血清降钙素原联合C-反应蛋白及中性粒细胞动态监测对儿童社区获得性肺炎的临床意义

Clinical Significance of Dynamic Monitoring of Procalcitonin, Hypersensitive C-Reactive Protein and Neutrophil Count in Children with Community Acquired Pneumonia

目的探讨降钙素原(PCT)联合超敏C反应蛋白(hsCRP)及中性粒细胞(NEU)计数动态水平在儿童社区获得性肺炎(CAP)病原体鉴别及抗生素治疗终止时机的价值。方法 200例CAP患儿分为细菌感染组100例、病毒感染组50例、支原体感染组50例,另选取30例健康儿童为对照组,动态监测所有儿童PCT、hsCRP和NEU水平并比较。细菌感染组随机分为两组各50例,A组依据PCT值调整抗生素的使用,B组按照医生的临床经验进行。结果 1细菌组治疗后PCT、hsCRP、NEU水平较治疗前显著下降(P<0.05),病毒组及支原体组治疗前后差异无统计学意义(P>0.05)。2细菌组PCT阳性率显著高于病毒组、支原体组及对照组的PCT阳性率,且显著高于细菌组的hsCRP、NEU阳性率(P<0.05)。3细菌组中,A组抗生素使用天数明显少于B组(P<0.05),两组肺炎复发率均为4.0%(P>0.05)。结论血清PCT联合hsCRP、NEU动态检测有助于儿童CAP病原体鉴别诊断,PCT比hsCRP和NEU有更高的特异性,是判断CAP抗菌治疗终止时间的良好指标。

Objective To study the clinical value of dynamic monitoring of procalcitonin（PCT）, hypersensitive C-reactive protein（hsCRP） and neutrophil（NEU） count in children with community acquired pneumonia（CAP）. Methods 200 CAP children were divided into bacterial group（n = 100）, viral group（n = 50） and mycoplasma group（n = 50）. 30 cases of healthy children were set as the control group.The levels of PCT, hsCRP and NEU of four groups were dynamically observed and compared. 100 cases of bacterial infection group were randomly divided into two groups equally, and the adjustment of antibiotics of group A and group B were decided by PCT value and doctors＇ clinical experience respectively. Results 1 The levels of PCT, hsCRP and NEU decreased significantly after treatment only in bacterial group（P 0.05）. 2The PCT positive rate of bacterial group was significantly higher than that of the other three groups（P 0.05）, and also significantly higher than the hsCRP positive rate and NEU positive rate of bacterial group（P 0.05）. 3Among the bacterial group, the days of antibiotic use of group A was significantly shorter than that of group B（P 0.05）, and the relapse rates of pneumonia of both groups were 4.0%.Conclusions The combined detection of serum PCT, hsCRP and NEU count has important value for differential diagnosis of CAP in children.PCT has higher specificity than hsCRP and NEU, which is a suitable indication for the decision of terminal time in antibiotic therapy.