不同类型肺炎患儿血清hs-CRP和PCT及部分外周血T细胞免疫指标的变化The Diagnosis Value of the Serum hs-CRP, PCT and T-lymphocytes Immune Index in Children with Pneumonia
范芸,归巧娣,施瑞洁,解娟,刘尧
FAN Yun,GUI Qiaodi,SHI Ruijie,XIE Juan,LIU Yao
摘要(Abstract):
目的:探讨不同类型肺炎患儿血清超敏C反应蛋白(hs-CRP)、降钙素原(PCT)及部分外周血T细胞免疫指标的变化。方法:120例肺炎患儿根据病原体检测结果分成细菌组(细菌性肺炎,n=67)、病毒组(病毒性肺炎,n=33)及支原体组(支原体肺炎,n=20),选取100例同期健康体检的健康儿童作为对照组;3个肺炎组患儿于入院次日、对照组儿童于体检时检测血清hs-CRP、PCT水平并计算PCT阳性率,同时检测外周血T淋巴细胞CD3~+、CD4~+、CD4~+CD25~+、CD8~+及CD4~+/CD8~+水平。结果:各组儿童血清hs-CRP水平比较,细菌组>支原体组>病毒组和对照组,差异有统计学意义(P<0.05);各组儿童血清PCT水平比较,细菌组>支原体组>病毒组>对照组,差异有统计学意义(P<0.05);各组儿童血清PCT阳性率比较,细菌组>支原体组和病毒组>对照组,差异有统计学意义(P<0.05);3组肺炎患儿外周血CD3~+、CD4~+、CD4~+/CD8~+水平均低于对照组(P<0.05),CD4~+CD25~+水平均显著高于对照组(P<0.05),除病毒组外,细菌组与支原体组的CD8~+水平均显著高于对照组,差异有统计学意义(P<0.05)。结论:不同类型肺炎患儿的机体内免疫功能均受到影响,血清hs-CRP及PCT水平可以辅助鉴别诊断肺炎的感染类型。
Objective: To analyze the diagnosis value of the detection of the serum high sensitivity C reactive protein(hs-CRP), procalcitonin(PCT), T-lymphocytes immune index in the children with pneumonia. Methods: 120 children with pneumonia received treatment at our hospital from March, 2018 to November, 2018 and 100 healthy children severd as the pneumonia group and control group respectively. The pneumonia group were divided into three groups according to the pathogen detection results——the bacterial pneumonia group(BP group, 67 cases), the virus pneumonia group(VP group, 33 cases) and the eaton agent pneumonia group(EAP group, 20 cases). The general information, the levels of hs-CRP, PCT and T cells immune index in the 4 groups were compared. Results: The general information in the 4 groups had no statistical difference(P>0.05). The hs-CRP, PCT levels and the PCT positive rate in BP group were obviously higher than those in VP group group, the eaton agent pneumonia group and the control group(P<0.05). The hs-CRP level in EAP group was obviously higher than those in the control group and VP group, the PCT level and positive rate in VP group group, EAP group were obviously higher than those in the control group, and the PCT level in VP group was obviously lower than that in EAP group(P<0.05). The levels of CD3~+,CD4~+,CD4~+/CD8~+ in BP group, VP group and EAP group were obviously lower than those in the control group, and the CD4~+CD25~+ level in BP group, VP group and EAP group were obviously higher than that in the control group(P<0.05), the CD8~+ level in BP group, EAP group were obviously higher than that in the control group(P<0.05). Conclusion: Children with pneumonia have cellular immune dysfunction. The detection of the serum hs-CRP, PCT could be used to identify and diagnose different types of children's pneumonia index.
关键词(KeyWords):
C反应蛋白;T淋巴细胞;降钙素原;肺炎;儿童;诊断
C-creactive protein;T-lymphocytes;procalcitonin;pneumonia;children;diagnosis
基金项目(Foundation): 陕西省科学技术研究发展计划项目(2013K12-15-02)
作者(Author):
范芸,归巧娣,施瑞洁,解娟,刘尧
FAN Yun,GUI Qiaodi,SHI Ruijie,XIE Juan,LIU Yao
DOI: 10.19367/j.cnki.1000-2707.2020.01.021
参考文献(References):
- [1]ZHANG Y X,LIU Y,XUE Y,et al.Correlational study on atmospheric concentrations of fine particulate matter and children cough variant asthma[J].Eur Rev Med Pharmacol Sci,2016,20(12):2650-2654.
- [2]蔡琴.WBC、PCT、hs-CRP检测在小儿肺炎诊断中的应用价值分析[J].中国保健营养,2018,(36):360-361.
- [3]LI Y,HAN F,YANG Y,et al.Principles of antibiotic application in children with lobar pneumonia:Step-up or step-down[J].Exp Ther Med,2017,13(6):2681-2684.
- [4]STOCKMANN C,AMPOFO K,KILLPACK J,et al.Procalcitonin accurately identifies hospitalized children with low risk of bacterial community-acquired pneumonia[J].J Pediatric Infect Dis Soc,2018,7(1):46-53.
- [5]NIJMAN R G,VERGOUWE Y,MOLL H A,et al.Validation of the feverkidstool and procalcitonin for detecting serious bacterial infections in febrile children[J].Pediatr Res,2018,83(2):466-476.
- [6]LEVY C,BISCARDI S,DOMMERGUES M A,et al.Impact of PCV13 on community-acquired pneumonia by C-reactive protein and procalcitonin levels in children[J].Vaccine,2017,35(37):5058-5064.
- [7]TAGARRO A,MARTíN M D,DEL-AMO N,et al.Hyponatremia in children with pneumonia rarely means SI-ADH[J].Paediatr Child Health,2018,23(7):126-133.
- [8]ALCOBA G,KEITEL K,MASPOLI V,et al.A threestep diagnosis of pediatric pneumonia at the emergency department using clinical predictors,C-reactive protein,and pneumococcal PCR[J].Eur J Pediatr,2017,176(6):815-824.
- [9]胡丹丹,何丽雅,李佩青,等.PCT联合hs CRP检测在小儿支气管肺炎感染诊治中的临床应用[J].中华肺部疾病杂志(电子版),2018(2):168-171.
- [10]何小宇.社区获得性肺炎患儿诊断PCT、hs-CRP、IL-6及TNF-α的意义[J].首都食品与医药,2018(7):53-54.
- [11]MATHA S M,RAHIMAN S N,GELBART B G,et al.The utility of procalcitonin in the prediction of serious bacterial infection in a tertiary paediatric intensive care unit[J].Anaesth Intensive Care,2016,44(5):607-614.
- [12]■DER R,CEYLAN G,AG(IN H,et al.New parameters for childhood ventilator associated pneumonia diagnosis[J].Pediatr Pulmonol,2017,52(1):119-128.
- [13]ZHU F,WEI H,LI W.Significance of serum procalcitonin levels in differential diagnosis of pediatric pneumonia[J].Cell Biochem Biophys,2015,73(3):619-622.
- [14]ZHU F,JIANG Z,LI W H,et al.Clinical significance of serum procalcitonin level monitoring on early diagnosis of severe pneumonia on children[J].Eur Rev Med Pharmacol Sci,2015,19(22):4300-4303.
- [15]BOLIA R,SRIVASTAVA A,MARAK R,et al.Role of procalcitonin and C-reactive protein as biomarkers of infection in children with liver disease[J].J Pediatr Gastroenterol Nutr,2016,63(4):406-411.
- [16]DAI B Q,YUAN X T,LIU J M.Value of serum procalcitonin for the guidance of antibiotic therapy in children with lower respiratory tract infection[J].Zhongguo Dang Dai Er Ke Za Zhi,2015,17(12):1292-1296.
- [17]GIULIA B,LUISA A,CONCETTA S,et al.Procalcitonin and community-acquired pneumonia(CAP)in children[J].Clin Chim Acta,2015,451(Pt B):215-218.
- [18]AGNELLO L,BELLIA C,DI G M,et al.Utility of serum procalcitonin and C-reactive protein in severity assessment of community-acquired pneumonia in children[J].Clin Biochem,2016,49(1-2):47-50.
文章评论(Comment):
|
||||||||||||||||||
|