降钙素原、C反应蛋白和白细胞水平在儿童急性细菌感染鉴别诊断中的价值

Value of procalcitonin, C-reactive protein, and white blood cell levels in differential diagnosis of acute bacterial infections in children

摘要:

目的 分析降钙素原（PCT）、C反应蛋白（CRP）和白细胞（WBC）水平在儿童急性细菌感染鉴别诊断中的价值。方法 调查了2022年3月至2023年6月在郑州市第七人民医院住院治疗的186例急性呼吸道感染的患儿。58例通过痰培养检测出细菌的患儿被列为A组，66例通过血清学检测发现患有常见呼吸道病毒感染的患儿被列为B组，62例通过血清学检测发现肺炎支原体的患儿被列为C组。检测所有研究对象的PCT、CRP、WBC水平并对急性细菌感染做受试者工作特征（ROC）曲线，并计算曲线下面积（AUC）。结果 A组患儿的PCT、CRP和WBC水平明显高于B组和C组（P<0.05）。ROC曲线分析表明，PCT、CRP、WBC以及三项联合诊断的曲线下面积分别为0.686（0.631~0.742，P<0.001）、0.516（0.408~0.625，P=0.757）、0.582（0.515~0.650，P=0.016）和0.779（0.730~0.827，P<0.001）。在58例细菌性呼吸道感染患儿中革兰氏阳性（G+）细菌感染有34例（58.62%），革兰氏阴性（G-）细菌感染有24例（41.38%），G+和G-细菌感染间的PCT、CRP、WBC水平和诊断阳性率比较差异均无统计学意义（P>0.05）。结论 PCT、CRP和WBC一定程度上有助于区分儿童急性细菌性或非细菌性感染，其水平可以提示临床医生注意病原体类型，并尽量避免滥用抗生素。

Abstract:

Objective To analyze the value of procalcitonin (PCT), C-reactive protein (CRP), and white blood cell (WBC) levels in the differential diagnosis of acute bacterial infections in children.Methods A survey was conducted on 186 children with acute respiratory infections who were hospitalized at Zhengzhou Seventh People's Hospital from March 2022 to June 2023. Fifty-eight children who detected bacteria through sputum culture were classified as Group A, 66 children who were found to have common respiratory viruses through serological testing were classified as Group B, and 62 children who were found to have Mycoplasma pneumoniae through serological testing were classified as Group C. Detect the levels of PCT, CRP, and WBC in all study subjects, perform receiver operating characteristic (ROC) curve analysis on acute bacterial infections, and calculate the area under the curve (AUC).Results The levels of PCT, CRP, and WBC in Group A were significantly higher than those in Group B and Group C (P<0.05). ROC curve analysis showed that the area under the curve for PCT, CRP, WBC, and three combined diagnoses were 0.686 (0.631–0.742, P<0.001), 0.516 (0.408–0.625, P=0.757), 0.582 (0.515–0.650, P=0.016), and 0.779 (0.730–0.827, P<0.001), respectively. Among 58 cases of bacterial respiratory tract infection, 34 cases (58.62%) were Gram positive (G+) bacterial infections, and 24 cases (41.38%) were Gram negative (G-) bacterial infections. There was no significant difference in PCT, CRP, WBC levels, and diagnostic positivity between the main G+ and G- bacterial infection groups (P>0.05).Conclusion PCT, CRP, and WBC can be effective indicators for identifying acute bacterial or non-bacterial infections in children, and their levels can prompt clinical doctors to pay attention to the types of pathogens and try to avoid overuse of antibiotics as much as possibletheir.