202例儿童肺炎静脉血C-反应蛋白和降钙素原的变化特点及意义
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摘要
目的观察儿童肺炎时两个炎性指标C-反应蛋白(CRP)、降钙素原(PCT)在不同病原感染时的血液表达水平及变化规律,以指导抗生素的临床应用,减少抗生素滥用。方法回顾性研究2015年1月～2017年9月期间在我院儿科住院治愈的202个肺炎病例,将其分为四组:病毒感染性肺炎组、细菌感染性肺炎组、支原体感染性肺炎组、支原体+病毒感染性肺炎组。收集这些病例的全血CRP、PCT实验室检查数据,去掉CRP、PCT的最大值和最小值,采用SAS 9.4统计学软件进行统计学分析,对比CRP、PCT在四组肺炎的表达水平。结果①病毒感染性肺炎组CRP表达水平最低,同细菌感染性肺炎组、支原体感染性肺炎组、支原体+流感病毒感染性肺炎组比较,差异有统计学意义(P<0.05);其余三组间CRP表达水平无统计学差异。②细菌感染性肺炎组PCT表达水平最高,同病毒感染性肺炎组、支原体感染性肺炎组、支原体+病毒感染性肺炎组比较,差异有统计学意义(P<0.05),其余三组间PCT无统计学差异。③CRP与PCT水平整体具有相关性,相关系数0.34(P<0.001)。结论 PCT作为一个新型炎性指标对于预测细菌感染性肺炎较CRP具有更大的优势。
Objective To observe the blood expression levels and law of change of two inflammatory markers C-reactive protein(CRP) and procalcitonin(PCT) in children with pneumonia when infected with different pathogens, to guide the application of antibiotics and reduce the abuse of antibiotics. Methods 202 pneumonia cases cured in the department of pediatrics in our hospital from January 2015 to September 2017 were retrospectively analyzed. The patients were divided into four groups: Viral infectious pneumonia group, bacterial infectious pneumonia group, mycoplasma infectious pneumonia group and mycoplasma + viral infectious pneumonia.The whole blood CRP and PCT laboratory data of these cases were collected, and the maximum and minimum values of CRP and PCT were removed. Statistical analysis was performed using SAS 9.4 statistical software. The expression levels of CRP and PCT in four groups of pneumonia were compared. Results ①The expression level of CRP in the virus-infected pneumonia group was the lowest, which was statistically different from that in the bacterial infection pneumonia group, the mycoplasma infectious pneumonia group, the mycoplasma + influenza virus infectious pneumonia group(P<0.05). There was no significant difference in CRP expression between the other three groups. There was no statistical difference in levels. ②The expression level of PCT was the highest in the bacterial infection pneumonia group, which was statistically different from that of the viral infection pneumonia group,the mycoplasma infectious pneumonia group, the mycoplasma +virus infection pneumonia group(P<0.05), and the PCT was not statistically different among the other three groups. ③CRP and PCT levels were correlated as a whole with a correlation coefficient of 0.34(P<0.001). Conclusion PCT as a new inflammatory indicator has a greater advantage than CRP in predicting bacterial infectious pneumonia.
Objective To observe the blood expression levels and law of change of two inflammatory markers C-reactive protein(CRP) and procalcitonin(PCT) in children with pneumonia when infected with different pathogens, to guide the application of antibiotics and reduce the abuse of antibiotics. Methods 202 pneumonia cases cured in the department of pediatrics in our hospital from January 2015 to September 2017 were retrospectively analyzed. The patients were divided into four groups: Viral infectious pneumonia group, bacterial infectious pneumonia group, mycoplasma infectious pneumonia group and mycoplasma + viral infectious pneumonia.The whole blood CRP and PCT laboratory data of these cases were collected, and the maximum and minimum values of CRP and PCT were removed. Statistical analysis was performed using SAS 9.4 statistical software. The expression levels of CRP and PCT in four groups of pneumonia were compared. Results ①The expression level of CRP in the virus-infected pneumonia group was the lowest, which was statistically different from that in the bacterial infection pneumonia group, the mycoplasma infectious pneumonia group, the mycoplasma + influenza virus infectious pneumonia group(P<0.05). There was no significant difference in CRP expression between the other three groups. There was no statistical difference in levels. ②The expression level of PCT was the highest in the bacterial infection pneumonia group, which was statistically different from that of the viral infection pneumonia group,the mycoplasma infectious pneumonia group, the mycoplasma +virus infection pneumonia group(P<0.05), and the PCT was not statistically different among the other three groups. ③CRP and PCT levels were correlated as a whole with a correlation coefficient of 0.34(P<0.001). Conclusion PCT as a new inflammatory indicator has a greater advantage than CRP in predicting bacterial infectious pneumonia.
引文
[1]王雪峰,姜之炎,刘芳,等.小儿肺炎840例常见病原分析[J].中国实用儿科杂志,2005,20(4):239-241.
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[3]Pasquale Di Pietro,Ornella Della Casa Alberighi,Michela Silvestri,et al.Monitoring adherence to guidelines of antibiotic use in pediatric pneumonia:The MAREA study[J].Italian Journal of Pediatrics,2017,43(1):113-125.
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[7]Filiz Bilir1,Nermin Akdemir1,Selcuk Ozden1,et al.Increased serum procalcitonin levels in pregnant patients with asymptomatic bacteriuria[J].Annals of Clinical Microbiology and Antimicrobials,2013,12(1):25-29.
[8]Kenneth L,Becker,Richard Snider and Eric S,Nylen.Procalcitonin in sepsis and systemic inflammation:A harmful biomarker and a therapeutic target[J].British Journal of Pharmacology,2010,159(2):253-264.
[9]苏青弟,严如金,魏金芬,等.小儿细菌性肺炎临床特征及白细胞计数、血清C反应蛋白和降钙素原水平变化[J].中国基层医药,2017,24(21):3322-3326.
[10]Mona Bafadhel,MBCh B,Tristan W.Clark,et al.Procalcitonin and C-reactive protein in hospitalized adult patients with community-acquired pneumonia or exacerbation of asthma or COPD[J].CHEST,2011,139(6):1410-1418.
[11]Philipp Schuetz,Matthias Briel,Mirjam Christ-Crain,et al.Procalcitonin to guide initiation and duration of antibiotic treatment in acute respiratory infections:An individual patient data meta-analysis[J].Clinical Infectious Diseases,2012,55(5):651-662.
[12]林泽鸿,蔡晓莹,林广裕,等.降钙素原在儿童非细菌感染性疾病诊断中的意义[J].中华儿科杂志,2017,55(11):873-876.
[13]Philipp Schuetz,Werner Albrich,Beat Mueller.Procalcitonin for diagnosis of infection and guide to antibiotic decisions:Past,present and future[J].BMC Medicine,2011,9(1):107-115.
[14]Carolina Panico,Eric Nylen.Procalcitonin beyond the acute phase:Novel biomediator properties?[J].Panico and Nylen BMC Medicine 2013,11(1):189-192.
[15]中华医学会儿科学分会呼吸学组,《中华实用儿科临床杂志》编辑委员会.儿童肺炎支原体肺炎诊治专家共识(2015年版)[J].中华实用儿科临床杂志,2015,30(17):1304-1308.
[2]Phuong,Tran T.Hoang,Pham H.Van,et al.Encouraging rational antibiotic use in childhood pneumonia:A focus on Vietnam and the western pacific region[J].Pneumonia,2017,9(1):7-15.
[3]Pasquale Di Pietro,Ornella Della Casa Alberighi,Michela Silvestri,et al.Monitoring adherence to guidelines of antibiotic use in pediatric pneumonia:The MAREA study[J].Italian Journal of Pediatrics,2017,43(1):113-125.
[4]Ramon Sager,Alexander Kutz,Beat Mueller,et al.Procalcitonin-guided diagnosis and antibiotic stewardship revisited[J].BMC Medicine,2017,15(1):15-25.
[5]江载芳,申昆玲,沈颖.褚福棠实用儿科学(上册)[M].第8版.北京:人民卫生出版社,2015:1253-1288.
[6]郭玮,何煜婷,邵琦,等.联合血降钙素原、脑钠肽、D-二聚体及PCIS评分对评估儿童重症肺炎预后的价值[J].临床儿科杂志,2017,35(8):575-579.
[7]Filiz Bilir1,Nermin Akdemir1,Selcuk Ozden1,et al.Increased serum procalcitonin levels in pregnant patients with asymptomatic bacteriuria[J].Annals of Clinical Microbiology and Antimicrobials,2013,12(1):25-29.
[8]Kenneth L,Becker,Richard Snider and Eric S,Nylen.Procalcitonin in sepsis and systemic inflammation:A harmful biomarker and a therapeutic target[J].British Journal of Pharmacology,2010,159(2):253-264.
[9]苏青弟,严如金,魏金芬,等.小儿细菌性肺炎临床特征及白细胞计数、血清C反应蛋白和降钙素原水平变化[J].中国基层医药,2017,24(21):3322-3326.
[10]Mona Bafadhel,MBCh B,Tristan W.Clark,et al.Procalcitonin and C-reactive protein in hospitalized adult patients with community-acquired pneumonia or exacerbation of asthma or COPD[J].CHEST,2011,139(6):1410-1418.
[11]Philipp Schuetz,Matthias Briel,Mirjam Christ-Crain,et al.Procalcitonin to guide initiation and duration of antibiotic treatment in acute respiratory infections:An individual patient data meta-analysis[J].Clinical Infectious Diseases,2012,55(5):651-662.
[12]林泽鸿,蔡晓莹,林广裕,等.降钙素原在儿童非细菌感染性疾病诊断中的意义[J].中华儿科杂志,2017,55(11):873-876.
[13]Philipp Schuetz,Werner Albrich,Beat Mueller.Procalcitonin for diagnosis of infection and guide to antibiotic decisions:Past,present and future[J].BMC Medicine,2011,9(1):107-115.
[14]Carolina Panico,Eric Nylen.Procalcitonin beyond the acute phase:Novel biomediator properties?[J].Panico and Nylen BMC Medicine 2013,11(1):189-192.
[15]中华医学会儿科学分会呼吸学组,《中华实用儿科临床杂志》编辑委员会.儿童肺炎支原体肺炎诊治专家共识(2015年版)[J].中华实用儿科临床杂志,2015,30(17):1304-1308.