摘要
目的观察小儿细菌性肺炎的临床特征及抗感染治疗前后炎症指标白细胞（WBC）、血清C反应蛋白（CRP）和降钙素原（PCT）的水平变化，探讨其在细菌性肺炎早期诊断及治疗中的价值。方法前瞻性纳入130例细菌性肺炎患儿（肺炎组）为研究对象。收集患儿临床病历资料，同步检测抗感染治疗前（人院24h内）及治疗后（人院第7天）患儿血清CRP、PCT和WBC水平，设34例健康儿童为对照组。观察肺炎组患儿的一般临床特征；比较肺炎组与对照组入院时血清CRP、PCT和WBC的水平；比较肺炎组抗感染治疗前后CRP、PCT和WBC的水平变化；分析PCT、CRP和WBC早期预测细菌性肺炎的意义。结果肺炎组与对照组患儿在年龄与性别方面比较，差异无统计学意义（t=1．012，P=0．395；x2z=0．003，P=0．959）。肺炎组患儿院前病程（5．34±1．27）d，入院体温（38．27±0．96）℃，平均住院时间（8．92±3．93）d，治愈35例、好转95例、死亡0例。肺炎组患儿抗感染治疗前CRP、PCT和WBC水平分别为（12．24±6．35）mg／L、（0．18±0．15）ng／mL、（14．25±7．59）×10^9／L，均高于对照组，差异均有统计学意义（t=4．650、5．867、2．548，均P〈0．05）。肺炎组患儿抗感染治疗前CRP、PCT和WBC水平明显高于治疗后，差异均有统计学意义（t=8．165、7．232、5．112，均P〈0．05）。PCT、CRP与WBC预测小儿细菌性肺炎的曲线下面积（AUC）依次为0．928、0．834和0．718（P〈0．05），PCT预测的敏感性和特异性均高于CRP和WBC。结论PCT早期预测肺炎患儿细菌感染的统计学效力明显高于CRP和PCT；将CRP、PCT和WBC联合检测有助于提高小儿细菌性肺炎诊断的敏感性和特异性。
Objective To observe the clinical characteristics of bacterial pneumonia children,and the changes of the serum levels of white blood cells （WBC）, C -reactive protein（CRP） and procalcitonin（PCT） before and after anti -bacterial therapy,and to explore the predictive value in early diagnosis and therapy. Methods 130 bacterial pneumonia children were enrolled prospectively as pneumonia group. The clinical data were collected and the serum CRP, PCT and WBC were detected before anti -bacterial therapy （within 24h after admission） and after anti -bacterial therapy （the seventh day after admission）. 34 healthy children were enrolled as control group. The general clinical characteristics of the children in the pneumonia group were observed. The levels of serum CRP, PCT and WBC between the pneumonia group and the control group were compared. The levels of serum CRP, PCT and WBC before and after anti - bacterial therapy in the bacterial pneumonia children were compared. The clinical value of PCT, CRP and WBC in early predicting bacterial pneumonia was identified. Results Compared with the control group, the sex and age of the bacterial pneumonia children demonstrated no statistically significant differences （ t = 1. 012, P =0. 395 ; x2 = 0. 003,P = 0. 959）. The mean course of the disease before admission was （5.34 ± 1.27 ） d, with mean temperature of （38.27 ± 0. 96） ℃, and hospital days of （ 8.92 ± 3.93 ） d. 35 cases were cured, and 95 cases were improved ,with no death. The serum levels of CRP,PCT and WBC in pneumonia children on admission were （ 12.24± 6.35） mg/L, （0.18 ±0.15 ） ng/mL and （ 14.25 ± 7.59） 10^9/L, respectively, which were higher than those of thecontrol group, the differences were statistically significant （t = 4.650,5. 867,2. 548, all P 〈 0.05 ）. The serum levels of CRP,PCT and WBC in pneumonia children before anti -bacterial therapy were higher than after bacterial therapy, showed statistically significant differences（ t = 8. 165,7. 232,5.112,
作者
苏青弟
严如金
魏金芬
苏振华
陈玲玲
Su QD Yan R J Wei JF Su ZH Chen LL(Department of Pediatrics, the Second People＇s Hospital of Yuhuan County, Zhejiang 317600, China Department of Clinical Laboratory, the Second People＇s Hospital of Yuhuan County, Zhejiang 317600, China Department of Pediatrics, Taizhou Hospital, Taizhou, Zhejiang 317500, China)
出处
《中国基层医药》
CAS
2017年第21期3322-3326,共5页
Chinese Journal of Primary Medicine and Pharmacy
关键词
细菌性肺炎
降钙素原
C反应蛋白
白细胞
Bacterial pneumonia
Procalcitonin
C reactive protein
White blood cells
