降钙素原测定在幼年特发性关节炎活动及全身性感染中的鉴别意义
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摘要
目的探讨降钙素原测定在幼年特发性关节炎(全身型)活动和全身性感染(脓毒症)中的鉴别诊断意义。方法搜集12名幼年特发性关节炎(全身型)活动和12名全身性感染的患儿资料,双抗体夹心免疫荧光法检测降钙素原值,酶联免疫吸附法检测幼年特发性关节炎患儿中PCT,ESR,CRP的含量,流式细胞术分析T细胞亚群,并记载入院时白细胞计数,中性粒细胞值,比较上述指标在两组患儿中的差别。结果 SO-JIA患儿CD4~+,CD8~+,CD4~+/CD8~+水平与正常对照组及全身性感染患儿相比,差异有显著性意义(P <0. 05),全身性感染(脓毒症)的患儿PCT水平明显高于SO-JIA活动者,差异具有统计学意义(P <0. 01)。而ESR,CRP,WBC,NEUT无明显异常。结论 SO-JIA存在细胞免疫功能紊乱,降钙素原在全身性感染时较其它炎症指标水平明显高于幼年特发性关节炎活动时,不受自身免疫状态的影响,与炎症程度有关,可用于二者的鉴别,指导抗生素的运用。
Objective To evaluate whether the concentration of serum procalcitonin( PCT) will help distinguish sepsis from disease flare in febrile patients with so-juvenile idiopathic arthritis( SO-JIA). Methods Tweleve SO-JIA disease flare and tweleve sepsis patients were involved. PCT was measured by PCT immunoluminometric assay,clusters of differentiation of CD4~+,CD8~+,CD4~+/CD8~+ration were measured by flow cytometry,it was determined in parallel with concentr-ations of C-reactive protein( CRP),erythrocyte sedimentatio rate( ESR),white blood cell count and absolute neutrophil count,Results There were significant difference in SO-JIA patients of CD4~+,CD8~+,CD4~+/CD8~+ration,Serum PCT were significantly higher in group of sepsisthan in the group of JIA flare,ESR,CRP,WBC,NEUT showed no significantly difference. Conclusion There is obvious disorders in the cellular immunity in JIA children,PCT may be a useful marker for the detection of sepsis in children patients with JIA children,and is not disturbed by autoimmunity,which is correlated with the severity of infection,can be used to distinguish between them two and guild the application of antibiotics.
Objective To evaluate whether the concentration of serum procalcitonin( PCT) will help distinguish sepsis from disease flare in febrile patients with so-juvenile idiopathic arthritis( SO-JIA). Methods Tweleve SO-JIA disease flare and tweleve sepsis patients were involved. PCT was measured by PCT immunoluminometric assay,clusters of differentiation of CD4~+,CD8~+,CD4~+/CD8~+ration were measured by flow cytometry,it was determined in parallel with concentr-ations of C-reactive protein( CRP),erythrocyte sedimentatio rate( ESR),white blood cell count and absolute neutrophil count,Results There were significant difference in SO-JIA patients of CD4~+,CD8~+,CD4~+/CD8~+ration,Serum PCT were significantly higher in group of sepsisthan in the group of JIA flare,ESR,CRP,WBC,NEUT showed no significantly difference. Conclusion There is obvious disorders in the cellular immunity in JIA children,PCT may be a useful marker for the detection of sepsis in children patients with JIA children,and is not disturbed by autoimmunity,which is correlated with the severity of infection,can be used to distinguish between them two and guild the application of antibiotics.
引文
[1] Aksentijevich I,Mcdermott MF. Lessons from characterization and treatment of the autoinflammatory syndromes[J]. Current Opinion in Rheumatology,2017,29(2); 187.
[2] Dewoolkar M,Cimaz R,Chickermane PR,et al. Course,outcome and complications in children with systemic onset juvenile idiopathic arthritis[J]. Indian Journal of pediatrics 2017,84(4):294-298.
[3] Singer M,Deutschman CS,Seymour CW,et al. The Third International Consensus Definitions for Sepsis Shock(Sepsis-3)[J]. JAMA,2016,315(8):801-810.
[4] Shankar-Hair M,Philips GS,Levy ML,et al. Developing a new definition and assessing new clinical crite ria for Sepsis and Septic Shock(Sepsis-3)[J]. JAMA,2016,315(8):775-787.
[5] Seymour CW,Liu VX,Iwashyna TJ,et al. Assessment of clinical criteria for sepsis:for the Third International Consensus Definitions for Sepsis and Septic Shock(Sepsis-3)[J]. JAMA,2016,315(8):762-774.
[6] El Maghraoui A. Juvenile idiopathic arthritis[J]. Presse Med,2014,43(1):27-33.
[7] Chang D,Jia,Zang B,et al. Changes in plasma interleukin-33concentration in sepsis and its correlation with seriousness of sepsis[J]. Chin Crit Crit Care Med,2015,27(2):138-142.
[8] Hrget-Rosenthal S,Klein T,Marggraf G,et al. Modulation and source of procalcitonin in reduced renal function and renal replacement therapy[J]. Scand J Immunol 2005; 61(2):180-186.
[9] Andrew J. Lautz,Adam C. Dziorny,Adam R. Denson,et al. Value of Procalcitonin Measurement for Early Evidence of Severe Bacterial Infections in the Pediatric Intensive Care Unit[J]. The Journal of Pediatrics,2016179(2):74.
[10] Oberhoffer M,Stonauns I,Russwurm S,et a1. Procalcitonin expression in human peripheral blood mononuclear cells and its modulation by lipopolysaccharides and sepsis—related cytokines in vitro[J]. J Lab Clin Med 1999,134(1):49-55.
[11] Dandona P,Nix D,Wilson MF,et a1. Procalcitonin Increase after Endotoxin Injection in Normal Subjects[J]. J C1in Endocrinol Metab 1994,79(5):1605-1608.
[12] Tamaki K,Kogata Y,Sugiyama D,et a L. Diagnostic accuracy of serum proealeitonin concentrations for detecting systemic bacterial infection in patients with systemic autoimmune diseases[J]. J Rheumatol,2008,35(1):114-119.
[13] Prelog,M,Schwarzenbrunner,N,Sailer-Hock,M,et al. Premature aging of the immune system in children with juvenile idiopathic arthritis[J]. Arthritis and Rheumatism,2008,58(7):2153-2162.
[14] Hammer S,Meisner F,Dirschedl P,et al. Procalcitonin fordifferential diagnosis of graft rejection and infection in pafients with heart and/or lung grafts[J]. Intensive Care Med,2000,26(2):182-186.
[2] Dewoolkar M,Cimaz R,Chickermane PR,et al. Course,outcome and complications in children with systemic onset juvenile idiopathic arthritis[J]. Indian Journal of pediatrics 2017,84(4):294-298.
[3] Singer M,Deutschman CS,Seymour CW,et al. The Third International Consensus Definitions for Sepsis Shock(Sepsis-3)[J]. JAMA,2016,315(8):801-810.
[4] Shankar-Hair M,Philips GS,Levy ML,et al. Developing a new definition and assessing new clinical crite ria for Sepsis and Septic Shock(Sepsis-3)[J]. JAMA,2016,315(8):775-787.
[5] Seymour CW,Liu VX,Iwashyna TJ,et al. Assessment of clinical criteria for sepsis:for the Third International Consensus Definitions for Sepsis and Septic Shock(Sepsis-3)[J]. JAMA,2016,315(8):762-774.
[6] El Maghraoui A. Juvenile idiopathic arthritis[J]. Presse Med,2014,43(1):27-33.
[7] Chang D,Jia,Zang B,et al. Changes in plasma interleukin-33concentration in sepsis and its correlation with seriousness of sepsis[J]. Chin Crit Crit Care Med,2015,27(2):138-142.
[8] Hrget-Rosenthal S,Klein T,Marggraf G,et al. Modulation and source of procalcitonin in reduced renal function and renal replacement therapy[J]. Scand J Immunol 2005; 61(2):180-186.
[9] Andrew J. Lautz,Adam C. Dziorny,Adam R. Denson,et al. Value of Procalcitonin Measurement for Early Evidence of Severe Bacterial Infections in the Pediatric Intensive Care Unit[J]. The Journal of Pediatrics,2016179(2):74.
[10] Oberhoffer M,Stonauns I,Russwurm S,et a1. Procalcitonin expression in human peripheral blood mononuclear cells and its modulation by lipopolysaccharides and sepsis—related cytokines in vitro[J]. J Lab Clin Med 1999,134(1):49-55.
[11] Dandona P,Nix D,Wilson MF,et a1. Procalcitonin Increase after Endotoxin Injection in Normal Subjects[J]. J C1in Endocrinol Metab 1994,79(5):1605-1608.
[12] Tamaki K,Kogata Y,Sugiyama D,et a L. Diagnostic accuracy of serum proealeitonin concentrations for detecting systemic bacterial infection in patients with systemic autoimmune diseases[J]. J Rheumatol,2008,35(1):114-119.
[13] Prelog,M,Schwarzenbrunner,N,Sailer-Hock,M,et al. Premature aging of the immune system in children with juvenile idiopathic arthritis[J]. Arthritis and Rheumatism,2008,58(7):2153-2162.
[14] Hammer S,Meisner F,Dirschedl P,et al. Procalcitonin fordifferential diagnosis of graft rejection and infection in pafients with heart and/or lung grafts[J]. Intensive Care Med,2000,26(2):182-186.