【摘要】 目的 观察先天性心脏病（先心病）患儿体外循环术后早期血清肝素结合蛋白水平变化情况，并探讨其对术后感染的评估价值。方法 选取本院收治的拟行体外循环术治疗的先心病患儿205例，均于术前及术后12 h、24 h、48 h、72 h、7 d采用双抗夹心酶联免疫吸附试验检测血清肝素结合蛋白水平。根据先心病患儿体外循环术后感染发生情况，将其分为感染组与未感染组，对比2组术后12 h、24 h、48 h、72 h血清肝素结合蛋白水平；绘制受试者工作特征（ROC）曲线，采用曲线下面积（AUC）评价术后48 h血清肝素结合蛋白水平对先心病患儿体外循环术后感染的评估价值，并与降钙素原、白细胞计数、C反应蛋白的评估效能进行对比。结果 先心病患儿术后12 h、24 h、48 h、72 h、7 d血清肝素结合蛋白水平均高于术前（P<0.05），术后24 h、48 h、72 h均高于术后12 h(P<0.05)，术后7 d低于术后12 h(P<0.05)，术后48 h与术后24 h比较差异无统计学意义（P> 0.05），术后72 h、7 d均低于术后24 h、48 h(P<0.05)，术后7 d低于术后72 h(P<0.05)。术后感染发生率为9.76%；感染组术后48 h、72 h血清肝素结合蛋白水平均高于未感染组（P<0.05）。术后48 h血清肝素结合蛋白水平评估先心病患儿体外循环术后感染发生情况的灵敏度、特异度、AUC分别为85.00%、92.43%、0.909，与降钙素原评估的灵敏度、特异度、AUC比较，差异均无统计学意义（P> 0.05），特异度高于白细胞计数、C反应蛋白（P<0.05）。结论 先心病患儿体外循环术后血清肝素结合蛋白水平较术前升高，但随着时间的推移逐渐降低，且术后发生感染的患儿术后48 h、72 h血清肝素结合蛋白水平均高于未发生感染者，动态监测术后早期血清肝素结合蛋白水平的变化情况对评估术后感染的发生和防控具有重要临床价值。更多还原

【Abstract】 Objective To observe the early changes of serum heparin binding protein level in children with congenital heart disease(CHD) after cardiopulmonary bypass and to explore its value in evaluating postoperative infection.Methods A total of 205 children with congenital heart disease who were admitted to our hospital for cardiopulmonary bypass were selected. The levels of serum heparin binding protein were detected by double-antibody sandwich enzyme-linked immunosorbent assay before operation and 12 hours,24 hours,48 hours,72 hours and 7 days after operation. According to the incidence of infection after cardiopulmonary bypass,these children were divided into the infected group and the uninfected group,and the serum heparin binding protein levels of the two groups were compared at 12 hours,24 hours,48 hours,72 hours after operation. Thereceiver operating characteristic(ROC) curve was drawn,and thearea under the curve(AUC) was used to analyze the value of serum heparin binding protein level at 48 hours after operation in evaluating the infection after cardiopulmonary bypass for children with congenital heart disease. And the evaluation efficiency were compared with the evaluation efficiency of procalcitonin,white blood cell count and C-reactive protein.Results The levels of serum heparin binding protein in children with congenital heart disease at 12 hours,24 hours,48 hours,72 hours and 7 days after operation were higher than that before operation(P< 0. 05);the levels at 24 hours,48 hours,72 hours after operation were higher than that at 12 hours after operation(P< 0. 05);the levels at 7 days after operation was lower than that at 12 hours after operation(P< 0. 05);but there was no significant difference between 48 hours and 24 hours after operation(P> 0. 05);the levels at 72 hours and 7 days after operation were lower than those at 24 hours and 48 hours after operation(P< 0. 05);the levels at 7 days after operation were lower than that at 72 hours after operation(P< 0. 05). The incidence of postoperative infection was9. 76%. The levels of serum heparin binding protein at 48 hours and 72 hours after operation in the infected group were higher than those in the uninfected group(P< 0. 05). The sensitivity,specificity andAUCof serum heparin binding protein level at 48 hours after operation in evaluating the incidence of infection after cardiopulmonary bypass in children with congenital heart disease were 85. 00%,92. 43% and0. 909,respectively. There was no significant difference in the sensitivity,specificity andAUCbetween serum heparin binding protein and procalcitonin evaluation(P> 0. 05);but the specificity of serum heparin binding protein was higher than that of white blood cell count and C-reactive protein evaluation(P< 0. 05).Conclusion The level of serum heparin binding protein in children with congenital heart disease after cardiopulmonary bypass is higher than that before operation,but it gradually decreases with the passage of time,and the levels of serum heparin binding protein at 48 hours and 72 hours after operation in children with postoperative infection are higher than those in children without postoperative infection. Dynamic monitoring of the changes of serum heparin binding protein level in the early stage after operation has important clinical value in evaluating the occurrence and prevention of postoperative infection.更多还原