多指标联合检测在小儿细菌性肺炎病原学诊断中的应用

Application of multi-index combined detection in the etiological diagnosis of bacterial pneumonia of children

目的探讨血清降钙素原(PCT)、C反应蛋白(CRP)、白细胞计数(WBC)、白细胞介素-6(IL-6)、P2X7受体及CD64联合检测对小儿细菌性肺炎的诊断价值。方法选取从2017年10月至2018年10月深圳市龙华区中心医院院收治的140例肺炎患儿,将入组患儿按照感染病原体的不同分为细菌组(60例)、肺炎支原体组(50例)和病毒组(30例);另选取同期于本院体检的健康儿童50例为健康对照组。分别检测并比较4组研究对象血清PCT、CRP、WBC和IL-6水平,以及血清P2X7受体和CD64表达量。通过受试者工作特征(ROC)曲线分析上述指标在小儿细菌性肺炎诊断中的价值。结果细菌组、肺炎支原体组、病毒组和健康对照组儿童血清PCT、CRP、和IL-6水平均呈逐渐降低趋势(F=24.935、31.942、21.764,P均<0.001);细菌组患儿WBC水平高于肺炎支原体组、病毒组、健康对照组(t=12.219、8.942、15.053,P均<0.001);但肺炎支原体组与病毒组患儿WBC水平差异无统计学意义(t=1.010、P=0.316)。细菌组患血清P2X7受体和CD64表达量均高于肺炎支原体组、病毒组、健康对照组;且肺炎支原体组和病毒组患儿血清P2X7受体、CD64表达量高于健康对照组(P均<0.001);肺炎支原体组、病毒组患儿血清P2X7受体和CD64表达量差异无统计学意义(t=0.525、1.629,P=0.601、0.107)。ROC曲线显示,血清PCT、CRP、WBC、IL-6、P2X7受体及CD64联合检测诊断小儿肺炎的曲线下面积(0.924)、敏感度(0.92)以及特异性(0.93)均高于上述6项指标单独检测(PCT:0.728、0.74、0.69,CRP:0.719、0.72、0.70,WBC:0.687、0.70、0.65,IL-6:0.744、0.78、0.72,P2X7受体:0.659、0.64、0.61,CD64:0.702、0.71、0.68)。结论血清PCT、CRP、WBC、IL-6、P2X7受体和CD64联合检测用于小儿细菌性肺炎的诊断价值较高。

Objective To investigate the diagnostic value of serum procalcitonin(PCT),C-reactive protein(CRP),white blood cell count(WBC),interleukin-6(IL-6),P2X7 receptor and CD64 combined detection in children with bacteria pneumonia.Methods Total of 140 children with pneumonia admitted to Shenzhen Longhua District Central Hospital from October 2017 to October 2018 were selected and divided into bacterial group(60 cases),mycoplasma pneumoniae group(50 cases)and virus group(30 cases)according to different infectious pathogens.While,50 healthy children who had physical examination in our hospital during the same period were selected as healthy control group.The levels of serum PCT,CRP,WBC and IL-6,the expressions of P2X7 receptor and CD64 in the four groups were measured and compared,respectively.The values of these indicators in the diagnosis of bacterial pneumonia in children were analyzed by receiver operating characteristic(ROC)curve.Results The serum PCT,CRP and IL-6 levels of children in bacteria group,mycoplasma pneumoniae group,virus group and healthy control group showed a gradually decreasing trends(F=24.935,31.942,21.764,all P<0.001).WBC level in cases of bacterial group was higher than that of cases in mycoplasma pneumoniae group,virus group and healthy control group(t=12.219,8.942,15.053,all P<0.001).There was no significant difference in WBC level between cases of mycoplasma pneumoniae group and virus group(t=1.010,P=0.316).The expression levels of P2X7 receptor and CD64 of cases in bacteria group were significantly higher than those of mycoplasma pneumoniae group,virus group and healthy control group.Moreover,the expression levels of P2X7 receptor and CD64 in serum of cases in mycoplasma pneumoniae group and virus group were significantly higher than that of healthy control group(all P<0.001).The expression levels of P2X7 receptor and CD64 in serum between cases in mycoplasma pneumoniae group and virus group were not significantly different(t=0.525,P=0.601;t=1.629,P=0.107).The ROC curves showed that the area of under the curve of serum PCT,CRP,WBC,IL-6,P2X7 receptors and CD64 combined detection(0.924),sensitivity(0.92)and specificity(0.93)were significantly higher than the separate detection indexes(PCT:0.728,0.74,0.69;CRP:0.719,0.72,0.70;WBC:0.687,0.70,0.65;IL-6:744,0.78,0.72;P2X7 receptors:0.659,0.64,0.61;CD64:0.702,0.71,0.68).Conclusion The combined detection of serum PCT,CRP,WBC,IL-6,P2X7 receptor and CD64 was of high diagnostic value for children with bacterial pneumonia.