小儿肺炎支原体肺炎合并全身炎症反应综合征时超敏CRP、PCT、WBC变化及临床意义研究
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摘要
目的探讨超敏C-反应蛋白(hs-CRP)、外周血白细胞(WBC)和降钙素原(PCT)的变化与合并全身炎症反应综合征(SIRS)的小儿肺炎支原体肺炎(MPP)的关系,以明确其对临床病情评估、疗效判定的意义。方法选取2016年1月—2017年12月蚌埠市第一人民医院收治的小儿肺炎支原体肺炎患儿共计104例,根据是否合并全身炎症反应综合征分为合并组和非合并组,每组患儿均为52例,将合并组患儿根据病情轻重分为重度组和轻度组各26例,对各组患儿均进行hs-CRP、PCT及WBC的检测。结果合并组患儿治疗后较治疗前的hs-CRP(P<0.001)、PCT(P=0.007)、WBC(P<0.001)均有下降,且差异均有统计学意义;未合并组治疗后较治疗前仅PCT(P=0.008)有下降,差异有统计学意义;重度组治疗后较治疗前的hs-CRP(P<0.001)、PCT(P=0.007)、WBC(P<0.001)均有下降,差异有统计学意义;轻度组治疗后较治疗前的hs-CRP(P=0.002)、WBC (P<0.001)有下降,差异有统计学意义;重度组第三代头孢及糖皮质激素应用率(69.2%、76.9%)均高于轻度组(30.8%、38.5%),差异有统计学意义(均P<0.05)。结论小儿肺炎支原体肺炎合并全身炎症反应综合征时检测其hsCRP、PCT、WBC,可帮助判断病情轻重、疗效及预后。
Objective To explore the relationship between the changes of inflammation-associated factors,hypersensitive C-reactive protein(hs-CRP),WBC,procalcitonin(PCT),and the mycoplasma pneumonia(MPP) combined with systemic inflammatory response syndrome(SIRS) in children.To clarify the significance of clinical condition evaluation and therapeutic effect assesment.Methods A total of 104 children with Mycoplasma pneumoniae pneumonia,from January2016 to December 2017,at Bengbu First People's Hospital were selected,52 cases with concomitant SIRS and 52 cases without SIRS.The 52 cases with concomitant SIRS were then divided into severe group(26 cases) and mild group(26cases) according to the severity of the disease.The levels of hs-CRP,WBC,and PCT in all cases were detected.Results Compared to the data of before the treatment,hs-CRP(P < 0.001),PCT(P = 0.007),and WBC(P < 0.001)were decreased after treatment in the group with concomitant SIRS,and the difference was statistically significant.However,in the group without concomitant SIRS,only PCT(P = 0.008) was decreased compared to the data of before the treatment,and the difference was statistically significant.After treatment in severe groups,hs-CRP(P < 0.001),PCT(P = 0.007),and WBC(P < 0.001) were all decreased compared to the data of before the treatment,and the difference was statistically significant.After treatment in mild groups,hs-CRP(P = 0.002) and WBC(P < 0.001) were decreased,and the difference was statistically significant.In the group with concomitant SIRS,the application rate of third generation cephalosporin and glucocorticoid in severe group(69.2%,76.9%) was higher than that in mild group(30.8%,38.5%),and the difference was statistically significant(all P < 0.05).Conclusion The detection of hsCRP,PCT,and WBC in children with Mycoplasma pneumonia combined with systemic inflammatory response syndrome could help determine the severity,therapeutic efficacy,and prognosis of the disease.
Objective To explore the relationship between the changes of inflammation-associated factors,hypersensitive C-reactive protein(hs-CRP),WBC,procalcitonin(PCT),and the mycoplasma pneumonia(MPP) combined with systemic inflammatory response syndrome(SIRS) in children.To clarify the significance of clinical condition evaluation and therapeutic effect assesment.Methods A total of 104 children with Mycoplasma pneumoniae pneumonia,from January2016 to December 2017,at Bengbu First People's Hospital were selected,52 cases with concomitant SIRS and 52 cases without SIRS.The 52 cases with concomitant SIRS were then divided into severe group(26 cases) and mild group(26cases) according to the severity of the disease.The levels of hs-CRP,WBC,and PCT in all cases were detected.Results Compared to the data of before the treatment,hs-CRP(P < 0.001),PCT(P = 0.007),and WBC(P < 0.001)were decreased after treatment in the group with concomitant SIRS,and the difference was statistically significant.However,in the group without concomitant SIRS,only PCT(P = 0.008) was decreased compared to the data of before the treatment,and the difference was statistically significant.After treatment in severe groups,hs-CRP(P < 0.001),PCT(P = 0.007),and WBC(P < 0.001) were all decreased compared to the data of before the treatment,and the difference was statistically significant.After treatment in mild groups,hs-CRP(P = 0.002) and WBC(P < 0.001) were decreased,and the difference was statistically significant.In the group with concomitant SIRS,the application rate of third generation cephalosporin and glucocorticoid in severe group(69.2%,76.9%) was higher than that in mild group(30.8%,38.5%),and the difference was statistically significant(all P < 0.05).Conclusion The detection of hsCRP,PCT,and WBC in children with Mycoplasma pneumonia combined with systemic inflammatory response syndrome could help determine the severity,therapeutic efficacy,and prognosis of the disease.
引文
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[13]刘雪梅,徐飞,谈华,等.进展为难治性支原体肺炎的危险因素分析[J].山东医药,2018,58(28):80-82.
[14]郑娜,孙大庆.甲泼尼龙治疗小儿难治性肺炎支原体肺炎的临床疗效分析[J].河北医学,2018,24(5):837-841.
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[16]楚文英,徐慧,高淑青,等.高敏C-反应蛋白与免疫功能检测在肺炎支原体肺炎中的意义[J].临床儿科杂志,2014,32(5):456-458.
[17]李文斌,邢静,王艳飞,等.儿童支原体肺炎合并全身炎症反应综合征患儿危险因素指标及其相关性[J].海南医学,2018,29(5):643-645.
[18]王旭,黎萍,闫丹丹,等.阿奇霉素治疗小儿肺炎支原体肺炎不同疗程临床疗效观察[J].中国妇幼保健,2017,32(11):2524-2525.
[19]李军文,倪良军,吴振波,等.纤维支气管镜下肺泡灌洗术治疗小儿肺炎支原体肺炎合并肺不张的疗效观察[J].中国妇幼保健,2017,32(17):4523-4526.
[20]郑茂,陈瑶,符佳.难治性肺炎支原体肺炎患儿的早期临床特征及相关细胞因子水平变化[J].中国医药,2017,12(10):1499-1502.
[21]曾庆娣,林爱翠.肺炎支原体抗体C-反应蛋白及血清降钙素原检测在儿童呼吸道医院感染诊断中的应用评价[J].河北医学,2016,22(4):563-566.
[22]傅宏,陈新平,张倩.C反应蛋白在不同病原体感染及不同病情肺炎患儿血清中的表达及临床意义[J].实用临床医药杂志,2015,19(11):67-69.
[23]叶炼,邓益斌,王芳,等.655例儿童肺炎支原体感染情况分析[J].国际检验医学杂志,2015,36(12):1676-1677,1679.
[24]薛海鲸,苏周.细胞免疫指标与血清hs-CRP、PCT早期鉴别诊断儿童肺炎临床研究[J].陕西医学杂志,2018,47(4):530-532.
[2]胡亚美,江载芳.诸福棠实用儿科学[M].8版.北京:人民卫生出版社,2015:1204-1205.
[3]白素萍.小儿肺炎支原体感染的临床检验结果分析[J].贵州医药,2014,11(12):1095-1096.
[4]袁凤佳,宋桂容.hs-CRP与免疫功能检测对MPP患儿的病情判断价值[J].西部医学,2015,27(5):742-744.
[5]黎世坤,吴庆莉,刘国英,等.超敏C反应蛋白细胞免疫指标以及降钙素对小儿肺炎的诊断价值研究[J].检验医学与临床,2014,11(12):1707-1709.
[6]金瑄.肺炎支原体抗体联合超敏C反应蛋白检测在小儿支原体肺炎感染诊断中的临床价值[J].标记免疫分析与临床,2015,22(8):49.
[7]刘绮婷,何凤娇.小儿肺炎支原体感染的临床检验分析[J].中国实用医药,2015,10(20):210-211.
[8]张晓娟,沈伊娜.小儿肺炎支原体肺炎发病机制的研究进展[J].安徽医学,2016,37(1):111-113.
[9]陈玲,覃军,胡荆江.儿童肺炎支原体突变体对大环内酯类药物耐药的研究[J].国际呼吸杂志,2015,35(19):1465-1467.
[10]姚慧生,张睿,刘立云,等.肺炎支原体耐药基因检测与难治性肺炎支原体肺炎的相关性分析[J].国际儿科学杂志,2016,43(6):492-496.
[11]赵素香.小儿难治性肺炎支原体肺炎78例临床分析[J].中国临床研究,2012,25(4):351-352.
[12]王臻,李雅春,陈璐.儿童难治性肺炎支原体肺炎的早期识别[J].中国当代儿科杂志,2015,17(11):1189-1192.
[13]刘雪梅,徐飞,谈华,等.进展为难治性支原体肺炎的危险因素分析[J].山东医药,2018,58(28):80-82.
[14]郑娜,孙大庆.甲泼尼龙治疗小儿难治性肺炎支原体肺炎的临床疗效分析[J].河北医学,2018,24(5):837-841.
[15]王朝燕,禹露.小儿支原体肺炎体液免疫功能与hs-CRP检验的临床意义[J].海南医学,2016,27(8):1257-1259.
[16]楚文英,徐慧,高淑青,等.高敏C-反应蛋白与免疫功能检测在肺炎支原体肺炎中的意义[J].临床儿科杂志,2014,32(5):456-458.
[17]李文斌,邢静,王艳飞,等.儿童支原体肺炎合并全身炎症反应综合征患儿危险因素指标及其相关性[J].海南医学,2018,29(5):643-645.
[18]王旭,黎萍,闫丹丹,等.阿奇霉素治疗小儿肺炎支原体肺炎不同疗程临床疗效观察[J].中国妇幼保健,2017,32(11):2524-2525.
[19]李军文,倪良军,吴振波,等.纤维支气管镜下肺泡灌洗术治疗小儿肺炎支原体肺炎合并肺不张的疗效观察[J].中国妇幼保健,2017,32(17):4523-4526.
[20]郑茂,陈瑶,符佳.难治性肺炎支原体肺炎患儿的早期临床特征及相关细胞因子水平变化[J].中国医药,2017,12(10):1499-1502.
[21]曾庆娣,林爱翠.肺炎支原体抗体C-反应蛋白及血清降钙素原检测在儿童呼吸道医院感染诊断中的应用评价[J].河北医学,2016,22(4):563-566.
[22]傅宏,陈新平,张倩.C反应蛋白在不同病原体感染及不同病情肺炎患儿血清中的表达及临床意义[J].实用临床医药杂志,2015,19(11):67-69.
[23]叶炼,邓益斌,王芳,等.655例儿童肺炎支原体感染情况分析[J].国际检验医学杂志,2015,36(12):1676-1677,1679.
[24]薛海鲸,苏周.细胞免疫指标与血清hs-CRP、PCT早期鉴别诊断儿童肺炎临床研究[J].陕西医学杂志,2018,47(4):530-532.