C-反应蛋白在小儿支原体肺炎中的检测价值

研究C反应蛋白(CRP)在小儿支原体肺炎中的应用价值.采用胶乳强化浊度法测定128例支原体肺炎和79例细菌性肺炎患儿血清CRP,与51名健康儿童作对比.结果表明,128例支原体肺炎组(A组)CRP阳性者45例,阳性率为35.2%,其中3例重症支原体肺炎患儿CRP大于80mg/L.79例细菌性肺炎组(B组)CRP阳性者为73例,阳性率为92.4%,对照组51名(C组)CRP阳性者为2例,阳性率为3.9%.A组、B组与C组相比较有显著性差异(P<0.01),A组与B组相比也有显著性差异(P<0.01).对于一般非重症肺炎,支原体肺炎患儿CRP稍高,但没有细菌性肺炎增高明显,CRP可作为鉴别支原体肺炎或细菌性肺炎的重要辅助指标.     

肺炎支原体肺炎与细菌性肺炎患儿心肌酶变化比较的意义

目的观察肺炎支原体肺炎（MPP）患儿血清心肌酶值的变化，与普通细菌性肺炎患儿心肌酶值变化水平进行比较，探讨其对心肌损害的影响程度，为心肌损害的早期诊断及治疗提供依据。方法选取普通细菌感染及肺炎支原体感染肺炎患儿各100名，进行急性期血清心肌酶值测定，与100名正常体检儿童进行对比并进行相互比较。结果肺炎急性期MP感染组与非MP感染组AST、LDH、CK—MB均明显高于正常对照组（P〈0．05），两组对比MP感染组心肌酶升高程度明显高于非支原体感染组，AST、LDH、CK—MB在两组间存在显著差异（P〈0．05）。结论细菌性肺炎与肺炎支原体肺炎急性期均有不同程度的心肌细胞损害，其中MP感染患儿血清心肌酶水平明显高于非MP感染患儿，提示MP肺炎患儿有明显心肌损害且心肌损害程度要重于非MP肺炎患儿。     

儿童难治性支原体肺炎早期血清学诊断指标比较

目的探讨儿童难治性支原体肺炎的早期血清学诊断指标,通过与普通肺炎支原体肺炎儿童的血清学指标进行对比分析,为早期诊断难治性支原体肺炎提供依据。方法选取2017年1月至2019年6月在南京医科大学附属无锡第二人民医院儿科住院的200例肺炎支原体肺炎患儿,对临床资料进行对比、分析,分为难治性肺炎支原体肺炎组48例和普通肺炎支原体肺炎患儿152例,检测血清指标(包括C反应蛋白(CRP)、乳酸脱氢酶(LDH)、IL-6、IL-10、D-二聚体)的水平。结果难治性肺炎支原体肺炎患儿与普通肺炎支原体肺炎患儿的早期血清学检测指标(包括CRP、LDH、IL-6、IL-10、D-二聚体)比较差异均有统计学意义(P均0.05)。结论难治性肺炎支原体肺炎患儿,早期CRP、LDH、IL-6、IL-10、D-二聚体等血清学指标增高明显,为临床早期诊断难治性支原体肺炎提供依据。     

CRP与WBC联检在儿科呼吸道感染性疾病诊断中的应用价值

目的：探讨CRP联合WBC检测在儿科急性呼吸道感染中的诊断价值。方法采集320例急性呼吸道感染患儿的血清,其中细菌感染组180例,病毒感染组70例,肺炎支原体感染组70例,检测其C-反应蛋白和白细胞值,并与100例健康儿童的血清检测资料进行比较。结果细菌感染组的CRP阳性率(90.00%)高于WBC阳性率(49.44%),MP感染组的CRP阳性率(11.43%)低于WBC阳性率(54.29%),两者比较有显著性差异(P<0.05);细菌感染组的CRP及WBC阳性率,MP感染组的WBC阳性率均高于病毒感染组和对照组,两组比较有显著性差异(P<0.05)。结论 CRP和WBC联检,对儿童急性呼吸道感染性疾病的病原体能够做出早期鉴别诊断且快速方便,成本低廉,值得临床推广应用。     

SAA、CRP联合血常规检测在儿童急性呼吸道感染中的临床应用价值

目的:研究血清淀粉样蛋白A(Serum amyloid A protein,SAA)、C反应蛋白(C reactive protein,CRP)联合血常规检测在儿童急性呼吸道感染中的意义.方法:回顾性分析2019年4月至2020年4月我院收治的424例感染性疾病患儿(细菌感染组133例,病毒感染组167例及支原体感染组124例)及同期本院体检的健康受检儿150例(对照组).比较不同组白细胞(White blood cell,WBC)、CRP及SAA水平及不同检测方法的诊断效能.结果:细菌感染组患儿CRP、WBC以及SAA水平均高于对照组;CRP、WBC水平高于病毒感染以及支原体感染组;SAA水平低于病毒感染、支原体感染组;病毒感染、支原体感染组CRP、SAA水平高于对照组(P<0.05).CRP、WBC、SAA联合检测特异度、敏感度、AUC均高于单一检测法(P<0.05).结论:SAA、CRP及WBC联合检测有利于提高儿童急性上呼吸道感染的诊断准确率.     

15例儿童难治性支原体肺炎的临床特征

目的探讨15例儿童难治性支原体肺炎的临床特征,与50例儿童普通肺炎支原体肺炎的临床特征进行对比分析,以提高对儿童难治性支原体肺炎的认识。方法回顾性分析2016年9月至2017年6月在南京医科大学附属无锡第二人民医院儿科住院的15例难治性支原体肺炎和50例儿童普通肺炎支原体肺炎患儿的临床资料,对临床表现、实验室检查、肺内外并发症、影像学资料及治疗进行对比、分析。结果难治性肺炎支原体肺炎患儿与普通肺炎支原体肺炎患儿在发热时间、血C反应蛋白(CRP)、红细胞沉降率(ESR)、乳酸脱氢酶(LDH)、D-二聚体、影像学表现及药物治疗等多个方面比较差异均有统计学意义(P均0.05);但2组在年龄、性别上比较差异均无统计学意义(P均0.05)。结论儿童难治性支原体肺炎具有热程长、病情重,肺内外并发症多,CRP、ESR、LDH、D-二聚体等指标增高明显,大环内酯类抗生素治疗耐药等特点,需早期联合糖皮质激素。     

肺炎支原体肺炎伴喘息患儿血IL-10、IL-17和VEGF的检测及其意义

目的 观察白细胞介素10(IL-10)、白细胞介素17(IL-17)和血管内皮生长因子(VEGF)在儿童肺炎支原体肺炎中的表达水平及其与喘息的相关性.方法 选取62例肺炎支原体肺炎患儿,分为伴喘息组(A组,32例)和无喘息组(B组,30例),另选取健康儿童30位作为对照组(C组),检测三组儿童血清中IL-10、IL-17和VEGF的浓度.结果 肺炎支原体肺炎伴喘息组和无喘息组患儿血清IL-17和VEGF的水平均高于对照组,差异有统计学意义(P＜0.01);肺炎支原体肺炎伴喘息患儿的IL-17和VEGF的水平高于不伴喘息者,差异有统计学意义(P＜0.01).与对照组相比,肺炎支原体肺炎伴喘息组和无喘息组患儿的IL-10水平明显降低,差异有统计学意义(P＜0.01);肺炎支原体肺炎伴喘息患儿的IL-10的水平低于不伴喘息者,差异有统计学意义(P＜0.01).结论 IL-10、IL-17和VEGF可能在小儿肺炎支原体肺炎导致喘息样发作中起重要作用.     

肺炎支原体肺炎患儿支原体抗体IgG滴度、年龄、CRP、乳酸、ALT、CKMB、胸片变化的临床意义

目的探讨肺炎支原体肺炎(MPP)血清肺炎支原体IgG抗体滴度与患儿年龄、血清C反应蛋白、血乳酸、谷丙转氨酶、CKMB、胸片改变的临床意义。方法 MPP患儿219例根据血MP IgG抗体滴度分为高滴度组(MP IgG≥1:640)和低滴度组(MP IgG <16:40),入院初检测CRP、血乳酸、ALT、CKMB、胸片等指标。结果 219例MPP中高滴度组有98例、低滴度组121例;高滴度组平均年龄(70.2±12.1月)较低滴度组(55.1±9.0月)大(P<0. 05);高滴度组血清CRP、血乳酸、ALT、CKMB值均较低滴度组高(P <0.05);高滴度组胸片改变为节段性肺炎的例数多于低滴度组(P <0. 05);高滴度组患儿WBC、PCT、ALT和血乳酸异常率显著高于低滴度组(P <0. 05);两组患儿CRP和CKMB异常率相比较,差异无统计学意义(P<0.05)。结论随着患儿肺炎支原体抗体滴度的升高,患儿的病情也逐渐加重,因此,检测MP抗体滴度、CRP、乳酸、ALT、CKMB、胸片改变并综合分析可以早期判断患儿病情的严重程度,调整治疗方案。     

C-反应蛋白、降钙素原检测在支原体肺炎诊断、病情评估中的应用

目的:探讨C-反应蛋白、降钙素原检测在支原体肺炎诊断、病情评估中的应用.方法:选择本院自2020年2月至2022年8月期间收诊治疗的74例支原体肺炎患儿作为观察组,另选取74例健康儿童做作为对照组.以病理检测为诊断金标准.两组均进行C-反应蛋白、降钙素原检测,并采用肺炎curb-65评分判定病危程度,并根据病危程度将支原体肺炎分为低、中、高三组.分析对比各组血清中C-反应蛋白(C-reactive Protein,CRP)、中性细胞比例(Neutrophil Ratio,NEUT)、降钙素原(Procalcitonin,PCT)、白细胞计数(White Blood Cell Count,WBC)并比较其诊断效能.结果:观察组CRP、NEUT、PCT、WBC指标均高于对照组(P<0.05);随着病情程度加重,患儿CRP、NEUT、PCT、WBC指标呈上升趋势(P<0.05);经CRP检测出有77例阳性患者,71例阴性患者;经PCT检测出有75例阳性患者,73例阴性患者;CRP检测、PCT检测的灵敏度、特异度分别为93.24％,89.19％,95.95％,95.59％,PCT检测灵敏度及特异性略高于CRP检测,但两种检测比较无显著差异(P>0.05).结论:CRP、PCT检测能对支原体肺炎患儿进行有效诊断,其诊断效能较高.     

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

目的 调查研究小儿支原体肺炎感染患者肺炎支原体抗体(MP-Ab)及超敏C反应蛋白(hs-CRP)水平的变化,探讨肺炎支原体抗体与超敏C反应蛋白联合检测对小儿支原体肺炎感染的临床诊断价值.方法 肺炎支原体肺炎患儿110例,对照儿童120例,均按照《诸福棠实用儿科学》中支原体肺炎诊断标准确诊,两组分别进行MP-Ab、hs-CRP检测,肺炎支原体抗体判定以MP-Ab滴度≥1:160为阳性,超敏C反应蛋白判定以hs-CRP＞ 5mg/L为阳性.通过分析MP-Ab检测法与MP-Ab联合hs-CRP检测法敏感性、特异性差异,探讨MP-Ab联合hs-CRP检测法诊断小儿支原体肺炎感染的临床意义.结果 肺炎支原体肺炎患儿组MP-Ab滴度≥1∶160比率高于正常对照组,肺炎支原体肺炎患儿组hs-CRP高于正常对照组,差异均有统计学意义(P＜0.05);MP-Ab检测法诊断肺炎支原体肺炎的灵敏度为78.2％,MP-Ab联合hs-CRP检测法诊断肺炎支原体肺炎的灵敏度为89.1％,MP-Ab联合hs-CRP检测肺炎支原体肺炎的灵敏度高于MP-Ab检测法,差异有统计学意义(P＜0.05);MP-Ab检测法诊断肺炎支原体肺炎的特异度为94.2％,MP-Ab联合hs-CRP检测法诊断肺炎支原体肺炎的特异度为89.2％,差异无统计学意义(P＞0.05).结论 MP-Ab与hs-CRP联合检测能提高小儿支原体肺炎感染的诊断率,具有较高临床价值.     

肺炎支原体实验室诊断的研究进展

肺炎支原体（MP）是一种常见的呼吸系统感染病原体,约占儿童社区获得性肺炎病例的40%。MP不仅引起肺部病变,也能侵犯心、脑、肝、肾等其他器官,引起多种肺外表现。然而MP感染临床表现不具有特征性,临床上亦缺乏早期有效的诊断方法,容易和其他病毒、细菌所致的呼吸道感染相混淆。目前MP的实验室诊断方法不断推陈出新,但各种方法均有其优势与不足,本文对此作一简要综述。     

哮喘患儿肺炎衣原体及肺炎支原体感染的临床特征分析

目的：探讨哮喘患儿肺炎衣原体(chlamydia pneumoniae,CP)及肺炎支原体(mycoplasma pneumoniae,MP)感染的临床特征。方法：选取2013年1月至2016年1月在我院治疗的哮喘急性发作患儿80例,其中CP感染41例,MP感染39例,分析CP及MP感染的临床特征。结果：CP及MP感染有相似的临床症状,常见症状包括头痛、流鼻涕、咳嗽、发热等。其中CP感染引起的呕吐和腹泻情况多于MP感染(P<0.05);MP感染引起的胸腔积液多于CP感染(P<0.05);CP感染中1岁以下患儿41.46%,而MP感染中4岁以上的患儿56.41%;CP感染中病程≤3个月48.78%,MP感染中病程>6个月46.15%;CP感染患者CD3+,CD3+CD4+,CD19+和CD4+CD25+明显低于MP感染(P<0.05)。结论：临床特征对哮喘急性发作患儿CP及MP感染的诊断可提供参考,有助于早期诊断。     

肺炎支原体感染患儿外周血CD4+CD25+调节性T细胞的变化及其临床意义

探讨肺炎支原体(MP)感染患儿外周血CD4+ CD25+调节性T细胞(Treg)频率变化及其意义.选取32例肺炎支原体感染患儿,其中肺炎支原体肺炎18例,肺炎支原体肺炎合并肺外症状14例;26名健康儿童,分离其外周血单个核细胞,以CD4、CD25单克隆抗体标记细胞后,用流式细胞仪(FACS)检测Treg细胞频率.FAC...     

3820例呼吸道感染患儿病原体的检测结果及流行病学特点分析

目的:了解垫江地区儿童呼吸道病原体流行情况,为疾病的预防和诊治提供实验室依据。方法:回顾性分析2018年1月至2020年10月本院收治的3820例呼吸道感染患儿入院时检测的血常规、血清淀粉样蛋白A(Serum amyloid A,SAA)、C反应蛋白(C-reactive protein,CRP)结果及采用间接免疫荧光法检测的11项呼吸道病原体IgM抗体结果。结果:病毒IgM抗体总检出率为51.65%(1973/3820),以流感病毒B(Influenza virus B,INFB)、流感病毒A(Influenza virus A,INFA)和肺炎支原体(Mycoplasma pneumoniae,MP)感染为主;在1973例呼吸道病原体阳性患者中有321例患者存在混合感染,混合感染率为16.27%;女性患儿阳性率高于男性患儿(χ²=9.67,P=0.002);学龄前组与学龄组呼吸道病原体阳性率较高,婴儿组最低,差异具有统计学意义(P<0.05)。夏季病原体阳性检出率明显低于其它三个季节(χ²=25.62,P=0.00);肺炎衣原体(Chlamydia pneumoniae,CP)组SAA水平最高,明显高于副流感病毒(Parainfluenza virus,PIV)组(P<0.05),INFA组和呼吸道合胞病毒(Respiratory syncytial virus,RSV)组白细胞(White blood cells,WBC)明显高于其它4组,其中INFA组以单核细胞(Monocytes,MONO#)增高为主,RSV组以淋巴细胞(Lymphocyte,LYMPH)增高为主。结论:INFB,INFA和MP是垫江地区儿童最主要的呼吸道感染病原体,不同性别、不同年龄段和不同季节病原体感染率存在显著差异,且感染不同类型病原体后实验室检测结果也有所差异,应针对性采取有效的措施预防感染和合理诊治。     

急性呼吸道感染患者血清CRP、PA和IL-6的检测及临床价值

目的:探讨血清C反应蛋白(CRP)、前白蛋白(PA)及白细胞介素-6(IL-6)在急性呼吸道感染性疾病中的诊断价值和临床意义。方法:检测56例急性呼吸道感染患者和30例健康对照者血清CRP、PA和IL-6的含量。结果:细菌感染组与健康对照组相比较,CRP及IL-6水平明显升高,PA则明显降低,组间差异有高度显著性(P<0.01)。病毒感染组与健康对照组相比较,血清CRP、PA及IL-6水平差异均无显著性(P>0.05)。细菌感染组治疗前、后CRP、PA和IL-6水平差异均有高度显著性(P<0.01)。结论:在急性呼吸道感染时,血清CRP、PA和IL-6的含量呈不同程度的变化有助于疾病的早期鉴别诊断,动态检测其变化对疗效判断有一定的临床价值。     

The course of C-reactive protein response in untreated upper respiratory tract infection.

BACKGROUND: High C-reactive protein (CRP) values are frequently found in patients with bacterial respiratory infection, and CRP testing has been shown to be useful in differentiating pneumonia from other respiratory infections. Raised CRP values may also be found in viral respiratory infection, and as a result there is a risk that antibiotics may be wrongly prescribed. AIMS: To describe the course of the CRP response during untreated upper respiratory tract infections and associations between the development of CRP values, erythrocyte sedimentation rate (ESR) and respiratory symptoms. DESIGN OF STUDY: Prospective study. SETTING: Seven general practices in northern Norway. METHOD: Patients with upper respiratory tract infection aged 16 years or over, who were not treated with antibiotics and who had been ill for no more than 3 days, were recruited. Microbiological examinations were undertaken, together with measurements of CRP, ESR and recording of symptoms daily during the first week of illness and on days 10, 14 and 21. RESULTS: An aetiological agent was established in 23 of the 41 included subjects. These were: influenza A, influenza B, rhinovirus, and other agents. Among the 15 patients examined on both the second and the third day of illness, the median CRP value increased from 7-10 mg/l, and the mean value was from 19-24 mg/l between day 2 and day 3. Peak CRP values were reached on days 2 to 4. Higher CRP values were found in those infected with influenza A and B than in the other subjects (P <0.001). A CRP value >10 mg/l was found in 26 subjects during the first 7 days, compared to five subjects after 1 week. Evidence of a secondary infection with group A streptococci was found in two of these five subjects. The development of the symptoms of sore throat, fatigue, clamminess, and pain from muscles and joints followed a similar course as the CRP response, while stuffy nose, cough, sputum production, and dyspnoea tended to persist after the CRP values had approached the normal range. CONCLUSION: A moderately elevated CRP value (10-60 mg/l) is a common finding in viral upper respiratory tract infection, with a peak during days 2-4 of illness. Moderately elevated CRP values cannot support a diagnosis of bacterial infection when the illness has lasted less than 7 days, but may indicate a complication of viral infection after a week.     

Polyclonal antibodies raised against Bacillus Calmette-Guerin, Mycobacterium duvalii, and Mycobacterium paratuberculosis used to detect mycobacteria in tissue with the use of immunohistochemical techniques.

Commercially available polyclonal antibodies raised against strains of mycobacteria were used to detect organisms in tissue sections from 34 cases of tuberculosis, leprosy, and atypical mycobacteria. Thirty-two cases of fungal infections, granulomatous inflammation, and sarcoidosis were used as negative controls. Sections stained with the use of antibodies raised against Bacillus Calmette-Guerin (BCG), Mycobacterium duvalii (MD), and Mycobacterium paratuberculosis (MP) were compared with Kinyoun and Fite-stained tissue sections. In caseating granulomata, clumps of mycobacterial debris, cells, and cell fragments stained. In histiocytic granulomata of mycobacterial infections, histiocyte cytoplasm contained both organisms and debris. The three antibodies showed cross-reactivity against the four groups of mycobacteria tested. Mycobacterial staining using immunoperoxidase was apparent in most cases at low-power (scanning) magnification. Thirty-two of 34 cases of mycobacterial infection, including all 24 Kinyoun-Fite-positive cases, were positive for immunoreactive organisms and debris using anti-MD, anti-BCG, and/or anti-MP. Eight of ten cases of culture-proven mycobacterial infection, in which Kinyoun and Fite stains were negative, had immunoreactive organisms or antigen with anti-BCG, MD, or MP. The antibodies also stained organisms in five cases of sporotrichosis in which the organisms were identified as yeast forms in tissue sections.     

Aggregation of white cells and C-reactive protein: relation between these two indices in acute phase reaction.

The association between aggregates of leucocytes in blood drawn from patients with various inflammatory conditions and the serum concentration of C-reactive protein (CRP) was examined: serum concentration of CRP might contribute to the development of cellular aggregations. A total of 213 patients with various inflammatory or necrotic conditions were examined (including 31 women with normal pregnancy and 59 controls). A significant correlation between the degree of leucocyte aggregation and CRP concentration was noted in patients with bacterial infections and in a group of patients with various inflammatory conditions. In contrast, there was no correlation between the extent of leucocyte aggregation and CRP concentrations in patients with viral infections, malignancies, or pregnancy. The presence or absence of aggregated leucocytes can help in differentiating between the respective bacterial or viral infections. The serum concentrations of CRP were increased in both types of infection, although when a quantitative CRP assay was used, considerably higher concentrations were detected in bacterial diseases.     

C-reactive protein measurement in general practice may lead to lower antibiotic prescribing for sinusitis.

BACKGROUND: Symptoms of bacterial sinusitis overlap with viral sinusitis, and it is difficult to distinguish between the two conditions based only on a clinical examination. Uncertain diagnosis results in the significant overuse of antibiotics, which is considered to be one of the most important reasons for development of bacterial resistance to antibiotics. A raised C-reactive protein (CRP) level is an indicator of bacterial infection and the CRP rapid test has been shown to be useful for the diagnosis of bacterial sinusitis in general practice. AIMS: To examine whether general practitioners (GPs) who use the CRP rapid test in their practice have a lower antibiotic prescribing rate for sinusitis than GPs who do not use the test. DESIGN OF STUDY: Observational design. SETTING: General practice in Denmark. METHOD: A group of GPs registered all contacts (n = 17 792) with patients who had respiratory tract infections during a 3-week period between 1 November 2001 and 31 January 2002. GPs who used a CRP rapid test were compared with GPs who did not, and the treatment of their patients (n = 1444) with suspected sinusitis was compared. RESULTS: A CRP rapid test was used by 77% (n = 281) of the GPs. In the group of GPs using a CRP rapid test, the rate of antibiotic prescribing was 59% (95% confidence interval [CI] = 56 to 62) compared with 78% (95% CI = 73 to 82) in the group of GPs who did not use a CRP test. Performing a CRP rapid test was the factor that exerted the greatest influence on whether the patients were prescribed antibiotics, and the level of CRP had a strong influence on the prescribing rate. CONCLUSION: The CRP rapid test has a substantial influence on the treatment of sinusitis, and implementing the test in general practice may lead to a reduction in antibiotic prescribing to patients with sinusitis.     

PCT和CRP联合检测对儿童呼吸道感染的临床意义

目的 分析PCT和CRP联合检测对儿童呼吸道感染的临床意义。方法 回顾性分析2016年6月~2017年3月我院呼吸科300例呼吸道感染疾病患儿,根据临床诊断分为病毒感染组（126例）和细菌感染组（174例）,分析两组检测的PCT和CRP结果并计算其阳性率。结果 细菌感染组PCT阳性率为85.63%,CRP阳性率为67.82%;病毒感染组PCT的阳性率为29.37%,CRP阳性率为63.49%。细菌感染组PCT阳性率明显高于病毒感染组;细菌感染组CRP阳性率与病毒感染组无明显差异。结论 PCT在细菌感染阳性率优于CRP,二者联合检测鉴别诊断儿童细菌、病毒感染性疾病具有更高临床价值。