临床常用感染指标在无明显感染灶幼儿急性发热诊断中的价值

Significance of routinely-used infection related biomarkers on the differential diagnosis of acute fever with undefined infection sites in children

目的探讨临床常用感染指标在无明显感染灶幼儿急性发热诊断中的应用价值。方法选择湖南省儿童医院2015年6月—2016年6月收治的200例无明显感染灶急性发热患儿(急性发热组)和同期200例健康体检的幼儿(健康体检组),观察两组C-反应蛋白(CRP)、降钙素原(PCT)、白细胞计数(WBC)和中性粒细胞比例(NEU)。结果急性发热组CRP、PCT、WBC、NEU均明显高于健康体检组[CRP(mg/L):55.28±0.40比4.00±0.35,PCT(μg/L):0.90±0.20比0.33±0.12,WBC(×10~9/L):16.88±0.50比6.08±0.42,NEU:0.73±0.01比0.59±0.01,均P<0.05];急性发热组不同感染类型患儿常用感染指标数值水平比较显示,细菌感染组>支原体感染组>病毒感染组,不同感染类型间比较差异均有统计学意义[CRP(mg/L)分别为64.28±1.14、33.84±1.16、13.88±1.12,PCT(μg/L)分别为0.82±0.20、0.59±0.19、0.42±0.18,WBC(×10~9/L)分别为15.59±1.11、10.84±1.16、8.48±1.12,NEU分别为0.83±0.01、0.70±0.01、0.64±0.01,均P<0.05]。结论在无明显感染灶幼儿急性发热诊断中,采用常用感染指标如CRP、PCT、WBC、NEU等,可准确揭示其感染类型,值得推广使用。

Objective To evaluate the significance of routinely-used infection related biomarkers on the differential diagnosis of acute fever with undefined infection sites in children. Methods A total of 200 acute febrile children（acute fever group） and 200 health checkup children（healthy control group） in Hunan Children＇s Hospital from June 2015 to June 2016 were enrolled. The measures of C-reactive protein（CRP）, procalcitonin（PCT）, white blood cell count（WBC） and neutrophil ratio（NEU） were observed. Results The levels of CRP, PCT, WBC and NEU in the acute fever group were significantly higher than those in the healthy group [CRP（mg/L）： 55.28±0.40 vs. 4.00±0.35, PCT（μg/L）： 0.90±0.20 vs. 0.33±0.12, WBC（×10~9/L）： 16.88±0.50 vs. 6.08±0.42, NEU： 0.73±0.01 vs. 0.59±0.01, all P〈 0.05]. The level of routinely-used infection related biomarkers in subgroup of different type of infections originated from different pathogens indicates that bacterial infection causes the highest biomarkers level, followed by mycoplasma infection and viral infection [CRP（mg/L）： 64.28±1.14, 33.84±1.16, 13.88±1.12, PCT（μg/L）： 0.82±0.20, 0.59±0.19, 0.42±0.18; WBC（×10~9/L）： 15.59±1.11, 10.84±1.16, 8.48±1.12, NEU： 0.83±0.01, 0.70±0.01, 0.64±0.01, all P 〈0.05]. Conclusion It is recommended to take the routinely-used infection indexes（such as CRP, PCT, WBC, NEU） into clinical practice in the procedure of distinguishing the origin of infection in acute febrile children with undefined infection site.