粪钙卫蛋白含量在预测和评估病毒性腹泻患儿严重程度的临床价值分析
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摘要
[目的]探讨粪钙卫蛋白的含量在预测和评估儿童病毒性腹泻临床诊断过程中的应用价值。[方法]纳入年龄为3个月～10岁的病毒性腹泻患者,每名患者收集2～3份粪便标本。通过酶联免疫吸附测定法测定粪钙卫蛋白水平,同时对患者的粪便标本进行病原体和疾病活性的比较。通过利用单变量线性回归分析法和广义估计方程(GEE)分析粪钙卫蛋白的含量与临床参数之间的相关性。[结果]本研究针对50为患者进行了150次评估。结果,轮状病毒感染患者的粪钙卫蛋白含量为89(11～426)mg/g。与之相比,诺如病毒感染患者和腺病毒感染患者的粪便钙卫蛋白水平较高,分别为93(25～405)mg/g和95(65～224)mg/g。重度病毒性腹泻患者843(284～1246)mg/g或中度病毒性腹泻患者402(71～995)mg/g也均具有较高含量的粪钙卫蛋白(P<0.05)。同时,GEE分析表明粪钙卫蛋白的含量与病毒性腹泻严重程度具有相关性,并可作为病毒性腹泻的临床诊断疾依据。[结论]病毒感染以及疾病严重程度的增加都会不同程度的促使粪钙卫蛋白水平的升高,并且粪钙卫蛋白水平与临床严重程度相关。粪钙卫蛋白可为用标志物用于儿童病毒性腹泻的临床诊断。
[Objective]To explore the diagnostic value of fecal calprotectin in predicting bacterial/viral diarrhea and the application of fecal calprotectin in the clinical course of infectious diarrhea.Methods:Patients ages from 3 months to 10 years with infectious diarrhea were enrolled,and from each patient,2 to 3 stool samples were collected.Fecal calprotectin levels were determined by enzyme-linked immunosorbent assay and compared by pathogen and disease activity.A univariate linear regression was used to determine the correlation between fecal calprotectin and the clinical parameters,and generalized estimating equations(GEEs)were used for the time course analyses.[Results]This study included 150 evaluations for 50 individuals across 3 different time points.The fecal calprotectin level was higher in patients with norovirus infection[93(25～405)mg/g],or adenovirus infection[95(65～224)mg/g]than that in patients with rotavirusinfection[89(11～426)mg/g].Fecal calprotectin concentrations were elevated in patients with severe[843(284～1246)mg/g]or moderate[402(71～995)mg/g]disease activity compared with those with mild[87(11～438)mg/g]disease activity(P<0.05).GEE analysis suggested that fecal calprotectin was correlated with clinical severity(eg,Vesikari score)and might provide information for disease management.[Conclusion]Fecal calprotectin level was increased during viral infection and as disease severity increased,and its levels on the initial evaluation and follow-up visit are correlated with clinical severity.Fecal calprotectin may be a useful marker for application in children with infectious diarrhea.
[Objective]To explore the diagnostic value of fecal calprotectin in predicting bacterial/viral diarrhea and the application of fecal calprotectin in the clinical course of infectious diarrhea.Methods:Patients ages from 3 months to 10 years with infectious diarrhea were enrolled,and from each patient,2 to 3 stool samples were collected.Fecal calprotectin levels were determined by enzyme-linked immunosorbent assay and compared by pathogen and disease activity.A univariate linear regression was used to determine the correlation between fecal calprotectin and the clinical parameters,and generalized estimating equations(GEEs)were used for the time course analyses.[Results]This study included 150 evaluations for 50 individuals across 3 different time points.The fecal calprotectin level was higher in patients with norovirus infection[93(25～405)mg/g],or adenovirus infection[95(65～224)mg/g]than that in patients with rotavirusinfection[89(11～426)mg/g].Fecal calprotectin concentrations were elevated in patients with severe[843(284～1246)mg/g]or moderate[402(71～995)mg/g]disease activity compared with those with mild[87(11～438)mg/g]disease activity(P<0.05).GEE analysis suggested that fecal calprotectin was correlated with clinical severity(eg,Vesikari score)and might provide information for disease management.[Conclusion]Fecal calprotectin level was increased during viral infection and as disease severity increased,and its levels on the initial evaluation and follow-up visit are correlated with clinical severity.Fecal calprotectin may be a useful marker for application in children with infectious diarrhea.
引文
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[3]许秀珍,王可,吴素蓉.276例婴幼儿腹泻病例轮状病毒抗原检测[J].黑龙江医学,2012,36(12):899-900.
[4]曾玫,陈洁,龚四堂,等.我国五所城市儿童医院诺如病毒和轮状病毒腹泻的流行病学监测[J].中华儿科杂志,2010,48(8):564-570.
[5]施前锋,潘新娣,邵伟芳,等.124例小儿病毒性腹泻的病原体分布特征分析[J].中国妇幼保健,2014,29(14):2178-2180.
[6]王瀚炜,王镜泉,陈敏红,等.福州市首起沙波病毒急性胃肠炎聚集性疫情调查[J].海峡预防医学杂志,2018,24(1):86-88.
[7]李刚,李玉林.钙卫蛋白与临床疾病的关系[J].实用医学杂志,2007,23(15):2437-2439.
[8]韩玮,许建明.钙卫蛋白、乳铁蛋白在溃疡性结肠炎患者中表达的临床研究[J].胃肠病学,2010,15(4):209-213.
[9]袁一铭,李翀.钙卫蛋白在炎症疾病中的研究进展[J].医药卫生:文摘版,2016(6):280,303.
[10]向军英,欧阳钦.钙卫蛋白在炎症性肠病中的作用研究进展[J].国际消化病杂志,2005,25(6):346-348.
[11]吕辉,郝世勇,严能斌,等.粪钙卫蛋白在炎症性肠病、肠易激综合征和大肠癌鉴别诊断中的意义[J].国际检验医学杂志,2012,33(21):2651-2652.
[12]麻婧,吴开春.粪钙卫蛋白在炎症性肠病应用中的优势探讨[J].胃肠病学和肝病学杂志,2016,25(2):231-234.
[13] Ruuska T,Vesikari T.Rotavirus disease in Finnish children:use of numerical scores for clinical severity of diarrhoeal episodes[J].Scand J Infect Dis,1990,22(3):259-267.
[14]Palimood A B,Mathan M M,MathanV I.Quantitative and ultrastructural analysis of rectal mucosal mast cells in acute infective diarrhea[J].Dig Dis Sci,1998,43(9):2111-2166.
[15]邱骅婧,刘占举.肠道细菌感染与炎症性肠病的关系[J].同济大学学报(医学版),2014,35(4):67-70.
[16]许晓红,范慧子,张志程,等.儿童细菌性腹泻病的病原菌分布及耐药性分析[J].现代生物医学进展,2014,14(7):1331-1335.
[17]胡芬芳,程智涛,田翔,等.粪钙卫蛋白在IBS与IBD鉴别诊断中的意义[J].四川医学,2011,32(11):1152-1155.
[18]Rugtveit J,Fagerhol M K.Age dependent variations in fecalcal protect in concentrations in children[J].J Pediatr Gastroenterol Nutr,2002,34(3):323-324.
[19]赵振,潘晓平,张俊辉.广义估计方程在纵向资料中的应用[J].现代预防医学,2006,33(5):707-708.
[2]任敏,李莉.病毒性腹泻研究概况[J].现代预防医学,2009,36(1):152-154.
[3]许秀珍,王可,吴素蓉.276例婴幼儿腹泻病例轮状病毒抗原检测[J].黑龙江医学,2012,36(12):899-900.
[4]曾玫,陈洁,龚四堂,等.我国五所城市儿童医院诺如病毒和轮状病毒腹泻的流行病学监测[J].中华儿科杂志,2010,48(8):564-570.
[5]施前锋,潘新娣,邵伟芳,等.124例小儿病毒性腹泻的病原体分布特征分析[J].中国妇幼保健,2014,29(14):2178-2180.
[6]王瀚炜,王镜泉,陈敏红,等.福州市首起沙波病毒急性胃肠炎聚集性疫情调查[J].海峡预防医学杂志,2018,24(1):86-88.
[7]李刚,李玉林.钙卫蛋白与临床疾病的关系[J].实用医学杂志,2007,23(15):2437-2439.
[8]韩玮,许建明.钙卫蛋白、乳铁蛋白在溃疡性结肠炎患者中表达的临床研究[J].胃肠病学,2010,15(4):209-213.
[9]袁一铭,李翀.钙卫蛋白在炎症疾病中的研究进展[J].医药卫生:文摘版,2016(6):280,303.
[10]向军英,欧阳钦.钙卫蛋白在炎症性肠病中的作用研究进展[J].国际消化病杂志,2005,25(6):346-348.
[11]吕辉,郝世勇,严能斌,等.粪钙卫蛋白在炎症性肠病、肠易激综合征和大肠癌鉴别诊断中的意义[J].国际检验医学杂志,2012,33(21):2651-2652.
[12]麻婧,吴开春.粪钙卫蛋白在炎症性肠病应用中的优势探讨[J].胃肠病学和肝病学杂志,2016,25(2):231-234.
[13] Ruuska T,Vesikari T.Rotavirus disease in Finnish children:use of numerical scores for clinical severity of diarrhoeal episodes[J].Scand J Infect Dis,1990,22(3):259-267.
[14]Palimood A B,Mathan M M,MathanV I.Quantitative and ultrastructural analysis of rectal mucosal mast cells in acute infective diarrhea[J].Dig Dis Sci,1998,43(9):2111-2166.
[15]邱骅婧,刘占举.肠道细菌感染与炎症性肠病的关系[J].同济大学学报(医学版),2014,35(4):67-70.
[16]许晓红,范慧子,张志程,等.儿童细菌性腹泻病的病原菌分布及耐药性分析[J].现代生物医学进展,2014,14(7):1331-1335.
[17]胡芬芳,程智涛,田翔,等.粪钙卫蛋白在IBS与IBD鉴别诊断中的意义[J].四川医学,2011,32(11):1152-1155.
[18]Rugtveit J,Fagerhol M K.Age dependent variations in fecalcal protect in concentrations in children[J].J Pediatr Gastroenterol Nutr,2002,34(3):323-324.
[19]赵振,潘晓平,张俊辉.广义估计方程在纵向资料中的应用[J].现代预防医学,2006,33(5):707-708.