血清IL-6、PCT、hs-CRP在新生儿肺炎早期诊断中的应用价值

Application value of serum IL-6, PCT and hs-CRP in early diagnosis of neonatal pneumonia

目的探究血清白细胞介素6(interleukin-6,IL-6)、降钙素原(procalcitonin,PCT)、超敏C反应蛋白(high sensitivity C-reactive protein,hs-CRP)在新生儿肺炎(neonatal neonatal pneumonia,NP)早期诊断中的应用价值。方法选择2010年12月至2018年10月在四川绵阳四0四医院新生儿科住院治疗的82例NP患儿为NP组,其中细菌感染肺炎46例纳入细菌感染组,非细菌感染肺炎36例纳入非细菌感染组,同期在我院体检健康新生儿42例纳入对照组,采用酶联免疫吸附法(enzyme linked immunosorbent assay,ELISA)检测血清IL-6水平,采用定量免疫比浊法测定血清PCT、hs-CRP水平。比较分析三组研究对象血清IL-6、PCT及hs-CRP的表达水平及相关性,分析IL-6、PCT、hs-CRP对新生儿细菌感染性肺炎患儿的诊断效能。结果细菌感染组NP患儿血清IL-6、PCT、hs-CRP的表达水平显著高于非细菌感染组和对照组,组间差异具有统计学意义[(218.36±50.33)pg/mL比(22.91±8.48)pg/mL比(9.02±8.11)pg/mL,(1.52±2.28)ng/mL比(0.49±0.37)ng/mL比(0.07±0.03)ng/mL,(15.87±2.60)mg/L比(4.60±2.29)mg/L比(2.08±0.53)mg/L,F值分别为606.662,12.443和573.974,P值均<0.05];且细菌感染组血清IL-6、PCT、hs-CRP水平明显高于非细菌感染组(P<0.05),非细菌感染组血清IL-6、PCT及hs-CRP表达水平明显高于对照组(P<0.05)。细菌感染组NP患儿血清IL-6与PCT、IL-6与hs-CRP、PCT与hs-CRP均呈正相关(r值分别为0.305,0.224和0.408,P值均<0.05)。细菌感染组NP患儿中的PCT阳性检出率显著高于hs-CRP和IL-6阳性检出率,组间差异具有统计学意义[93.48%(43例)比60.87%(28例),93.48%(43例)比78.26%(36例),χ2值分别为13.883和4.389,P值均<0.05]。IL-6、PCT、hs-CRP对细菌感染性NP患儿单独检测效能分别为63.41%,79.27%和90.24%,三者联合检测的诊断效能为96.34%,均优于以上指标的单独检测效能。结论细菌感染性NP患儿血清中IL-6、PCT、hs-CRP表达水平均有所上升,各指标对于细菌感染性NP患儿早期诊断均具有一定的价值,但IL-6、PCT、hs-CRP指标联合检测效果更佳。

Objective To explore the application value of serum interleukin-6(IL-6),procalcitonin(PCT),high sensitivity C-reactive protein(hs-CRP)in the early diagnosis of neonatal pneumonia(NP).Methods Total of 82 cases of NP children hospitalized in the Department of Neonatology,Mianyang 404 Hospital from December 2010 to October 2018 were selected as NP group,of which 46 cases of bacterial pneumonia were included as bacterial infection group,36 cases of non bacterial pneumonia were included as non bacterial infection group,and 42 cases of healthy children in the hospital were included as control group.The serum IL-6 level was detected by enzyme-linked immunosorbent assay(ELISA),and the levels of PCT and hs-CRP were measured by quantitative immunoturbidimetry.The serum levels of PCT,hs-CRP and IL-6 were compared among the three groups,and the correlations among them were analyzed.The diagnostic efficacy of IL-6,PCT and hs-CRP in neonatal bacterial infection pneumonia was also analyzed.Results The expression levels of IL-6,PCT and hs-CRP in NP patients with bacterial infection group were significantly higher than that of non bacterial infection group and control group[(218.36±50.33)pg/mL vs(22.91±8.48)pg/mL vs(9.02±8.11)pg/mL,(1.52±2.28)ng/mL vs(0.49±0.37)ng/mL vs(0.07±0.03)ng/mL,(15.87±2.60)mg/L vs(4.60±2.29)mg/L vs(2.08±0.53)mg/L,F values were 606.662,12.443 and 573.974 respectively,all P values<0.05].The levels of IL-6,PCT and hs-CRP in the non bacterial infection group were significantly higher than those in the control group(P<0.05),and the levels of serum IL-6,PCT and hs-CRP in non bacterial infection group were significantly higher than those in control group(P<0.05).The positive correlations had been found in the bacterial infection group between IL-6 and PCT,IL-6 and hs-CRP,and PCT and hs-CRP(r values were 0.305,0.224 and 0.408 respectively,all P values<0.05).The PCT positive rate of NP children was significantly higher than that of hs-CRP and IL-6 in bacterial infection group[93.48%(43 cases)vs 60.87%(28 cases),93.48%(43 cases)vs 78.26%(36 cases),χ^(2) values were 13.883 and 4.389 respectively,both P values<0.05].The detection efficiency of IL-6,PCT and hs-CRP were 63.41%,79.27%and 90.24%respectively.The diagnostic efficiency of combined detection of IL-6,PCT and hs-CRP was 96.34%,which was better than the single detection efficiency of the above indicators.Conclusion The expression levels of IL-6,PCT and hs-CRP were significantly increased in the serum of bacterial infection NP children.All the indexes have certain value for the early diagnosis of bacterial infection NP children,but the combined detection of IL-6,PCT and hs-CRP is better.