肝素结合蛋白与β淀粉样蛋白1-42在儿童上呼吸道细菌感染诊断中的价值

The value of heparin binding protein and amyloidβ1-42 in the diagnosis of upper respiratory tract bacterial infection in children

目的探讨肝素结合蛋白(HBP)、β淀粉样蛋白1-42(Aβ1-42)联检在儿童上呼吸道细菌感染诊断中的价值。方法选取亳州市人民医院2020年1月-2022年4月治疗的上呼吸道感染患儿215例,其中单纯细菌感染患儿89例(细菌感染组),非细菌感染患儿60例(非细菌感染组),细菌合并其他感染患儿66例(细菌合并其他感染组)。215例患儿中,反复呼吸道感染患儿94例,非反复呼吸道感染患儿121例。同时选取健康儿童70名作为对照组。比较不同病原菌感染患儿血清HBP、Aβ1-42、C反应蛋白(CRP)、降钙素原(PCT)和白细胞计数(WBC)水平,同时分析反复呼吸道感染和非反复呼吸道感染患儿临床资料以及HBP等差异。结果细菌合并其他感染组血清HBP为(22.23±4.46)ng/mL,明显高于细菌感染组、非细菌感染组和对照组[(10.64±1.32)、(15.22±1.15)、(4.65±1.23)ng/mL],差异均有统计学意义(t=4.332、5.593、6.011,P均<0.05),Aβ1-42为(0.82±0.16)pg/mL,明显低于细菌感染组、非细菌感染组和对照组[(1.09±0.18)、(1.12±0.20)、(1.51±0.29)pg/mL],差异均有统计学意义(t=3.021、4.454、5.833,P均<0.05)。细菌合并其他感染组CRP、PCT和WBC分别为(21.03±4.46)mg/L、(2.35±0.82)ng/mL和(15.51±1.83)×10^(9)/L,明显高于非细菌感染组[(10.15±2.84)mg/L、(0.20±0.09)ng/mL、(7.56±1.03)×10^(9)/L]和对照组[(2.20±0.96)mg/L、(0.15±0.06)ng/mL、(6.88±1.01)×10^(9)/L],差异均有统计学意义(t_(非细菌感染组)=3.432、2.833、3.022,t_(对照组)=4.011、4.011、3.983,P均<0.05),与细菌感染组比较差异无统计学意义(P>0.05)。反复呼吸道感染患儿HBP为(16.65±2.26)ng/mL,明显高于非反复呼吸道感染患儿(14.56±2.30)ng/mL,差异有统计学意义(t=6.660,P<0.05),Aβ1-42为(0.89±0.15)pg/mL,明显低于非反复呼吸道感染患儿(1.11±0.14)pg/mL,差异有统计学意义(t=-11.077,P<0.05)。血清HBP联合Aβ1-42鉴别诊断细菌合并其他感染的ROC曲线下面积明显高于血清HBP、Aβ1-42单独诊断,差异有统计学意义(P<0.05),其灵敏度和特异度分别为94.00%和78.00%。血清HBP联合Aβ1-42鉴别诊断反复呼吸道感染的ROC曲线下面积明显高于血清HBP、Aβ1-42单独诊断,差异有统计学意义(P<0.05),其灵敏度和特异度分别为96.00%和82.00%。结论上呼吸道感染儿童血清HBP升高,而Aβ1-42降低,在鉴别诊断细菌合并其他感染、反复呼吸道感染方面有一定应用价值。

Objective To explore the value of combined detection of heparin binding protein(HBP)and amyloid β1-42(Aβ1-42)in the diagnosis of upper respiratory tract bacterial infection in children.Methods A total of 215 children with upper respiratory tract infection treated in our hospital from January 2020 to April 2022 were selected,including 89 children with simple bacterial infection(bacterial infection group),60 children with non-bacterial infection(non-bacterial infection group),and 66 children with bacterial and other infections(bacterial combined with other infection group).Among 215 children,there were 94 children with recurrent respiratory tract infection and 121 children with non-recurrent respiratory tract infection.Seventy health children were selected as the control group.The serum HBP,Aβ1-42,C-reactive protein(CRP),procalcitonin(PCT)and white blood cell count(WBC)were compared among children infected with different pathogens,and the clinical data,HBP and so on of children with recurrent respiratory tract infection and non-recurrent respiratory tract infection were analyzed.Results The serum HBP of bacteria combined with other infection group was(22.23±4.46)ng/mL,which was significantly higher than those of bacteria infection group,non-bacterial infection group and control group[(10.64±1.32),(15.22±1.15),(4.65±1.23)ng/mL],the differences were statistically significant(t=4.332,5.593,6.011,all P<0.05),while Aβ1-42 was(0.82±0.16)pg/mL,which was significantly lower than those of bacteria infection group,non-bacterial infection group and control group[(1.09±0.18),(1.12±0.20),(1.51±0.29)pg/mL],the differences were statistically significant(t=3.021,4.454,5.833,all P<0.05).The CRP,PCT and WBC of the bacteria combined with other infection group were(21.03±4.46)mg/L,(2.35±0.82)ng/mL and(15.51±1.83)×10^(9)/L,which were significantly higher than those of non-bacterial infection group[(10.15±2.84)mg/L,(0.20±0.09)ng/mL,(7.56±1.03)×10^(9)/L]and the control group[(2.20±0.96)mg/L,(0.15±0.06)ng/mL,(6.88±1.01)×10^(9)/L],the differences were statistically significant(t_(non bacterial infection group)=3.432,2.833,3.022,t_(control group)=4.011,4.011,3.983,all P<0.05),but there were no significant differences when compared with the bacterial infection group(P>0.05).The HBP of children with recurrent respiratory tract infection was(16.65±2.26)ng/mL,which was significantly higher than that of children with non-recurrent respiratory tract infection(14.56±2.30)ng/mL,the difference was statistically significant(t=6.660,P<0.05),while Aβ1-42 was(0.89±0.15)pg/mL,which was significantly lower than that of children with non-recurrent respiratory tract infection(1.11±0.14)pg/mL(t=-11.077,P<0.05).The area under the ROC curve of serum HBP combined with Aβ1-42 in the differential diagnosis of bacterial and other infection was significantly higher than that of serum HBP and Aβ1-42 alone(P<0.05),and its sensitivity and specificity were 94.00%and 78.00%,respectively.The area under the ROC curve of serum HBP combined with Aβ1-42 in the differential diagnosis of recurrent respiratory tract infection was significantly higher than that of serum HBP and Aβ1-42 alone(P<0.05),and its sensitivity and specificity were 96.00%and 82.00%respectively.Conclusion The serum HBP of children with upper respiratory tract infection increased,while Aβ1-42 decrease,which had certain application value in the differential diagnosis of bacterial infection with other and recurrent respiratory tract infection.