2026 年第 2 期 第 21 卷

血清补体C3a受体1联合相关评分对脓毒症性凝血病患儿预后的预测价值

Predictive value of serum complement C3a receptor 1 combined with relevant scores for prognosis of children with septic coagulopathy

作者：齐共健1张蕊1胡丹2朱峰1席晓莹1

英文作者：Qi Gongjian1 Zhang Rui1 Hu Dan2 Zhu Feng1 Xi Xiaoying1

单位：1江苏省徐州市儿童医院徐州医科大学附属徐州儿童医院急诊医学科，徐州221000；2江苏省徐州市儿童医院徐州医科大学附属徐州儿童医院重症医学科，徐州221000

英文单位：1Department of Emergency Medicine Xuzhou Children′s Hospital Jiangsu Province Xuzhou Children′s Hospital Affiliated to Xuzhou Medical University Xuzhou 221000 China; 2Intensive Care Unit Xuzhou Children′s Hospital Jiangsu Province Xuzhou Children′s Hospital Affiliated to Xuzhou Medical University Xuzhou 221000 China

关键词：脓毒症性凝血病；补体C3a受体1；国际血栓止血学会-脓毒症性凝血病评分

英文关键词：Septiccoagulopathy;ComplementC3areceptor1;Internationalsocietyonthrombosisandhaemostasis-septiccoagulopathyscore

• 摘要：

• 目的 探讨血清补体C3a受体1（C3AR1）联合国际血栓止血学会-脓毒症性凝血病（ISTH-SIC）评分对脓毒症性凝血病（SIC）患儿预后的预测价值。方法 按照2∶1比例前瞻性选取2021年1月至2025年2月江苏省徐州市儿童医院收治的SIC患儿150例（SIC组）和同期收治的单纯脓毒症患儿75例（单纯脓毒症组）。检测血清C3AR1水平和计算ISTH-SIC评分，Spearman相关性分析方法评估SIC患儿血清C3AR1水平与ISTH-SIC评分的相关性。根据28 d预后将SIC患儿分为死亡组和存活组，多因素Logistic回归方法分析SIC患儿预后的影响因素；受试者工作特征（ROC）曲线分析血清C3AR1联合ISTH-SIC评分对SIC患儿预后的预测价值。结果 SIC组血清C3AR1和ISTH-SIC评分均高于单纯脓毒症组［6.31（4.02,9.13）μg/L比2.38（1.53,3.43）μg/L、5.00（4.00,6.00）分比2.00（1.00,3.00）分］（均P<0.001）。SIC患儿血清C3AR1水平与ISTH-SIC评分呈正相关（rs＝0.728，P＜0.001）。150例SIC患儿入院后28 d死亡52例，即死亡组（52例）、存活组98例，死亡率为34.7%（52/150）。多因素Logistic回归结果显示，国际标准化比值、儿童序贯器官衰竭评估评分、C3AR1、ISTH-SIC评分均为SIC患儿死亡的独立危险因素（均P＜0.05）。ROC曲线分析结果显示，血清C3AR1、ISTH-SIC评分单独及联合预测SIC患儿预后的曲线下面积分别为0.828、0.737、0.903，二者联合预测价值优于血清C3AR1和ISTH-SIC评分（均P＜0.05）。结论 SIC患儿血清C3AR1和ISTH-SIC评分升高与预后不良有关，血清C3AR1联合ISTH-SIC评分对预后不良的预测价值较高。

• Objective To explore the predictive value of serum complement C3a receptor 1 (C3AR1) combined with the international society on thrombosis and haemostasis-septic coagulopathy (ISTH-SIC) score for the prognosis of children with septic coagulopathy (SIC). Methods A total of 150 SIC children (SIC group) and 75 children with simple sepsis (simple sepsis group) admitted to Xuzhou Children′s Hospital, Jiangsu Province from January 2021 to February 2025 were prospectively selected at a ratio of 2∶1. Serum C3AR1 levels were detected and ISTH-SIC scores were calculated. Spearman correlation analysis was used to evaluate the correlation between serum C3AR1 levels and ISTH-SIC scores in SIC children. According to the 28 d prognosis, SIC children were divided into death group and survival group. Multivariate Logistic regression analysis was used to identify the influencing factors of prognosis in SIC children. Receiver operating characteristic (ROC) curve was used to analyze the predictive value of serum C3AR1 combined with ISTH-SIC score for the prognosis of SIC children. Results Serum C3AR1 level and ISTH-SIC score in the SIC group were significantly higher than those in the simple sepsis group ［6.31(4.02, 9.13)μg/L vs 2.38(1.53, 3.43)μg/L, 5.00(4.00, 6.00) vs 2.00(1.00, 3.00), respectively］(both P<0.001). Serum C3AR1 level was positively correlated with ISTH-SIC score in SIC children (rs=0.728, P<0.001). Among the 150 SIC children, 52 died within 28 d after admission (death group, 52 cases) and 98 survived (survival group), with a mortality rate of 34.7%(52/150). Multivariate Logistic regression analysis showed that international normalized ratio, pediatric sequential organ failure assessment score, C3AR1, and ISTH-SIC score were independent risk factors for death in SIC children (all P<0.05). ROC curve analysis revealed that the area under the curve of serum C3AR1 alone, ISTH-SIC score alone, and their combination for predicting the prognosis of SIC children was 0.828, 0.737 and 0.903, respectively. The combined predictive value was superior to that of serum C3AR1 alone or ISTH-SIC score alone (all P<0.05). Conclusion Elevated serum C3AR1 level and ISTH-SIC score are associated with poor prognosis in children with SIC, and the combination of serum C3AR1 and ISTH-SIC score has high predictive value for poor prognosis.