張珍,白威峰
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降鈣素原與C反應(yīng)蛋白聯(lián)合檢測(cè)在兒童支氣管肺炎及細(xì)菌性肺炎中的應(yīng)用評(píng)價(jià)
張珍1,白威峰2
[摘要]目的:評(píng)價(jià)聯(lián)合檢測(cè)降鈣素原(PCT)和C反應(yīng)蛋白(CRP)水平變化在兒童支氣管肺炎及細(xì)菌性肺炎患者療效及預(yù)后判斷中的臨床意義。方法:2014年2月-2015年2月兒科綜合病區(qū)102例支氣管肺炎及細(xì)菌性肺炎兒童血清標(biāo)本,其中支氣管肺炎55例,細(xì)菌性肺炎47例,另將35名健康的兒童作為對(duì)照組。用化學(xué)發(fā)光法和乳膠凝集法分別檢測(cè)其血清PCT及CRP水平。結(jié)果:以PCT>0.5 ng/ml及CRP>10 mg/L作為陽(yáng)性判斷標(biāo)準(zhǔn),支氣管肺炎及細(xì)菌性肺炎組血清PCT和CRP的陽(yáng)性率明顯高于對(duì)照組(P<0.01);同時(shí),支氣管肺炎及細(xì)菌性肺炎組血清中的PCT和CRP的水平也明顯高于對(duì)照組(P<0.01);再經(jīng)過(guò)有效抗菌藥物治療后,支氣管肺炎及細(xì)菌性肺炎組血清中的PCT和CRP的水平明顯降低(P<0.01)。結(jié)論:血清PCT及CRP聯(lián)合測(cè)定能夠?qū)和夤芊窝缀图?xì)菌性肺炎的鑒別診斷具有重要的參考價(jià)值,而動(dòng)態(tài)監(jiān)測(cè)PCT、CRP的變化更有助于評(píng)估疾病的進(jìn)展和預(yù)后。
[關(guān)鍵詞]支氣管肺炎;肺炎,細(xì)菌性;降鈣素原;C反應(yīng)蛋白;兒童
Application of combined determination of serum procalcitonin and CRP in children with bronchial pneumonia and bacterial pneumoniaZHANGZhen,BAIWei-feng.(BengbuFirstPeople'sHospital,Anhui233000,China)
【Abstract】Objective:To evaluate the clinical significance of combined determination of serum procalcitonin (PCT) and C reactive protein(CRP) in the curative effect and prognosis in children with bronchial pneumonia and bacterial pneumonia.Methods:From February 2014 to February 2015,a total of 102 blood samples were collected from children who had been diagnosed with bronchial pneumonia and bacterial pneumonia in pediatric department of our hospital.Among them,55 were diagnosed with bronchial pneumonia,47 with bacterial pneumonia.At the same time 35 healthy children were chosen as a control group.Serum PCT and CRP levels were analyzed by using chemiluminescence method and latex agglutination.Results:PCT level exceeding 0.5 ng / ml and CRP level exceeding 10mg/L in serum was judged as positive.The positive rates of PCT and CRP in the bronchial pneumonia and bacterial pneumonia group were significantly higher than those in the control group(P<0.01).Meanwhile, serum PCT and CRP levels for the bronchial pneumonia and bacterial pneumonia group were significantly higher than those of the control group(P<0.01).The changed levels of PCT and CRP in the bronchial pneumonia and bacterial pneumonia group after the effective antibiotic treatment were statistically significant(P<0.01).Conclusion:The combined determination of serum PCT and CRP levels are of important value for differential diagnosis of childhood with bronchial pneumonia and bacterial pneumonia.Dynamically monitoring serum PCT and CRP level will contribute to evaluating progress and prognosis of the disease.
【Key words】Bronchopneumonia;Pneumonia, bacterial; Procalcitonin; C reactive protein; Children
支氣管肺炎(常由細(xì)菌或病毒引起,也可由病毒、細(xì)菌“混合感染”)和細(xì)菌性肺炎是臨床上比較常見(jiàn)的威脅兒童身心健康的下呼吸道感染疾病,若得不到及時(shí)治療或處理不當(dāng),則會(huì)引發(fā)較嚴(yán)重的并發(fā)癥。然而,由于該疾病在臨床上缺乏特異性癥狀和體征,較容易與其他的疾病混淆,在發(fā)病早期容易誤診和誤治。降鈣素原(procalcitonin,PCT)在細(xì)菌感染的患者血清水平明顯增高,對(duì)于細(xì)菌引起的感染有著較高的靈敏度和特異性,現(xiàn)已成為重要炎性反應(yīng)檢測(cè)指標(biāo)[1];C反應(yīng)蛋白(c-reactive protein,CRP)是主要的急性期蛋白,在細(xì)菌感染機(jī)體時(shí)其在血漿內(nèi)濃度明顯升高[2]。本研究通過(guò)對(duì)在我院確診的支氣管肺炎及細(xì)菌性肺炎患兒的血清PCT和CRP進(jìn)行檢測(cè),以探討二者聯(lián)合檢測(cè)在臨床上的應(yīng)用價(jià)值。
1資料與方法
1.1一般資料2014年2月-2015年2月在我院兒科病區(qū)住院治療102例肺炎患兒,男55例,女47例,年齡1~9歲。依據(jù)確診疾病分為:支氣管肺炎組55例(男34例,女21例),細(xì)菌性肺炎組47例(男21例,女26例),所有患兒均符合診斷標(biāo)準(zhǔn)。另將35名健康的體檢兒童(男20例,女15例)作為對(duì)照組。
1.2檢測(cè)方法PCT檢測(cè)采用化學(xué)發(fā)光法,所用儀器為深圳新產(chǎn)業(yè)Maglumi 4000全自動(dòng)化學(xué)發(fā)光儀,PCT檢測(cè)試劑為儀器配套試劑。血清CRP采用乳膠凝集法測(cè)定,檢測(cè)儀器為全自動(dòng)生化分析儀OLYMPUS,試劑盒為波音特生物科技有限公司生產(chǎn)。所有操作嚴(yán)格按照說(shuō)明書(shū)執(zhí)行。
2結(jié)果
2.13組患兒PCT及CRP陽(yáng)性率比較以PCT>0.5 ng/mL及CRP>10 mg/L作為陽(yáng)性判斷標(biāo)準(zhǔn)。患兒支氣管肺炎和細(xì)菌性肺炎組其血清PCT及CRP的陽(yáng)性率明顯高于健康兒童,差異有統(tǒng)計(jì)學(xué)意義(P<0.05)。見(jiàn)表1。
表1 3組患兒PCT及CRP陽(yáng)性率比較
注:與對(duì)照組比較,*P<0.01
2.23組患兒血清PCT及CRP水平比較支氣管肺炎和細(xì)菌性肺炎患兒組其血清PCT及CRP水平明顯高于健康兒童,經(jīng)有效抗菌治療后,其PCT及CRP水平明顯下降,差異有統(tǒng)計(jì)學(xué)意義(P<0.05)。見(jiàn)表2。
組別例數(shù)治療前PCT/(ng/ml) CRP/(mg/L)治療后PCT/(ng/ml) CRP/(mg/L)支氣管肺炎551.72±1.53**43.57±33.46**0.19±0.10△△4.07±1.41△△細(xì)菌性肺炎472.57±2.03**63.61±32.11**0.24±0.11△△3.93±1.79△△對(duì)照組350.22±0.063.19±1.01——
注:與對(duì)照組比較,**P<0.01;與治療前比較,△△P<0.01。
3討論
支氣管肺炎和細(xì)菌性肺炎是兒童常患的疾病。由于兒童自身免疫力低、抵抗力差,且臨床癥狀往往不明顯,較易導(dǎo)致臨床誤診,致使病情發(fā)展迅速,并發(fā)癥多,因此更需要及時(shí)的診斷及治療。
降鈣素原主要是由甲狀腺C細(xì)胞產(chǎn)生的分子量約為13 000的糖蛋白。在正常情況下,其在正常人血清中含量極低(通常<0.1ng/ml),在血液中的半衰期為25~30 h[3],體內(nèi)外性質(zhì)穩(wěn)定,是一個(gè)理想的監(jiān)測(cè)感染的指標(biāo)[4]。當(dāng)機(jī)體受到細(xì)菌感染時(shí),PCT在2~3 h即會(huì)輕度升高,6~12 h后到達(dá)高峰,在48 h內(nèi)維持高水平[5]。在經(jīng)過(guò)有效的治療后,其水平會(huì)迅速下降。CRP作為急性時(shí)相蛋白,在機(jī)體受到急、慢性感染的情況下,4~6 h可迅速升高,且其升高幅度與細(xì)菌感染程度呈正比例。
本資料結(jié)果顯示,支氣管肺炎和細(xì)菌性肺炎患兒的PCT和CRP水平顯著高于正常兒童,提示二者在臨床上可作為對(duì)細(xì)菌感染及與其它感染的可靠指標(biāo),以及也是作為抗菌藥物治療的療效指標(biāo)。在經(jīng)過(guò)有效治療后,支氣管肺炎和細(xì)菌性肺炎患兒的PCT和CRP水平顯著下降。因此,血清PCT與CRP及白細(xì)胞等相結(jié)合將有助于臨床醫(yī)師制定有效的治療方案,而動(dòng)態(tài)監(jiān)測(cè)PCT、CRP的變化更有助于觀察疾病的進(jìn)展和預(yù)后,這也與國(guó)內(nèi)外的相關(guān)研究報(bào)道一致[6-7]。
總之,PCT和CRP的聯(lián)合檢測(cè)能夠?qū)和夤芊窝缀图?xì)菌性肺炎做出及時(shí)有效的鑒別診斷,連續(xù)監(jiān)測(cè)二者的動(dòng)態(tài)變化更能有助于對(duì)疾病的進(jìn)展與預(yù)后做出及時(shí)準(zhǔn)確的評(píng)估。
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(收稿日期:2015-09-25)
[中圖分類號(hào)]R 563.12;R 563.19
[文獻(xiàn)標(biāo)識(shí)碼]A
[文章編號(hào)]1008-7044(2016)02-0155-02
DOI:10.14126/j.cnki.1008-7044.2016.02.012
[作者簡(jiǎn)介]張珍(1988-),女,檢驗(yàn)師,研究生。
[作者單位] 安徽省蚌埠市第一人民醫(yī)院 1.檢驗(yàn)科;2.核醫(yī)學(xué)科,233000
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