摘要
目的探讨不同病原体类型重症肺炎(SP)患儿血清白细胞介素-6(IL-6)、降钙素原(PCT)、C反应蛋白(CRP)、红细胞沉降率(ESR)水平变化,分析其对病原体类型的鉴别诊断价值及与病情程度的相关性。方法选取2022年1—10月收治的SP患儿60例作为重症组,轻症肺炎患儿40例作为轻症组,体检健康儿童40例作为对照组。对比重症组、轻症组入院当日及入院第3、5、7日和对照组体检当日血清IL-6、PCT、CRP、ESR水平。对比重症组不同病原体类型患儿入院当日及入院第3、5、7日血清IL-6、PCT、CRP、ESR水平和急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、临床肺部感染评分(CPIS)。评价各血清指标对SP患儿病原体类型的鉴别诊断价值及与APACHEⅡ、CPIS评分的相关性。结果重症组入院当日及入院第3、5、7日血清IL-6、PCT、CRP、ESR水平高于轻症组同时间、对照组体检当日,且轻症组入院当日及入院第3、5、7日上述指标水平高于对照组体检当日(P<0.05)。入院当日及入院第3、5、7日重症组细菌感染患儿血清IL-6、PCT、CRP、ESR水平>支原体感染患儿>病毒感染患儿(P<0.05);血清IL-6、PCT、CRP、ESR联合诊断SP细菌感染、鉴别支原体感染与病毒感染的曲线下面积分别为0.908、0.936,均大于各血清指标单一诊断;入院当日及入院第3、5、7日重症组细菌感染患儿APACHEⅡ、CPIS评分>支原体感染患儿>病毒感染患儿(P<0.05);Pearson相关性分析显示,SP患儿入院当日及入院第3、5、7日血清IL-6、PCT、CRP、ESR与APACHEⅡ、CPIS评分呈正相关(P<0.01)。结论SP患儿血清IL-6、PCT、CRP、ESR水平升高,且与感染病原体类型、病情程度呈正相关,联合检测对SP病原体类型具有一定鉴别诊断价值。
Objective To investigate the changes of serum levels of interleukin-6(IL-6),procalcitonin(PCT),C reactive protein(CRP)and erythrocyte sedimentation rate(ESR)in children with severe pneumonia(SP)of different pathogen types,and to analyze their value in the differential diagnosis of pathogen types and their correlation with the severity of the disease.Methods From January to October 2022,60 children with severe pneumonia were selected as the severe group,40 children with mild pneumonia as the mild group,and 40 healthy children undergoing physical examination were selected as the control group.Serum levels of IL-6,PCT,CRP and ESR in the severe and mild groups were compared on admission day,at the 3rd,5th and 7th day after admission,and on the day of physical examination in the control group.The serum levels of IL-6,PCT,CRP and ESR,Acute Physiology and Chronic Health Status Score SystemⅡ(APACHEⅡ)and clinical pulmonary infection score(CPIS)were compared on admission day and at the 3rd,5th and 7th day after admission in the severe group with different pathogen types.The value of serum indexes in the differential diagnosis of pathogen types in children with SP and their correlation with APACHEⅡand CPIS scores were evaluated.Results The levels of IL-6,PCT,CRP and ESR in the severe group were higher than those in the mild group on admission day and at the 3rd,5th and 7th day after admission and in the control group on the day of physical examination,and the levels were higher in the mild group on admission day and the 3rd,5th and 7th day after admission than in the control group in the day of physical examination(P<0.05).The serum levels of IL-6,PCT,CRP and ESR of the children with bacterial infection were higher than those of the children with mycoplasma infection and higher than those of the children with viral infection(P<0.05)on admission day and at the 3rd,5th and 7th day after admission.The area under the receiver operating characteristic(ROC)curve(AUC)of serum IL-6,PCT,CRP and ESR in combination for the diagnosis of SP bacterial infection and in the differentiation of mycoplasma and viral infection were 0.908 and 0.936,respectively,which were higher than the single diagnosis of each serum index.On admission day and at the 3rd,5th and 7th day after admission,the APACHEⅡand CPIS scores of the children with bacterial infection in the severe group were higher than those with mycoplasma infection and those with viral infection(P<0.05).Pearson correlation analysis showed that serum levels of IL-6,PCT,CRP and ESR were positively correlated with APACHEⅡand CPIS scores on the day of admission and on the 3rd,5th and 7th day of admission(P<0.01).Conclusion The serum levels of IL-6,PCT,CRP and ESR in children with SP are increased,which are positively correlated with the type of infectious pathogen and the severity of the disease.Combined detection has certain value in the differential diagnosis of the type of SP pathogen.
作者
张若男
关薇
刘连凤
田滑华
牛琳
ZHANG Ruonan;GUAN Wei;LIU Lianfeng;TIAN Huahua;NIU Lin(Department of Pediatrics,Shijiazhuang Maternal and Child Health Hospital,Shijiazhuang 050000,China;Department of Cardiology,the Second Hospital of Shijiazhuang City,Shijiazhuang 050000,China)
出处
《临床误诊误治》
CAS
2023年第3期83-89,共7页
Clinical Misdiagnosis & Mistherapy
基金
石家庄市科技支撑计划(经费自筹)项目(211461083)
河北省中医药管理局科研计划项目(2020041)。
