细菌性感染儿童CRP和SAA水平与抗菌药物使用时间的关系研究

Study on the relationship between CRP,SAA and the duration of antibiotic treatment in children with bacterial infection

目的分析细菌感染的患儿C反应蛋白(CRP)、血清淀粉样蛋白A(SAA)与抗菌药物使用时间的关系。方法选取2018年1月至2019年1月该院收治的182例细菌感染患儿作为细菌感染组。按照用药方式分为单用组(142例)、二联组(24例)和三联组(16例);按照青霉素类抗菌药物使用剂量分为低剂量组(15例)、中剂量组(36例)、高剂量组(12例);按照头孢菌素类抗菌药物给药途径分为静脉滴注组(34例)、口服组(28例)、肌肉注射组(10例)。分别在未使用抗菌药物(0 h)时,以及使用抗菌药物0 h、12 h、3 d、5 d、7 d时检测各组CRP及SAA水平,与30例体检健康儿童(对照组)CRP、SAA水平进行对比。结果对照组儿童CRP、SAA分别为(5.2±2.3)、7.5(4.9,9.8)mg/L,细菌感染组0 h时CRP、SAA分别为(50.9±13.8)、312.6(296.7,323.7)mg/L,两组比较,差异有统计学意义(P<0.05)。使用不同用药方式进行治疗,仅在单用抗菌药物7 d时CRP水平与对照组比较,差异无统计学意义(P>0.05)。细菌感染组使用抗菌药物12 h时,CRP水平以高剂量、中剂量、低剂量依次升高,SAA水平以低剂量、中剂量、高剂量依次降低;使用抗菌药物3、5、7 d时,CRP及SAA水平以中剂量、高剂量、低剂量依次升高。在不同给药途径治疗7 d时,CRP及SAA水平与对照组比较,差异无统计学意义(P>0.05),静脉滴注、口服及肌肉注射等途径之间,CRP及SAA水平差异无统计学意义(P>0.05)。结论CRP、SAA水平与细菌感染儿童抗菌药物使用时间关系密切,在合理使用时间范围内,抗菌药物使用时间越长,二者降低越明显,治疗效果越好。

Objective To explore the relationship between C-reactive protein(CRP),serum amyloid A(SAA)and antibiotic use time in children with bacterial infection.Methods A total of 182 children with bacterial infection in Changhai Hospital Affiliated to Naval Military Medical University from January 2018 to January 2019 were selected as bacterial infection group.According to the way of administration,they were divided into single use group(142 cases),double use group(24 cases)and triple use group(16 cases).According to the dose of penicillin,they were divided into low dose group(15 cases),medium dose group(36 cases)and high dose group(12 cases).According to the method using of cephalosporin,they were divided into intravenous drip group(34 cases),oral group(28 cases)and intramuscular injection group(10 cases).CRP and SAA were measured at 5 time points including no antibiotic were used(0 h),and use antibiotic 12 h,3 d,5 d,7 d,and compared with CRP and SAA in the blood of 30 healthy children(control group).Results CRP and SAA of control group were(5.2±2.3),7.5(4.9,9.8)mg/L respectively,CRP and SAA at 0 h in bacterial infection group were(50.9±13.8),312.6(296.7,323.7)mg/L respectively,there were significant differences between the two groups(P<0.05).Using different way of administration,the level of CRP in bacterial infection group has no significant difference with control group only at 7 d and single use group(P>0.05).The CRP level increased successively in high dose group,middle dose group and low dose group,and the SAA decreased successively from low dose group to high dose group in the bacterial infection group when antibiotics were used for 12 h.At 3,5 and 7 days after using antimicrobial agents,CRP and SAA level increased successively in middle dose group,high dose group and low dose group.After 7 days of treatment with different doses,there was no significant difference on CRP and SAA between the bacterial infection group and control group(P>0.05).There was no significant difference on CRP and SAA between intravenous drip group,oral group and intramuscular injection group(P>0.05).Conclusion The content of CRP and SAA relate to the using time of antibiotics in children with bacterial infection.Within the reasonable use time range,the longer the use time of antibiotics,the more significant the decrease,the better effect of treatment.