血清PCT、IL-6、CRP、D-D联合检测诊断急诊发热患儿重症感染的价值

The value of serum PCT combined with IL-6,CRP and D-D in the diagnosis of severe infection in children with emergency fever

目的探究血清降钙素原(PCT)、白细胞介素-6(IL-6)、C反应蛋白(CRP)和D-二聚体(D-D)联合检测诊断急诊发热患儿重症感染的价值。方法分析2020年5月-2021年5月荆州市第二人民医院接收的150例急诊发热患儿(体温≥37.5℃)的临床资料,根据病情进展程度,分为重症感染组(n=37)、发热组(n=113),统计所有患儿入院时、治疗7 d后血清IL-6、PCT、CRP、D-D水平,采用受试者工作特征曲线(ROC)分析各指标对急诊发热患儿重症感染的评估价值。结果重症感染组发热患儿血清PCT、IL-6、CRP、D-D水平分别为(13.34±3.38)μg/L、(27.42±5.73)pg/mL、(17.15±3.52)mg/L和(2.37±0.49)mg/L,均高于发热组(2.67±0.76)μg/L、(13.02±3.34)pg/mL、(5.43±1.97)mg/L和(1.38±0.24)mg/L,差异有统计学意义(t=31.412、18.757、25.365、16.366,P均<0.05)。治疗7 d,重症感染组发热患儿血清IL-6、CRP、D-D水平分别为(0.44±0.08)pg/mL、(2.02±0.92)mg/L和(0.33±0.09)mg/L,均高于发热组(0.39±0.06)pg/mL、(1.45±0.49)mg/L和(0.21±0.06)mg/L,差异有统计学意义(t=4.034、4.834、9.246,P均<0.05),但两组血清PCT水平比较[(1.01±0.42)μg/L vs.(0.93±0.33)μg/L],差异无统计学意义(t=1.193,P>0.05)。ROC曲线分析显示,入院时血清CRP、PCT、D-D、IL-6四者联合预测发热患儿重症感染的曲线下面积(AUC)为0.930,显著高于单独检测0.812、0.736、0.692、0.780。结论血清IL-6、PCT、CRP、D-D水平与急诊发热患儿感染情况密切相关,治疗后上述指标水平降低,IL-6、PCT、CRP、D-D四者联合对急诊发热患儿重症感染具有较好的预测价值。

Objective To explore the value of serum procalcitonin(PCT)combined with interleukin-6(IL-6),C-reactive protein(CRP)and D-dimer(D-D)in the diagnosis of severe infection in children with emergency fever.Methods A retrospective analysis was performed on the clinical data of 150 children with emergency fever(body temperature≥37.5℃)admitted to the hospital between May 2020 and May 2021.According to the degree of disease progression,they were divided into severe infection group(n=37)and fever group(n=113).The levels of serum IL-6,PCT,CRP and D-D in all children at admission and after 7 d of treatment were statistically analyzed.The evaluation value of each index for severe infection in children with emergency fever was analyzed by receiver operating characteristic(ROC)curves.Results The levels of serum PCT,IL-6,CRP and D-D in severe infection group were(13.34±3.38)μg/L,(27.42±5.73)pg/mL,(17.15±3.52)mg/L and(2.37±0.49)mg/L,and were higher than those in fever group[(2.67±0.76)μg/L,(13.02±3.34)pg/mL,(5.43±1.97)mg/L,(1.38±0.24)mg/L](t=31.412,18.757,25.365,16.366,all P<0.05).After 7 d of treatment,levels of serum IL-6,CRP and D-D in severe infection group were(0.44±0.08)pg/mL,(2.02±0.92)mg/L and(0.33±0.09)mg/L,and were higher than those in fever group[(0.39±0.06)pg/mL,(1.45±0.49)mg/L,(0.21±0.06)mg/L](t=4.034,4.834,9.246,all P<0.05),but there was no significant difference in serum PCT level between the two groups[(1.01±0.42)μg/L vs.(0.93±0.33)μg/L](t=1.193,P>0.05).ROC curve analysis showed that area under the curve(AUC)of serum CRP combined with PCT,D-D and IL-6 at admission for predicting severe infection was 0.930,significantly greater than that of single index(0.812,0.736,0.692,0.780).Conclusions The levels of serum IL-6,PCT,CRP and D-D were closely related to infection in children with emergency fever,which decreased after treatment.The combined detection of the four indexes was of good predictive value for severe infection in children with emergency fever.