降钙素原、白细胞介素6、C反应蛋白在新生儿坏死性小肠结肠炎手术时机选择中的应用研究

目的探讨降钙素原(procalcitonin,PCT)、白细胞介素6(interleukin-6,IL-6)及C反应蛋白(C reactive protein,CRP)指导新生儿坏死性小肠结肠炎手术时机选择的临床应用价值。方法选取遵义医学院附属医院131例患儿为研究对象,其中非手术组33例,手术组47例,对照组36例。采用电化学发光法和速率散射比浊法检测三组患儿起病后1 h、6 h、12 h血清PCT、IL-6、CRP浓度,对可能影响治疗方式选择的因素进行Logistic回归分析。通过ROC曲线评价PCT、IL-6、CRP三者对手术时机选择的作用。结果三组患儿胎龄差异有统计学意义(P 0. 05),其中手术组胎龄最低,其后依次为非手术组、对照组;手术组出生体重显著低于非手术组和对照组,差异有统计学意义(P 0. 05),但非手术组与对照组出生体重差异没有统计学意义(P0. 05);三组间性别比例、发病时间差异无统计学意义(P 0. 05)。合并症主要为低血糖、新生儿肺炎、低体重及窒息,三组间新生儿肺炎发生率及死亡率差异有统计学意义(P 0. 05)。三组确诊时血清PCT、IL-6、CRP水平,手术组均显著高于非手术组和对照组(P 0. 05)。同一监测时点组内,Bell分期从Ⅰ到Ⅲ期血清PCT、IL-6、CRP水平呈现出逐渐升高的趋势(P 0. 05);同一Bell分期组内,发病后1 h、6 h、12 h血清PCT、IL-6、CRP水平呈现出逐渐升高的趋势(P 0. 05); Bell分期与检测时间不存在交互效应(P0. 05),其中PCT、IL-6、CRP最高值均出现在发病后12 h组内Bell分期为Ⅲ期的亚组中,最低值均出现在发病后1 h组内Bell分期为Ⅰ期的亚组中。发病后6 h血清PCT(OR=2. 612,95%CI:1. 725～4. 781)、发病后6 h血清IL-6(OR=1. 896,95%CI:1. 439～3. 234)及发病后12 h血清CRP(OR=1. 330,95%CI:1. 004～2. 314)水平是NEC患儿是否选择手术治疗的主要影响因素。PCT 6 h、IL-6 6 h、CRP 12 h三个指标的ROC曲线下面积分别为0. 86(95%CI:0. 768～0. 934)、0. 89(95%CI:0. 803～0. 967)、0. 73(95%CI:0. 652～0. 806)。考虑到手术指征的严谨性,每项检查结果需结合95%医学参考值范围,因此最佳临界点分别为0. 62(0. 38～0. 86) ng/m L、145. 85(137. 70～154. 01) pg/m L、8. 35(7. 27～9. 43) mg/L。结论 PCT、IL-6、CRP水平对NEC手术时机的判断具有一定意义,但NEC患儿是否需要外科手术干预还应结合上述指标的医学参考值范围、临床表现和其他辅助检查结果。     

超声可视化技术在急性阑尾炎腹腔镜手术患儿围手术期的应用

目的探讨超声可视化技术在急性阑尾炎腹腔镜手术患儿围手术期的应用价值。方法选取2017年8月至2019年8月期间河北省儿童医院收治的急性阑尾炎患儿88例为研究对象,遵循随机化原则分为对照组和实验组,每组各44例。对照组予腹腔镜手术治疗,实验组借助超声可视化技术进行腹腔镜手术治疗。比较两组术前、术后治疗效果(术后呕吐、腹胀、喂养反复、腹腔残余感染发生率)、中性粒细胞(neutrophilic granulocyte,NEUT)]、炎症因子[C反应蛋白(C-reactive protein,CRP)、降钙素原(procalcitonin,PCT)、白介素6(Interleukin-6,IL-6)]、细胞免疫功能(CD4+、CD8+、CD4+/CD8+)、体液免疫功能[免疫球蛋白M(Ig M)、免疫球蛋白G(Ig G)、C3、C4]变化情况。结果实验组患者术后呕吐、腹胀、喂养反复、腹腔残余感染发生率均低于对照组(P 0.05);实验组患者的住院时间短于对照组,住院费用也低于对照组(P 0.05)。两组术前CRP、PCT、IL-6、CD4+、CD8+、CD4+/CD8+、Ig M、Ig G、C3、C4比较差异均无统计学意义(P 0.05);两组术后CD4+、CD8+、CD4+/CD8+、Ig M、Ig G、C3、C4均显著降低,CRP、PCT、IL-6均显著升高,与术前比较差异有统计学意义(P 0.05),且实验组术后CRP、PCT、IL-6低于对照组,CD4+、CD8+、CD4+/CD8+、Ig M、Ig G、C3、C4高于对照组(P 0.05)。结论超声可视化技术在腹腔镜手术治疗急腹症患儿围手术期应用可指导临床治疗,为患儿快速康复提供新思路。     

D- 二聚体、N 末端脑钠素原及炎症标志物与儿童重症肺炎 预后的关系#br#

目的探讨D-二聚体(DD)、N末端脑钠素原(NT-ProBNP)及降钙素原(PCT)、白介素-6(IL-6)、白细胞计数(WBC)、C-反应蛋白(CRP)等炎症标志物与儿童重症肺炎预后的关系。方法 107例重症肺炎患儿根据是否需要机械通气,分为未机械通气组和机械通气组,机械通气组再分为无创通气组和有创通气组。按重症监护时间分为重症监护时间≤7天组和重症监护时间7天组。按出院时转归分为生存组和死亡组,比较和分析各组的DD、NT-ProBNP、PCT、IL-6、WBC、CRP水平,应用二分类logistic回归分析和受试者工作特征曲线对各指标进行比较和评价。结果机械通气组、有创通气组、重症监护时间7天组和死亡组患儿的DD、NT-ProBNP、PCT和IL-6水平均分别明显高于未机械通气组、无创通气组、重症监护时间≤7天组和生存组(P均0.05),而WBC和CRP在各组中的差异均无统计学意义(P均0.05)。Logistic回归分析表明,DD对重症肺炎患儿死亡风险评估具有统计学意义(OR=2. 72,95%CI:1. 32～5. 60)。ROC分析结果显示,用于预测重症肺炎患儿存亡情况的曲线下面积最大为DD(0.89),其后依次为IL-6(0.85)、PCT(0.84)和NTProBNP(0. 80),联合DD、NT-ProBNP、PCT和IL-6四项检测指标的曲线下面积为0. 91,诊断灵敏度0. 91、特异度0. 85。结论 DD、NT-ProBNP、PCT与IL-6在儿童重症肺炎病情严重程度和预后评估中具有一定的临床价值,四项指标联合检测可提高对存亡情况的预测能力,DD可能可以作为预测重症肺炎患儿死亡风险的独立生物学指标。     

D-二聚体、N末端脑钠素原及炎症标志物与儿童重症肺炎预后的关系

目的探讨D-二聚体(DD)、N末端脑钠素原(NT-ProBNP)及降钙素原(PCT)、白介素-6(IL-6)、白细胞计数(WBC)、C-反应蛋白(CRP)等炎症标志物与儿童重症肺炎预后的关系。方法 107例重症肺炎患儿根据是否需要机械通气,分为未机械通气组和机械通气组,机械通气组再分为无创通气组和有创通气组。按重症监护时间分为重症监护时间≤7天组和重症监护时间7天组。按出院时转归分为生存组和死亡组,比较和分析各组的DD、NT-ProBNP、PCT、IL-6、WBC、CRP水平,应用二分类logistic回归分析和受试者工作特征曲线对各指标进行比较和评价。结果机械通气组、有创通气组、重症监护时间7天组和死亡组患儿的DD、NT-ProBNP、PCT和IL-6水平均分别明显高于未机械通气组、无创通气组、重症监护时间≤7天组和生存组(P均0.05),而WBC和CRP在各组中的差异均无统计学意义(P均0.05)。Logistic回归分析表明,DD对重症肺炎患儿死亡风险评估具有统计学意义(OR=2. 72,95%CI:1. 32～5. 60)。ROC分析结果显示,用于预测重症肺炎患儿存亡情况的曲线下面积最大为DD(0.89),其后依次为IL-6(0.85)、PCT(0.84)和NTProBNP(0. 80),联合DD、NT-ProBNP、PCT和IL-6四项检测指标的曲线下面积为0. 91,诊断灵敏度0. 91、特异度0. 85。结论 DD、NT-ProBNP、PCT与IL-6在儿童重症肺炎病情严重程度和预后评估中具有一定的临床价值,四项指标联合检测可提高对存亡情况的预测能力,DD可能可以作为预测重症肺炎患儿死亡风险的独立生物学指标。     

儿童急性阑尾炎手术后粘连性肠梗阻的相关因素分析

目的探讨儿童急性阑尾炎(acute appendicitis,AA)术后发生粘连性肠梗阻(adhesive ileus,AI)的影响因素及相关预防措施。方法收集天津市儿童医院2014年1月至2017年6月行阑尾切除术(acute appendicitis resection,AAR)的168例AA患者为研究对象,按照术后是否发生AI分为梗阻组(n=42)和未梗阻组(n=126),以性别、年龄、病程、阑尾炎类型、是否穿孔、手术方式、手术操作时间、是否留置引流管、术前相关炎症指标(PCT、CRP、白细胞及中性粒细胞)为自变量进行回归分析。结果42例AAR后发生AI的时间与年龄存在相关性(r=0.535,P<0.05),Logistic分析结果显示:病程长(OR=1.071,95%CI:1.040~1.104)、PCT水平升高(OR=1.735,95%CI:1.178~2.555)为AI的危险因素;而年龄较大(OR=0.966,95%CI:0.945~0.987)、男性(OR=0.199,95%CI:0.049~0.802)及采用腹腔镜手术(OR=0.092,95%CI:0.015~0.543)为AI的保护因素。结论AA病程、PCT、年龄、性别及手术方式是AAR后发生粘连性肠梗阻的影响因素,当儿童AA满足手术适应证时,应及早行腹腔镜阑尾切除术;对于年龄较小及术前PCT水平较高的患者,术后应警惕AI发生的可能。     

降钙素原鉴别儿童血流感染与污染的临床价值

目的探讨血清降钙素原(PCT)鉴别儿童血液培养检出凝固酶阴性葡萄球菌(CNS)血流感染与污染的临床价值。方法回顾性收集湖南省常宁市人民医院2013年1月–12月连续就诊的经血液培养检出凝固酶阴性葡萄球菌患儿的病例资料,将病例分为血流感染组及污染组,分别比较两组患儿的一般人口学特征、病例来源、C反应蛋白(CRP)、血培养阳性结果报警时间(TP)、降钙素原等实验室检测结果,并根据受试者工作特征(ROC)曲线分析降钙素原的鉴别诊断性能。结果共83例纳入研究,血流感染组(38例)与污染组(45例)患儿的月龄、性别、CRP、TP的差异无统计学意义(P均0.05);外科病房住院患儿的血流感染比例(70.59%)高于内科(39.39%),差异有统计学意义(χ2=5.30,P0.05);血流感染组的PCT水平高于污染组(Z=5.17,P=0.000)。PCT鉴别血流感染组及污染组的灵敏度、特异度、准确度分别为86.8%、82.2%、84.3%,最佳截断值为0.195 ng/ml,ROC曲线下面积(AUC)为0.822(95%CI:0.726~0.918)。结论 PCT对于鉴别儿童凝固酶阴性葡萄球菌血流感染与污染具有一定的临床价值,可帮助临床医师正确诊断血流感染、减少抗生素滥用。     

降钙素原对尿路感染儿童膀胱输尿管反流的诊断价值及其关联性

目的 探讨降钙素原（PCT）对儿童尿路感染伴膀胱输尿管反流（VUR）的诊断价值及其关联。 方法 纳入2012年1月1日至2015年12月31日湖南省儿童医院首次诊断为尿路感染且住院期间进行了PCT、CRP检测、排尿期膀胱尿道造影（VCUG）检查和尿液细菌定量培养的患儿,排除医院获得性尿路感染者和进行过尿道外科手术者。以VCUG作为金标准,以PCT和CRP为待测标准,将诊断为VUR的患儿分为无反流组和反流组（轻度反流亚组和重度反流亚组）。采集性别、月龄和VCUG信息,仅截取入院后24 h内行PCT和CRP检测的结果。比较PCT和CRP对VUR的诊断参数。 结果 进入本文分析的尿路感染患儿156例,经VCUG确诊的VUR （反流组）58例,其中轻度反流亚组38例,重度反流亚组20例;无反流组98例。无反流组与反流组患儿月龄、男女比例差异无统计学意义（Z=-1.667, P=0.096;χ2=0.291,P=0.590）。PCT(ng·mL-1)和CRP(mg·L-1)反流组高于无反流组［1.01（0.78,1.28）vs 0.40（0.10,0.60）和14.2（8.9,31.1）vs 11.0（6.6,19.5）］,差异有统计学意义（Z=-7.863, P=0.000;Z=-2.327, P=0.02）。PCT无反流组与轻度反流亚组［0.99（0.68,1.16）］和重度反流亚组［1.57（0.93,1.96）］、CRP无反流组与重度反流亚组［28.9（12.7,45.2）］、PCT与CRP轻度反流亚组及重度反流亚组,差异均有统计学意义。CRP无反流组与轻度反流亚组［12.6（8.5,19.5）］,差异无统计学意义。PCT区分有无反流的最佳截值为0.77 ng·mL-1,敏感度为77.6%,特异度90.8%,ROC曲线下面积0.877（95％CI：0.811~0.943）。在控制了性别和CRP等因素的情况下,PCT≥0.77 ng·mL-1的尿路感染患儿VUR的风险是PCT＜0.77 ng·mL-1的3.604倍。 结论 PCT对于判断尿路感染患儿是否存在VUR具有一定的临床价值,可作为预测VUR的独立指标。     

PCT、IL-6及CRP在伴外科并发症的过敏性紫癜患儿血清中变化的意义

目的探讨伴腹部外科并发症的过敏性紫癜(HSP)患儿血清前降钙素(PCT)、白介素-6(IL-6)及C-反应蛋白(CRP)水平的动态变化。方法选择2010年1月至2013年6月期间住院的伴腹部外科并发症的HSP患儿48例,于入院第1、3、5天及出院前采集空腹静脉血,检测血清PCT、IL-6及CRP水平。结果 HSP患儿入院第1、3、5天血清PCT、IL-6水平以及入院第1、3天血清CRP水平均高于对照组,差异有统计学意义(P均0.05)。手术组和非手术组HSP患儿,入院第1、3、5天以及出院前血清PCT、CRP和IL-6水平的差异有统计学意义(P均0.01),均呈逐渐下降趋势。手术治疗患儿第3、5天的血清PCT、IL-6水平低于非手术治疗患儿,第5天血清CRP水平低于非手术治疗患儿,差异有统计学意义(P均0.05)。患儿血清PCT水平与IL-6、CRP的水平均呈直线正相关(r=0.48、0.62,P均0.01)。结论 PCT、IL-6及CRP水平变化可能与HSP伴发的腹部外科并发症的发生与感染因素关系密切,监测其变化有助于判断病情及指导治疗。     

脐血和0~24h外周血炎性标志物在新生儿早发败血症中的诊断价值

目的 了解脐血和0~24h外周血标志物中性粒细胞CD64(nCD64)、降钙素原(PCT)、C-反应蛋白(CRP)对新生儿早发败血症的诊断价值.方法 分析宫内感染和疑似宫内感染的新生儿100例及无宫内感染证据的新生儿100例,其中44例确诊为新生儿早发败血症,设为感染组,无任何感染的正常新生儿106例,设为对照组,分析比较两组炎症指标.结果 感染组脐血nCD64(2.58±1.02)明显高于对照组(1.23±0.68)(P=0.000),0~24h外周血nCD64感染组(2.67±2.13)明显高于对照组(1.36±0.29)(P=0.000),感染组脐血PCT(2.96±4.89)μg/L,明显高于对照组(1.39±1.57)μg/L(P=0.003),0~24h外周血PCT感染组(25.25±48.68)μg/L,明显高于对照组(3.15±4.16)μg/L(P=0.001),0~24h外周血CRP感染组(12.52±34.02)mg/L,明显高于对照组(3.12±5.36)mg/L(P=0.006).脐血CRP两组差异无统计学意义(P>0.05),脐血中nCD64和PCT敏感度分别为81.5%、75.12%,nCD64敏感度高于PCT,特异度分别为83.47%、86.42%,PCT稍高于nCD64;0~24h外周血中nCD64、PCT和CRP敏感度分别为83.25%、87.38%和48.65%,PCT敏感度最高,CRP最低,特异度分别为85.36%、93.63%和92.45%,PCT特异度最高,nCD64稍差.结论 脐血nCD64、PCT和0-24h外周血nCD64、PCT、CRP均可作为诊断新生儿早期败血症的指标,其中脐血nCD64敏感性更好,0~24h外周血中PCT敏感性、特异性均好,CRP敏感性最差.     

降钙素原在幼年特发性关节炎诊断中的临床意义

目的检测幼年特发性关节炎(JIA)血清降钙素原(PCT)改变,探讨PCT在JIA诊断中的临床意义。方法检测2011年1月至2012年12月湖北省武汉市妇女儿童医疗保健中心风湿免疫科150例JIA患儿血清PCT和C反应蛋白(CRP)值,比较PCT和CRP对诊断JIA细菌感染的敏感度、特异度、阳性预测值、阴性预测值。同时,检测PCT在JIA各种临床类型的表达情况。结果 JIA细菌感染组血清PCT与CRP值,均明显高于JIA病毒感染组、JIA活动不伴感染组及对照组,差异均有统计学意义(P均0.05)。以PCT≥0.5μg/L及CRP≥8 mg/L为诊断细菌感染的阳性阈值,两指标敏感度分别为76.2%、85.7%,特异度分别为87.6%、51.9%,阳性预测值分别为50.0%、21.2%,阴性预测值分别为95.8%、95.4%,阳性似然比6.14、1.65,阴性似然比0.27、0.30。ROC曲线下面积:PCT为0.928,优于CRP(0.714),差异有统计学意义(u=2.19,P0.05)。98.99%(98/99)JIA活动不伴感染组PCT值0.5μg/L,中位数为0.2μg/L。66.7%(66/99)JIA活动不伴感染组PCT值0.1μg/L。结论血清PCT值对JIA并发细菌感染具有重要鉴别意义,其预测感染价值优于CRP。推荐PCT值0.5μg/L作为诊断JIA合并感染临界值。     

降钙素原对儿童急性肾盂肾炎的诊断价值

目的：探讨降钙素原（PCT）对儿童急性肾盂肾炎（APN）的诊断价值。方法：回顾性分析2011年9月至2012年2月诊断为初发的尿路感染（UTI）且年龄<3岁患儿的病例资料,以核素肾静态扫描（99mTc-DMSA）结果作为诊断APN的金标准,比较上尿路感染（APN）及下尿路感染（非APN）患儿血清PCT、CRP的水平,并绘制二者诊断APN的受试者工作特征曲线（ROC曲线）,判断其诊断性能。结果：共65例UTI患儿纳入研究,其中APN 39例,下尿路感染者26例,前者的血清PCT、CRP水平显著高于后者（分别 3.08 ng/mL vs 0.37 ng/mL;6.25 mg/L vs 3.01 mg/L;均P<0.01）。血清PCT诊断APN的敏感性为84.6%,特异性为88.5%,曲线下面积为0.873（95%可信区间为0.781~0.965）,最佳阈值为1.03 ng/mL;血清CRP诊断APN的敏感性为71.8%,特异性为69.2%,曲线下面积为0.735（95%可信区间为0.612~0.858）,最佳阈值为3.91 mg/L。结论：PCT对儿童APN的诊断具有较高的敏感性及特异性,有助于临床对APN的早期识别。     

Procalcitonin and C-reactive protein as diagnostic markers of severe bacterial infections in febrile infants and children in the emergency department

OBJECTIVE: To assess the value of procalcitonin (PCT) and C-reactive protein (CRP), compared with that of total white-blood cell count (WBC) and absolute neutrophil count (ANC), in predicting severe bacterial infections (SBIs) in febrile children admitted to Emergency Department. METHODS: A prospective study was conducted in 408 children aged 7-days to 36-months, admitted with fever without source, at a tertiary care Pediatric Emergency Department. PCT, CRP, WBC, and ANC were determined upon admission and compared. Specificity, sensitivity, multilevel likelihood ratios, receiver operating characteristic (ROC) analysis, and multivariate stepwise logistic regression were carried out. RESULTS: SBI was diagnosed in 94 children (23.1%). PCT, CRP, WBC, and ANC were significantly higher in this group than in non-SBI patients. The area under the ROC (AUC) obtained was 0.82 (95% CI: 0.78-0.86) for PCT, 0.85 (95% CI: 0.81-0.88) for CRP (P = 0.358), 0.71 (95% CI: 0.66-0.75) for WBC, and 0.74 (95% CI: 0.70-0.78) for ANC. Only PCT (OR: 1.32; 95% CI: 1.11-1.57; P < 0.001) and CRP (OR: 1.02; 95% CI: 1.01-1.03; P < 0.001) were retained as significant predictors of SBI in a multiple regression model. For infants with fever <8 hours (n = 45), AUC for PCT and CRP were 0.92 (95% CI: 0.80-0.98) and 0.75 (95% CI: 0.60-0.87), respectively (P = 0.056). CONCLUSION: Both PCT and CRP are valuable markers in predicting SBI in children with fever without source and they perform better than WBC and ANC. PCT appears more accurate at the beginning of infections, but overall CRP may be the most convenient marker for its better sensitivity and feasibility.     

降钙素原对儿童急性阑尾炎严重程度的预测价值

目的 评价降钙素原（PCT）对儿童急性阑尾炎严重程度的预测价值.方法 收集2011年10月至2012年3月我们收治的93例诊断为急性阑尾炎的患儿临床资料,包括年龄、性别、入院时PCT及CRP、并发症（腹腔脓肿、肠梗阻）、住院时间等.根据手术所见或病理检查结果将患儿分为急性阑尾炎组和急性阑尾炎伴局限性或弥漫性腹膜炎组.结果 急性阑尾炎组53例,腹膜炎组40例.腹膜炎组出现并发症的比例高于急性阑尾炎组,住院时间较长,且PCT、CRP水平显著高于急性阑尾炎组（PCT：0.43 vs 3.37 ng/mL,P＜0.001,CRP：3.0vs13.8 mg/L,P＜0.001）.在诊断腹膜炎的敏感性、特异性、阳性预测值、阴性预测值方面,当PCT以0.93 ng/mL为阈值时,分别为85.0％、91.6％、88.3％、89.0％,而CRP以4.05 mg/L为阈值时,分别为90.0％、67.9％、67.9％、90.0％.结论 入院时PCT及CRP对儿童急性阑尾炎的严重程度具有一定的预测价值,且PCT性能略优于CRP.     

Serum procalcitonin, C-reactive protein and interleukin-6 for distinguishing bacterial and viral pneumonia in children

OBJECTIVE: Serum procalcitonin (PCT), C-reactive protein (CRP) and interleukin-6 (IL-6) concentrations were measured in 126 children hospitalized for community-acquired, radiologically confirmed pneumonia to assess whether these host response values could be used to distinguish bacterial from viral pneumonia. METHODS: The samples for PCT, CRP and IL-6 measurements were obtained on admission or the first day of hospitalization. The etiology of pneumonia was studied with an extensive panel of methods that detected 6 bacteria and 11 viruses. RESULTS: In all, 54% had evidence of bacterial pneumonia, and 32% had evidence of sole viral pneumonia. In 14% of the cases the etiology could not be determined. Children with bacterial pneumonia had significantly higher PCT (median 2.09 ng/ml vs. 0.56 ng/ml, P = 0.019) and CRP concentrations (96 mg/l vs. 54 mg/l, P = 0.008) than those with sole viral etiology. However, the values markedly overlapped. No significant difference in IL-6 concentrations was seen between the two patient groups. Using PCT > or = 2.0 ng/ml, CRP > or = 150 mg/l or IL-6 > or = 40 pg/ml, the specificity was > or =80% for bacterial pneumonia. The sensitivities with these cutoff values were 50% for PCT, 31% for CRP and 34% for IL-6. CONCLUSIONS: The results indicate that the measurement of serum PCT, CRP and IL-6 has little value in the differentiation of bacterial and viral pneumonia in children. However, in some patients with very high serum PCT, CRP or IL-6 values, bacterial pneumonia is probable.     

降钙素原对不同热程不明原因发热儿童严重细菌感染诊断价值的Meta分析

目的 探讨降钙素原（PCT）对不同热程不明原因发热儿童严重细菌感染(SBIs)的诊断价值。方法 计算机检索获得PCT对不明原因发热儿童SBIs诊断价值的文献,检索时间为建库至2014年7月,按照QUADAS标准对纳入文献进行质量评估。使用MetaDisc 1.4软件进行Meta分析,对不同平均热程（<24、～48和>48 h）PCT、WBC和中性粒细胞绝对计数（ANC）诊断SBIs的敏感度、特异度等指标进行汇总,并进行异质性检验,绘制综合受试者工作特征曲线（SROC）,计算曲线下面积（AUC）。使用Stata 12.0软件判断发表偏倚并绘制漏斗图。结果 初检到442篇文献,11篇文献符合纳入标准进入Meta分析（中文1篇,英文10篇）。①平均热程<24 h对SBIs的诊断价值：PCT的汇总敏感度和特异度分别为0.75（95％CI：0.69~0.80）和0.80（95％CI：0.77~0.83）,SROC AUC为0.870（95％CI：0.817~0.923）;WBC的汇总敏感度和特异度分别为0.48（95％CI：0.41~0.55）和0.54（95％CI：0.51~0.58）,AUC为0.484（95％CI：0.440~0.663）;ANC的汇总敏感度和特异度分别为0.30（95％CI：0.21~0.40）和0.78（95％CI：0.73~0.83）。②平均热程24~48 h对SBIs的诊断价值：PCT的汇总敏感度和特异度分别为0.86（95％CI：0.79~0.91）和0.63（95％CI：0.60~0.67）,AUC为0.857（95％CI：0.761~0.953）;WBC的汇总敏感度和特异度分别为0.54（95％CI：0.44~0.65）和0.46（95％CI：0.41~0.51）,AUC为0.558（95％CI：0.479~0.636）;ANC的汇总敏感度和特异度分别为0.47（95％CI：0.28~0.66）和0.12（95％CI：0.08~0.17）。③平均热程>48 h对SBIs的诊断价值：PCT 的汇总敏感度和特异度分别为0.83（95％CI：0.75~0.90）和0.55（95％CI：0.50~0.59）,AUC为0.816（95％CI：0.596~0.996）;2篇WBC文献的敏感度分别为0.69（95％CI：0.41~0.89）和0.34（95％CI：0.28~0.41）,特异度分别为0.81（95％CI：0.69~0.91）和0.29（95％CI：0.24~0.35）;ANC的敏感度和特异度分别为0.87（95％CI：0.75~0.95）和0.40（95％CI：0.34~0.46）。结论 对不明原因发热儿童诊断SBIs的价值,发热<24 h检测PCT有较高的特异度;发热24~48 h检测PCT有较高的敏感度。     

Procalcitonin versus CRP as an early indicator of fetal infection in preterm premature rupture of membranes

The aim of this study was to examine the diagnostic sensitivity and specificity of C-reactive protein (CRP) and procalcitonin (PCT) in neonates who were born after preterm premature rupture of membranes (PPROM) and compare these with interleukin-6 (IL-6). The study involved 74 preterm neonates who were born after PPROM. IL-6, CRP, complete blood count and leukocyte ratios, and PCT levels were measured in the 1st day of life, and CRP, PCT, and blood counts were repeated on the 3rd day of life. Seventy-four infants with PPROM were divided into two groups according to the development of sepsis and infection (Group 1: sepsis, n = 32; Group 2: no sepsis, n = 42). There were no significant differences between these groups with respect to gestational age, birthweight and duration of membrane rupture. There were significant differences between the two groups in the 1st day CRP (Group 1: 0.85 -/+ 1.36 mg/dl, Group 2: 0.23 +/- 0.25 mg/dl; p = 0.016), 1st day PCT (Group 1: 7.2 +/- 7.6 ng/ml, Group 2, 1.6 +/- 4.0 ng/ml; p < 0.001), and 3rd day PCT (Group 1: 9.01 +/-11.5 ng/ml, Group 2: 1.34 +/- 1.35 ng/ml; p = 0.001) and IL-6 (Group 1: 80.7 +/- 67.2 pg/ml, Group 2: 3.4 +/- 3.5 ng/ml; p < 0.001) levels. CRP levels were not significantly different between Group 1 (1.2 +/- 1.7 mg/dl) and Group 2 (0.58 +/- 1.1 mg/dl) on the 3rd day of life (p=0.059). CRP levels on the 1st day of life had a cut-off value of 0.72 mg/dl with a sensitivity and specificity of 56% and 58%, respectively. CRP levels on the 3rd day had a cut-off level of 0.78 mg/dl with 60% sensitivity and 63% specificity. PCT levels had a cut-off level of 1.74 ng/ml with 76% sensitivity and 85% specificity on the 1st day of life, and of 1.8 with 89% sensitivity and 86% specificity on the 3rd day of life. Statistical analysis revealed that the cut-off value of 7.6 pg/ml for IL-6 had a 93% sensitivity and 96.7% specificity. Interleukin (IL)-6 is the most reliable marker for the detection of early-onset sepsis in preterm neonates with PPROM. Early PCT levels seemed to be more sensitive than early CRP in this population.     

Procalcitonin and interleukin-6 in the diagnosis of early-onset sepsis of the neonate

The reliability of procalcitonin (PCT) and interleukin-6 (IL-6) was determined and compared with that of C-reactive protein (CRP) in the diagnosis of early-onset sepsis of the neonate within the first 12 h of life. ROC analysis of values of 41 neonates with blood-cultures-positive and clinical sepsis compared with those of 27 uninfected neonates revealed sensitivities for PCT (> or = 6 ng/mL), IL-6 (> or = 60 pg/mL), and CRP (> or = 2.5 mg/L) of 77%, 54%, and 69% and specificities of 91%, 100% and 96%, respectively. Sensitivity of CRP at > or = 8 mg/L was 49% (p = 0.012 compared to PCT). CONCLUSION: PCT was the most sensitive diagnostic parameter in the diagnosis of early-onset sepsis within 12 h of life.     

感染对阑尾Cajal间质细胞的影响

目的 研究感染对阑尾Cajal间质细胞(interstitial cells of Cajal,ICCs)表型的影响.方法 收集2008年1月至6月间我科收治64例化脓性阑尾炎和24例阑尾炎穿孔伴腹膜炎为病例组,并以17例阑尾脓肿治愈后6个月再次手术及非炎症性阑尾切除15例患儿作为对照.取阑尾全层组织行HE染色及c-Kit+免疫组织化学染色(Envision二步法),对照分析阑尾ICCs的c-Kit+表达情况,并同时分析4组患儿C反应蛋白(CRP)和前降钙素(PCT)的改变.结论 c-Kit+ICCs在脓肿后组分布较均匀,ICCs间距小,构成网络状结构.脓肿后组与对照组差异无统计学意义(P＝0.687);化脓组、腹膜炎组均分别较对照组明显减少,网络状结构破坏,差异有统计学意义(P＜0.001),腹膜炎组ICCs较化脓组减少更明显,差异有统计学意义(P＜0.001).CRP在化脓组(28.7±8.4)mg/L、腹膜炎组(116.1±34.3) mg/L较脓肿后组(2.8±0.6)mg/L均有明显升高(P＜0.001),腹膜炎组较化脓组升高更明显(P＜0.001),脓肿后组与对照组(2.2±0.4)mg/L均在正常范围;PCT在化脓组(0.96±0.31) ng/ml、腹膜炎组(2.08±0.59ng/ml)较脓肿后组(0.32±0.09)ng/ml均有明显升高(P＜0.001),腹膜炎组较化脓组升高更明显(P＜0.001),脓肿后组与对照组(0.17±0.04)ng/ml均在正常范围.结论 感染与阑尾ICCs表型改变有关,感染越重c-Kit+ICCs减少越明显.感染控制后ICCs表型可恢复,网络状结构重新建立.

Abstract：

Objective To investigate the phenotypic alterations of interstitial cells of Cajal(ICCs) in children with appendicitis.Methods Appendectomy specimens and the levels of CRP and PCT from 64 patients with suppurative appendicitis(suppurative group),24 patients of perforated appendicitis with peritonitis(peritonitis group) and 17 patients with appendiceal abscess accepted conservative treatment and then with elective interval appendectomy 6 months later(abscess group) were respectively compared with appendectomy specimens and CRP and PCT from 15 control patients with congenital malrotation of intestine(control group).We investigated the ICCs distribution in 120 appendices of these patients using immunohistochemistry and anti-c-kit antibodies.Results Compared to control group,c-Kit+ICCs were abundant and showed a network structure in the appendices of abscess group and there was no significant difference between them.The number of c-kit+ ICCs was remarkably reduced or even disappeared and the network structures was destroyed in the both suppurative group and peritonitis group,and were significant less than those of the controls,there was a significant difference between suppurative group and peritonitis group in the distribution of c-Kit+ICCs.The CRP and PCT were significantly elevated in suppurative group (28.7±8.4mg/L,0.96±0.31ng/ml)and peritonitis group (116.1±34.3mg/L,2.08±0.59ng/ml),but maintained in normal levels in abscess group(2.8±0.6mg/L,0.32±0.09ng/ml).Conclusions Infection might lead to temporary losses of the phenotype and the network structure of ICCs,but these alterations can be recovered with recession of infection.     

Role of procalcitonin, C-reactive protein, interleukin-6, interleukin-8 and tumor necrosis factor-alpha in the diagnosis of neonatal sepsis

Diagnosis of neonatal sepsis may be difficult because clinical presentations are often nonspecific, bacterial cultures are time-consuming and other laboratory tests lack sensitivity and specificity. In this study, we aimed to investigate the role of procalcitonin (PCT), C-reactive protein (CRP), interleukin (IL)-6, IL-8 and tumor necrosis factor-alpha (TNF-alpha) in establishing the diagnosis and evaluating the prognosis of neonatal sepsis. Twenty-six neonates with blood-culture positivity and clinical sepsis, hospitalized for clinical suspicion of neonatal sepsis in neonatal intensive care units of Balcali Hospital, Cukurova University and Adana State Hospital between May 2000 and January 2001 (Group I) and 29 healthy neonates followed at the neonatal units and outpatient clinics of these hospitals (Group II) in the same period were studied. Among the septic neonates, 13 had early-onset (Group Ia) and 13 had late-onset (Group Ib) neonatal sepsis, while 14 of the healthy neonates had perinatal risk factors (Group IIa) and 15 of them had no risk factors (Group IIb). The demographic and clinical characteristics of the septic and healthy neonates were recorded, blood samples for determining serum PCT, CRP, IL-6, IL-8 and TNF-alpha were collected from the healthy and the septic neonates before starting treatment, and these investigations were repeated on the 3rd and 7th days of treatment. In this study, it was found that: (a) pre-treatment mean serum PCT, CRP, IL-6, IL-8 and TNF-alpha levels were significantly higher in the septic neonates than in the healthy ones, (b) compared with the pre-treatment values, serum PCT, IL-6 and TNF-alpha had progressively decreased on the 3rd and 7th days of the treatment in the 17 recovered patients, though they progressively increased in nine patients who died during treatment, (c) the area under the receiver operating characteristic (ROC) curve (AUC) for PCT, TNF-alpha, IL-6, CRP, and IL-8 were 1.00, 1.00, 0.97, 0.90 and 0.68, respectively. For the cut-off value of PCT > or = 0.34 ng/ml, the test was found to have a sensitivity of 100%, specificity of 96.5%, positive predictive value of 96.2%, negative predictive value of 100% and diagnostic efficacy of 98.3% for bacterial sepsis in neonates. For the cut-off value of TNF-alpha > or = 7.5 pg/ml, sensitivity, specificity, positive predictive value, negative predictive value and diagnostic efficacy were found to be 100%, 96.6%, 96.2%, 96.5% and 98.3%, respectively. It was detected that sensitivity, specificity and diagnostic efficacy values were lower for IL-6, CRP and IL-8. We conclude that PCT and TNF-alpha are the best markers in the diagnosis of neonatal sepsis, and these markers are also valuable in following the effectiveness of treatment and determining the prognosis of the disease.