降钙素原与氨基末端B型利钠肽原联合评分对甲泼尼龙联合集成化血液净化治疗儿童严重脓毒症效果的分层价值

doi:10.3877/cma.j.issn.2095-3216.2026.02.005

目的

探讨降钙素原(procalcitonin，PCT)与氨基末端B型利钠肽原(N-terminal pro-B-type natriuretic peptide，NT-proBNP)联合评分对甲泼尼龙联合集成化血液净化治疗儿童严重脓毒症效果的分层价值。

方法

回顾性分析2024年1月至2025年12月接受甲泼尼龙联合集成化血液净化治疗的严重脓毒症儿童患者，根据治疗后72 h器官功能与灌注情况将患儿分为治疗反应组与非反应组。比较两组的基线特征，构建PCT与NT-proBNP联合评分预测模型，以多因素Logistic回归方法分析治疗反应的独立影响因素，并以受试者工作特征曲线、校准曲线及决策曲线分析评估联合指标的预测效能与临床实用性。

结果

共纳入117例儿童患者，其中治疗反应组68例、非反应组49例。与非反应组相比，治疗反应组患者的基线儿科序贯器官衰竭评估分数、乳酸、PCT、NT-proBNP及联合评分均较低(P均<0.05)。较高的联合评分是治疗反应不佳的独立危险因素(OR＝4.150，95%CI：1.892~9.102，P<0.01)。根据联合评分最佳截点(0.85)分层，联合评分较高的患儿治疗反应率更低，28 d死亡率较高，器官功能恢复较慢，儿童重症监护病房的住院时间更长(P均<0.05)。基于联合评分预测模型预测，治疗反应曲线下面积为0.842，校准良好，决策曲线分析亦显示其在合理阈值范围内具有较高的临床净受益。

结论

基线PCT与NT-proBNP联合评分与严重脓毒症患儿对甲泼尼龙联合集成化血液净化治疗的72 h早期治疗反应及28 d死亡风险相关；基于该评分构建的预测模型具有较好的判别力与校准表现，可作为早期风险分层与管理的参考指标。

关键词: 儿童, 严重脓毒症, 甲泼尼龙, 集成化血液净化, 降钙素原, 氨基末端B型利钠肽原

Objective

To investigate the stratification value of combined scoring of procalcitonin (PCT) and amino-terminal pro-B-type natriuretic peptide (NT-proBNP) on the efficacy of methylprednisolone combining integrated blood purification in children with severe sepsis.

Methods

A retrospective analysis was conducted on children with severe sepsis who received methylprednisolone combined with integrated blood purification from January 2024 to December 2025. Based on organ function and perfusion status at 72 hours post-treatment, the patients were divided into a treatment response group and a non-response group. Baseline characteristics were compared between the two groups, and a combined PCT and NT-proBNP scoring model was constructed. Multivariate logistic regression was used to analyze independent factors influencing treatment response, while receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis were employed to evaluate the predictive performance and clinical utility of the combined markers.

Results

A total of 117 children patients were included, comprising 68 in the treatment response group and 49 in the non-response group. Compared with the non-response group, the treatment response group exhibited significantly lower baseline pediatric sequential organ failure assessment scores, lactate, PCT, NT-proBNP, and combined scores (all P<0.05). A higher combined score was identified as an independent risk factor for poor treatment response (OR=4.150, 95%CI: 1.892-9.102, P<0.01). According to the stratification of the optimal cut-off value of 0.85, children with higher combined scores exhibited lower treatment response rates, higher 28-day mortality, slower organ function recovery, and longer pediatric intensive care unit (all P<0.05). Based on the combined scoring prediction model, the area under the curve for predicting treatment response was 0.842, with good calibration. Additionally, decision curve analysis demonstrated a high clinical net benefit within reasonable threshold ranges.

Conclusion

Baseline combined PCT and NT-proBNP scoring is associated with the 72-hour early treatment response and 28-day mortality risk in children with severe sepsis treated with methylprednisolone and integrated blood purification. The prediction model constructed based on this score demonstrates favorable discrimination and calibration, suggesting it could serve as a valuable reference for early risk stratification and management.

Key words: Children, Severe sepsis, Methylprednisolone, Integrated blood purification, Procalcitonin, Amino-terminal pro-B-type natriuretic peptide

表1 不同患儿基线资料比较

变量	治疗反应组(68例)	非反应组(49例)	t/χ²值	P值
一般资料
性别(男/女，例)	39/29	33/16	1.083^a	0.298
年龄(岁)	7.62±4.05	8.13±4.21	0.683^b	0.496
体重指数(kg/m²)	16.85±3.42	17.20±3.67	0.535^b	0.594
感染相关(例)
感染部位(肺/腹腔/其他)	42/11/15	38/6/5	4.127^a	0.127
病原学检出(是/否)	45/23	37/12	0.837^a	0.360
病情严重度
机械通气	45(66.18)	41(83.67)	4.309^a	0.038
pSOFA评分	8.47±2.15	11.24±2.39	6.401^b	<0.001
乳酸(mmol/L)	3.12±1.04	4.25±1.18	5.404^b	<0.001
实验室指标
降钙素原和(ng/ml)	18.54±7.23	28.96±9.15	6.178^b	<0.001
N末端B型利钠肽(pg/ml)	5120.45±2310.67	9845.72±3412.85	7.415^b	<0.001
C反应蛋白(mg/L)	68.75±32.14	75.82±36.50	1.103^b	0.272
白细胞计数(×10⁹/L)	12.45±5.62	13.88±6.41	1.258^b	0.211
血小板计数(×10⁹/L)	185.32±76.45	152.18±81.23	2.274^b	0.025
血清肌酐(μmol/L)	52.36±20.14	58.91±25.67	1.568^b	0.119
总胆红素(μmol/L)	25.68±12.35	34.72±15.88	3.458^b	<0.001
凝血酶原时间国际标准化比值	1.25±0.32	1.48±0.41	3.425^b	<0.001
联合评分	0.32±0.81	1.45±0.92	7.034^b	<0.001

表1 不同患儿基线资料比较

变量	治疗反应组(68例)	非反应组(49例)	t/χ²值	P值
一般资料
性别(男/女，例)	39/29	33/16	1.083^a	0.298
年龄(岁)	7.62±4.05	8.13±4.21	0.683^b	0.496
体重指数(kg/m²)	16.85±3.42	17.20±3.67	0.535^b	0.594
感染相关(例)
感染部位(肺/腹腔/其他)	42/11/15	38/6/5	4.127^a	0.127
病原学检出(是/否)	45/23	37/12	0.837^a	0.360
病情严重度
机械通气	45(66.18)	41(83.67)	4.309^a	0.038
pSOFA评分	8.47±2.15	11.24±2.39	6.401^b	<0.001
乳酸(mmol/L)	3.12±1.04	4.25±1.18	5.404^b	<0.001
实验室指标
降钙素原和(ng/ml)	18.54±7.23	28.96±9.15	6.178^b	<0.001
N末端B型利钠肽(pg/ml)	5120.45±2310.67	9845.72±3412.85	7.415^b	<0.001
C反应蛋白(mg/L)	68.75±32.14	75.82±36.50	1.103^b	0.272
白细胞计数(×10⁹/L)	12.45±5.62	13.88±6.41	1.258^b	0.211
血小板计数(×10⁹/L)	185.32±76.45	152.18±81.23	2.274^b	0.025
血清肌酐(μmol/L)	52.36±20.14	58.91±25.67	1.568^b	0.119
总胆红素(μmol/L)	25.68±12.35	34.72±15.88	3.458^b	<0.001
凝血酶原时间国际标准化比值	1.25±0.32	1.48±0.41	3.425^b	<0.001
联合评分	0.32±0.81	1.45±0.92	7.034^b	<0.001

表2 影响治疗反应的多因素Logistic回归分析

变量	β	标准误	Wald χ²	OR值	95%CI	P值
联合评分	1.423	0.401	12.589	4.150	1.892~9.102	<0.01
pSOFA	0.285	0.078	13.345	1.330	1.142~1.549	<0.01
机械通气	0.872	0.392	4.949	2.392	1.109~5.160	0.026
常量	－3.841	1.214	10.012	0.021	－	0.002

表2 影响治疗反应的多因素Logistic回归分析

变量	β	标准误	Wald χ²	OR值	95%CI	P值
联合评分	1.423	0.401	12.589	4.150	1.892~9.102	<0.01
pSOFA	0.285	0.078	13.345	1.330	1.142~1.549	<0.01
机械通气	0.872	0.392	4.949	2.392	1.109~5.160	0.026
常量	－3.841	1.214	10.012	0.021	－	0.002

表3 不同PN分层的短期疗效比较

变量	低分组(55例)	高分组(62例)	t/χ²值	P值
治疗反应者	43(78.18)	25(40.32)	16.923^a	<0.01
pSOFA变化值	－3.42±2.11	－1.25±2.18	5.168^b	<0.01
乳酸清除率(%)	41.23±18.54	23.76±16.83	5.097^b	<0.01
休克逆转时间(d)	3.21±1.48	5.04±2.13	5.040^b	<0.01
机械通气时间(d)	5.83±2.91	8.12±3.54	3.800^b	<0.01
PICU住院时间(d)	9.75±3.84	13.21±4.65	4.507^b	<0.01

表3 不同PN分层的短期疗效比较

变量	低分组(55例)	高分组(62例)	t/χ²值	P值
治疗反应者	43(78.18)	25(40.32)	16.923^a	<0.01
pSOFA变化值	－3.42±2.11	－1.25±2.18	5.168^b	<0.01
乳酸清除率(%)	41.23±18.54	23.76±16.83	5.097^b	<0.01
休克逆转时间(d)	3.21±1.48	5.04±2.13	5.040^b	<0.01
机械通气时间(d)	5.83±2.91	8.12±3.54	3.800^b	<0.01
PICU住院时间(d)	9.75±3.84	13.21±4.65	4.507^b	<0.01

图1 各指标预测治疗反应的受试者工作特征曲线

图2 联合评分构建的预测模型预测治疗反应的校准曲线

图3 联合评分构建的预测模型预测治疗反应的决策曲线分析曲线分析图

表4 各指标预测治疗反应的受试者工作特征曲线分析结果

指标	曲线下面积	95%CI	最佳截点	敏感度	特异度	P值
PCT	0.691	0.578~0.785	22.50 ng/ml	0.653	0.711	0.017
NT-proBNP	0.772	0.671~0.874	7 920.47 pg/ml	0.758	0.712	0.031
联合评分	0.826	0.732~0.920	0.850	0.815	0.756	0.183
基于联合评分构建的预测模型	0.842	0.752~0.931	0.360	0.852	0.756	－

表4 各指标预测治疗反应的受试者工作特征曲线分析结果

指标	曲线下面积	95%CI	最佳截点	敏感度	特异度	P值
PCT	0.691	0.578~0.785	22.50 ng/ml	0.653	0.711	0.017
NT-proBNP	0.772	0.671~0.874	7 920.47 pg/ml	0.758	0.712	0.031
联合评分	0.826	0.732~0.920	0.850	0.815	0.756	0.183
基于联合评分构建的预测模型	0.842	0.752~0.931	0.360	0.852	0.756	－

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Stratification value of combined scoring of procalcitonin and amino-terminal pro-B-type natriuretic peptide on the efficacy of methylprednisolone combining integrated blood purification in children with severe sepsis

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Stratification value of combined scoring of procalcitonin and amino-terminal pro-B-type natriuretic peptide on the efficacy of methylprednisolone combining integrated blood purification in children with severe sepsis