婴幼儿社区获得性肺炎血清CRPPCT检测的临床意义

Detection of serum C-reactive protein and procalcitonin levels in infants with community-acquired pneumonia

摘要:

目的 由于采集痰标本的困难及实验条件的制约 ,确定婴幼儿肺炎的病原相对困难 ,也制约了抗生素的合理使用。该研究探讨血清C 反应蛋白 (CRP)及降钙素原 (PCT)测定在鉴别婴幼儿社区获得性肺炎病原学方面的意义。方法 分别采用速率散射比浊法及免疫荧光法测定 6 4例婴幼儿社区获得性肺炎患儿血清CRP及PCT水平 ,同时进行血常规及部分病原学检查。结果 CRP或PCT阳性共 2 3例 ,其中CRP和PCT均阳性 18例 ,仅CRP阳性 3例 ,仅PCT阳性 2例。 6 4例中有 11例MP IgM(+) ,其中PCT或CRP阳性 8例 (7例PCT、CRP均阳性 ,1例CRP阳性 )。白细胞总数或中性分类增高 30例 ,其中CRP或PCT阳性 18例 ,白细胞总数或中性分类均不高 34例 ,CRP或PCT阳性 5例 ,其阳性率明显低于前者 ,差异有显著性意义 (14 .7%vs 6 0 .0 % ;P <0 .0 1)。结论 血CRP和PCT测定可作为鉴别婴幼儿肺炎细菌、肺炎支原体或病毒感染的重要辅助指标 ,对指导抗生素的使用及病情评估、疗效判断有重要参考意义。

Abstract:

Objective To detect serum C-reactive protein (CRP) and procalcitonin (PCT) levels in infants with community-acquired pneumonia (CAP) so as to investigate the significance of the two markers in identification of pathogens of infantile CAP. Methods Serum CRP and PCT levels were measured by enzyme immunoassay and immunoluminometric assay respectively in 64 infants with CAP. Results Among the 64 cases, there were 23 with positive serum CRP and/or PCT, 18 with both positive serum CRP and PCT, 3 with single positive CRP, and 2 with single positive PCT. Positive serum MP-IgM occurred in 11 cases, in which 7 cases had both positive serum CRP and PCT and 1 case had single positive CRP. Among the 30 patients with elevated WBC or neutrophil levels, there were 18 cases with positive serum CRP and/or PCT, while there were only 5 cases in the 34 patients with normal WBC or neutrophil levels. The incidence of positive serum PCT or CRP in the former was significantly higher than that in the latter ( 60.0% vs 14.7%; P< 0.01). Conclusions Detection of serum CRP or PCT levels may be of value in the differential diagnosis of infantile CAP due to bacteria, Mycoplasma or viruses.