C反应蛋白及降钙素原在小儿脓毒症血流感染及其他部位感染性疾病中的诊断价值

Diagnostic value of serum CRP and procalcitonin levels in children with bloodstream infectionassociated sepsis and septic infection at other sites

摘要:

目的：评估入住PICU 6 h内血清CRP及PCT水平在脓毒症血流感染及其他部位感染患儿临床诊断中的价值。方法：回顾性分析2010年1月至2012年1月期间，中国医科大学附属盛京医院PICU收治的30名明确诊断SIRS患儿，脓毒症血流感染及脓毒症其他部位感染患儿各15名，收集入住6 h内的血清CRP、PCT及D-二聚体含量资料，进行差异性比较并通过ROC曲线分析其诊断价值。结果：脓毒症血流感染组患儿的血清CRP及PCT水平较脓毒症其他部位感染组显著升高（P<0.05），而血清D-二聚体水平在两组间差异无统计学意义（P>0.05）。血清PCT水平较CRP水平在诊断与鉴别脓毒症血流感染与其他部位感染性疾病方面有明显优势，PCT<2 ng/mL时诊断脓毒症血流感染可能性不大（阴性预测值：100%），PCT>10 ng/mL时诊断脓毒症血流感染具有较高的可信度（阳性预测值：77%）。结论：入院6 h内的血清PCT水平较CRP水平在早期鉴别入住PICU脓毒症血流感染与其他部位感染患儿具有更好的诊断价值；当血清PCT水平>10 ng/mL时，脓毒症血流感染的诊断可能性较大。

Abstract:

OBJECTIVE: To evaluate the diagnostic value of measuring serum C-reactive protein (CRP) and procalcitonin (PCT) levels, within 6 hours after admission to the pediatric intensive care unit (PICU) in children with bloodstream infection (BSI)-associated sepsis and septic infection at other sites. METHODS: A retrospective analysis was performed on 30 children with a confirmed diagnosis of systemic inflammatory response syndrome who were admitted to the Shengjing Hospital of China Medical University between January 2010 and January 2012. Clinical data on serum CRP, PCT and D-dimer levels were collected within 6 hours after admission. The diagnostic values of the indices were determined by comparative analysis. RESULTS: Serum CRP and PCT levels in children with BSI-associated sepsis were significantly higher than in children with septic infection at other sites (P<0.05), but there was no significant difference in serum D-dimer levels between the two groups (P>0.05). Serum PCT level was superior to serum CRP level in distinguishing children with BSI-associated sepsis from those with septic infection at other sites. Serum PCT level could not realistically be used for diagnosing BSI-associated sepsis when it was less than 2 ng/mL (negative predictive value: 100%), but could be reliably used when it was more than 10 ng/mL (positive predictive value: 77%). CONCLUSIONS: Serum PCT level is superior to serum CRP level in distinguishing children with BSI-associated sepsis from those with septic infection at other sites within 6 hours after admission to the PICU. Serum PCT level has a better diagnostic value for BSI-associated sepsis when it is more than 10 ng/mL.