dilatation between two groups were statistically analyzed by chi-square test, continuity correction of chi-square test. There was no significant difference in gender ratio between two groups (P>0.05). This study was in line with the World Medical Association Declaration of Helsinki revised in 2013.

The age of children in sepsis group was younger than that in Kawasaki disease group, but the fever duration before admission in sepsis group was shorter than that in Kawasaki disease group, and the differences between two groups were statistically significant (P<0.05). ②The PCT level in sepsis group was higher than that in Kawasaki disease group, but the percentage of neutrophils, ANC and ESR levels were lower than those in Kawasaki disease group, and the differences between two groups were statistically significant (P<0.05). In addition, in sepsis group, the proportion of PCT value >0.5 ng/mL and PCT value >2 ng/mL were higher than those of Kawasaki disease group, while the proportion of CRP level >30 mg/L and ESR >40 mm/h were lower than those of Kawasaki disease group, and the difference between two groups in terms of above indexes were statistically significant (P<0.05). ③The levels of MPV, AST, LDH, BUN, SCr, Cl^-, DD, FDP, cTnI and Mb in sepsis group were higher than those in Kawasaki disease group (P<0.05). In addition, the levels of Hb, PLT, ALT and Fg in sepsis group were lower than those in Kawasaki disease group, and the differences between groups were statistically significant (P<0.05). ④There were significant differences in the proportion of respiratory system dysfunction, circulatory system dysfunction, digestive system dysfunction, urinary system dysfunction, coagulation dysfunction, blood electrolyte abnormality, anemia and thrombocytosis between two groups (P<0.05). ⑤The mortality rates of children in sepsis group and Kawasaki disease group were 5.2% (15 cases) and 0, respectively, and the difference was statistically significant (χ²=17.527, P<0.001).

Childhood sepsis and Kawasaki disease are difficult to differentiate in the early stages and are easily misdiagnosed. Although many laboratory results are similar, there are some differences between the two. In children with sepsis, the organ damage is more severe and the prognosis is worse.