外周血CRP和PCT检测对小儿脓毒症的早期诊断价值
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摘要
目的研究检测外周血中C-反应蛋白(CRP)和血清降钙素原(PCT)对小儿脓毒症患者早期诊断的意义。方法将310例感染患儿按临床表现分为脓毒症组(160例)和局部感染组(150例)。采用全自动免疫和生化分析仪检测2组患儿外周血CRP及PCT水平并比较其差异及治疗后改变。以白细胞计数(WBC)为对照,通过受试者工作特征曲线(ROC)评估CRP和PCT在小儿脓毒症患者中的早期诊断价值。结果脓毒症组患儿外周血中CRP及PCT水平明显高于局部感染组(P <0. 05)。给予相应治疗后,脓毒症组患儿外周血CRP及PCT水平均较治疗前显著降低(P <0. 05)。ROC曲线分析显示,以10 ng/mL作为PCT水平临界值时,其早期诊断小儿脓毒症患者的敏感度和特异性分别为88. 3%及87. 7%,而曲线下面积(AUC)为0. 833(95%CI为0. 756～0. 918);以45. 5 mg/L作为CRP水平临界值时,其早期诊断小儿脓毒症患者的敏感度和特异性分别为82. 6%及81. 3%,AUC为0. 725(95%CI为0. 728～0. 914),均显著高于WBC。结论检测患儿外周血CRP和PCT水平可作为早期诊断小儿脓毒症的有效指标,具有一定的临床应用价值。
Objective To study the early diagnosis value of CRP and PCT levels in peripheral blood in pediatric sepsis.Methods Anumber of 310 infected children were divided into the pediatric sepsis group( n = 160) and local infection group( n = 150)according to the clinical manifestations. The CRP and PCT levels in peripheral blood were measured by the electrochemical luminescence method and immuneturbidimetric test,respectively. The diagnostic value of these indexes on pediatric sepsis were evaluated by the ROC curve. Results The CRP and PCT levels in pediatric sepsis group were significantly higher than those in local infection group( P <0. 05). After system standard treatment,the CRP and PCT levels decreased significantly compared with the pre-treatment levels( P <0. 05). The ROC curve analysis showed that when PCT levels( 10μg/L) considered as the boundary for early diagnosis of pediatric sepsis,the sensitivity and specificity of diagnosis for pediatric sepsis were 88. 3% and 87. 7%,and the area under the ROC curve( AUC)was 0. 833( 95% CI,0. 756 ～ 0. 918). When CRP levels( 45. 5 mg/L) considered as the boundary for early diagnosis of pediatric sepsis,the sensitivity and specificity of diagnosis for pediatric sepsis were 82. 6% and 81. 3%,and the area under the ROC curve( AUC) was0. 725( 95% CI,0. 728 ～ 0. 914). The levels of PCT and CRP were significantly better than WBC level. Conclusion The levels of CRP and PCT are higher in pediatric sepsis,which can be used as an effective indicator for early diagnosis of pediatric sepsis,and it has an important clinical application value.
Objective To study the early diagnosis value of CRP and PCT levels in peripheral blood in pediatric sepsis.Methods Anumber of 310 infected children were divided into the pediatric sepsis group( n = 160) and local infection group( n = 150)according to the clinical manifestations. The CRP and PCT levels in peripheral blood were measured by the electrochemical luminescence method and immuneturbidimetric test,respectively. The diagnostic value of these indexes on pediatric sepsis were evaluated by the ROC curve. Results The CRP and PCT levels in pediatric sepsis group were significantly higher than those in local infection group( P <0. 05). After system standard treatment,the CRP and PCT levels decreased significantly compared with the pre-treatment levels( P <0. 05). The ROC curve analysis showed that when PCT levels( 10μg/L) considered as the boundary for early diagnosis of pediatric sepsis,the sensitivity and specificity of diagnosis for pediatric sepsis were 88. 3% and 87. 7%,and the area under the ROC curve( AUC)was 0. 833( 95% CI,0. 756 ～ 0. 918). When CRP levels( 45. 5 mg/L) considered as the boundary for early diagnosis of pediatric sepsis,the sensitivity and specificity of diagnosis for pediatric sepsis were 82. 6% and 81. 3%,and the area under the ROC curve( AUC) was0. 725( 95% CI,0. 728 ～ 0. 914). The levels of PCT and CRP were significantly better than WBC level. Conclusion The levels of CRP and PCT are higher in pediatric sepsis,which can be used as an effective indicator for early diagnosis of pediatric sepsis,and it has an important clinical application value.
引文
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[12]余燕红,陈影,梁燕芬.降钙素原在脓毒血症患儿早期预后预测中的应用价值[J].中国医药导报,2014,11(8):44-47.
[13] Shabaan AE,Elbaz LM,El-Emshaty WM,et al. Role of serum 1,3β-d-glucan assay in early diagnosis of invasive fungal infections in a neonatal intensive care unit[J]. Jornal de Pediatria,2017(17):30353-30358.
[14]蒋贤高,汪晓波,王仁数.脓毒血症患者监测血清降钙素原、C反应蛋白的临床意义[J].中国呼吸与危重监护杂志,2009,8(5):429-431.
[15]伍方红,许得泽,韦继政,等.降钙素原及C反应蛋白检测在术后重度脓毒血症患者预后判断中的意义[J].广东医学,2013,34(9):1369-1371.
[2] Dellinger RP,Levy MM,Carlet JM,et al. Surviving sepsis campaign:international guidelines for management of severe sepsis and septic shock:2008[J]. Intensive Care Medicine,2008,34(1):17-60.
[3] Dondorp AM,Haniffa R. Critical care and severe sepsis in resource poor settings[J]. Transactions of the Royal Society of Tropical Medicine and Hygiene,2014,108(8):453-454.
[4] Reinhart K,Bauer M,Riedemann NC,et al. New approaches to sepsis:molecular diagnostics and biomarkers[J]. Clinical Microbiology Reviews,2012,25(4):609-634.
[5] Schuetz P. Procalcitonin and other biomarkers to improve assessment,antibiotic stewardship in infections-hope for hype[J]. Swiss Med Wkly,2009,139(23/24):318-326.
[6] Jonsson N,Nilsen T,Gille-Johnson P,et al. Calprotectin as an early biomarker of bacterial infections in critically ill patients:an exploratory cohort assessment[J]. Critical Care and Resuscitation:Journal of the Australasian Academy of Critical Care Medicine,2017,19(3):205-213.
[7] Ljungstrm L,Pernestig AK,Jacobsson G,et al. Diagnostic accuracy of procalcitonin,neutrophil-lymphocyte count ratio,C-reactive protein,and lactate in patients with suspected bacterial sepsis[J].PLOS One,2017,12(7):0181704.
[8]俞慧,曾元临,周从阳. Presepsin在脓毒症诊断中的研究进展[J].中华危重病急救医学,2017,29(8):756-759.
[9] Sharma D,Farahbakhsh N,Shastri S,et al. Biomarkers for diagnosis of neonatal sepsis:a literature review[J]. The Journal of Maternalfetal&Neonatal Medicine,2017,31(12):1-14.
[10] Lanziotti VS,Póvoa P,Prata-Barbosa A,et al. Patterns of C-reactive protein ratio response to antibiotics in pediatric sepsis:A prospective cohort study[J]. Journal of Critical Care,2018,44:217-222.
[11] Limper M,De Kruif MD,Duits AJ,et al. The diagnostic role of procalcitonin and other biomarkers in discriminating infectious from non-infectious fever[J]. The Journal of Infection,2010,60(6):409-416.
[12]余燕红,陈影,梁燕芬.降钙素原在脓毒血症患儿早期预后预测中的应用价值[J].中国医药导报,2014,11(8):44-47.
[13] Shabaan AE,Elbaz LM,El-Emshaty WM,et al. Role of serum 1,3β-d-glucan assay in early diagnosis of invasive fungal infections in a neonatal intensive care unit[J]. Jornal de Pediatria,2017(17):30353-30358.
[14]蒋贤高,汪晓波,王仁数.脓毒血症患者监测血清降钙素原、C反应蛋白的临床意义[J].中国呼吸与危重监护杂志,2009,8(5):429-431.
[15]伍方红,许得泽,韦继政,等.降钙素原及C反应蛋白检测在术后重度脓毒血症患者预后判断中的意义[J].广东医学,2013,34(9):1369-1371.