摘要
目的研究血清C-反应蛋白(CRP)、降钙素原(PCT)和免疫功能检测在儿童肺炎中的应用效果。方法选取2015年7月-2016年6月杭州市儿童医院儿童肺炎患儿88例,其中轻度肺炎45例为轻度肺炎组、重症肺炎43例为重症肺炎组。另选取同期健康体检儿童22例为对照组。比较3组儿童入院时、急性期和恢复期白细胞计数(WBC)、CRP、PCT和免疫功能指标(IgM、IgG、CD4^+、CD8^+、CD4^+/CD8^+)。结果入院时重症肺炎组、轻度肺炎组WBC、CRP、PCT水平高于对照组(P<0.05)。重症肺炎组入院时、急性期WBC、CRP、PCT水平高于轻度肺炎组(P<0.05)。重症肺炎组急性期WBC、CRP、PCT水平高于入院时,恢复期低于入院时(P<0.05);轻度肺炎急性期与入院时比较差异无统计学意义(P>0.05),恢复期低于入院时(P<0.05)。CRP、PCT敏感度与特异性、阳性预测值、阴性预测值均优于WBC,CRP、PCT曲线下面积0.790、0.829,截断值13.00 mg/L、11.10 ng/ml。入院时重症肺炎组、轻度肺炎组IgM、IgG高于对照组,CD4^+、CD4^+/CD8^+低于对照组,CD8^+高于对照组(P<0.05)。重症肺炎组,患儿急性期IgM、IgG、CD4^+、CD4^+/CD8^+低于入院时,CD8^+高于入院时(P<0.05),恢复期IgM、IgG、CD8^+低于入院时,CD4^+、CD4^+/CD8^+高于入院时(P<0.05);轻度肺炎组急性期与入院时比较差异无统计学意义(P>0.05),恢复期与入院时比较差异有统计学意义(P<0.05);重症肺炎组、轻度肺炎组恢复期与对照组比较差异无统计学意义(P>0.05)。结论 CRP、PCT联合检测有助于儿童肺炎早期诊断、病情评价、临床用药指导,且优于传统指标;同时免疫功能变化参与儿童肺炎疾病发生发展过程,为临床治疗使用免疫调节剂提供参考依据。
Objective To research the application effect of serum C-reactive protein（CRP）,procalcitonin（PCT）,and immune function detection in children with pneumonia.Methods Eighty-eight children with pneumonia were selected from the hospital from July2015 to June 2016,then they were divided into mild pneumonia group（45 children） and severe pneumonia group（43 children）.Twentytwo children receiving healthy physical examination in the hospital during the same period were selected as control group.The levels of white blood cell count,CRP,PCT,and immune function parameters（IgM,IgG,CD4^＋,CD8^＋,CD4^＋/CD8^＋ratio） on admission,at acute phase and recovery phase in the three groups were compared.Results The levels of WBC,CRP,and PCT on admission in severe pneumonia group and mild pneumonia group were statistically significantly higher than those in control group（P〈0.05）.The levels of WBC,CRP,and PCT on admission and at acute phase in severe pneumonia group were statistically significantly higher than those in control group（P〈0.05）.In severe pneumonia group,the levels of WBC,CRP,and PCT at acute phase were statistically significantly higher than those on admission,while the levels of WBC,CRP,and PCT at recovery phase were statistically significantly lower than those on admission（P〈0.05）.In mild pneumonia group,there was no statistically significant difference in the levels of WBC,CRP,and PCT between at acute phase and on admission（P〈0.05）;the levels of WBC,CRP,and PCT at recovery phase were statistically significantly lower than those on admission（P〈0.05）.The sensitivities,specificies,positive predictive values,and negative predictive values of CRP and PCT were superior to WBC.The areas under the curve of CRP and PCT were 0.790 and 0.829,respectively;the cutoff values of CRP and PCT were 13.00 mg/L and 11.10 ng/ml,respectively.The levels of Ig M,Ig G,CD8^＋on admission in mild pneumonia group and severe pneumonia group were statistically significantly higher than those in control group,while the levels of CD4^＋and CD4^＋/CD8^＋ratio in mild pneumonia group and severe pneumonia group were statistically significantly lower than those in control group（P〈0.05）.In severe pneumonia group,the levels of Ig M,Ig G,CD4^＋,and CD4^＋/CD8^＋ratio at acute phase were statistically significantly lower than those on admission,while the level of CD8^＋at acute phase was statistically significantly higher than that on admission（P〈0.05）.In severe pneumonia group,the levels of Ig M,Ig G,and CD8^＋at recovery phase were statistically significantly lower than those on admission,while the level of CD4^＋and CD4^＋/CD8^＋ratio at recovery phase were statistically significantly higher than those on admission（P〈0.05）.In mild pneumonia group,there was no statistically significant difference between at acute phase and on admission（P〈0.05）;there was statistically significant difference between at recovery phase and on admission（P〈0.05）.There was no statistically significant difference between at recovery phase in mild pneumonia group,severe pneumonia group and control group（P〈0.05）.Conclusion Combined detection of CRP and PCT can contribute to early diagnosis,disease evaluation,and clinical medication guidance in children with pneumonia,which is superior to traditional indicators.At the same time,the changes of immune function are involved in occurrence and development of pneumonia in children,which provide a reference basis for clinical application of immunomodulator.
出处
《中国妇幼保健》
CAS
2017年第22期5625-5629,共5页
Maternal and Child Health Care of China
