白细胞介素6、C反应蛋白和降钙素原等感染指标在链球菌感染暴发中的早期诊断价值

目的 明确白细胞介素6（interleukin-6,IL-6）、C反应蛋白、降钙素原等在链球菌暴发感染早期诊断中的价值.方法 收集2010年10月某单位员工集体宿舍暴发链球菌感染所有患者就诊时及治疗后两次IL-6、血白细胞计数、血中性粒细胞百分数、C反应蛋白、降钙素原等数值,比较患者就诊时和治疗2d后的IL-6、血白细胞计数、血中性粒细胞百分数、C反应蛋白、降钙素原变化,分析炎性因子变化的意义及原因.结果 白细胞、中性粒细胞百分比、IL-6水平就诊时升高明显,治疗2d后白细胞、中性粒细胞百分比、IL-6均明显低于就诊时,分别为（6.5±1.9）×10^9 vs （11.6±3.2）×10^9、（61％±8％）vs（79％±10％）、25.1（16.9,39.2） ng/Lvs1.5（1.5,1.5） ng/L,P=0.000;C反应蛋白水平高于就诊时0.7（0.3,1.6） mg/Lvs2.7（0.9,4.7） mg/L,P=0.000];降钙素原阳性率治疗前后差异无统计学意义（P=0.317）.结论 IL-6在细菌感染早期反应迅速,与白细胞、中性粒细胞百分比升高趋势一致,C反应蛋白升高相对滞后,降钙素原在急性局部细菌感染时无明显升高;IL-6、白细胞、中性粒细胞百分比为此次溶血性链球菌感染的早期诊断提供了依据.

Early diagnostic value of application of IL-6, CRP,PCT in hemolytic streptococcal infection

Objective To investigate the role of serum interleukin-6 （IL-6）, C-reactive protein （CRP） and procalcitonin （PCT） in the early diagnosis of hemolytic streptococcal infection. Methods Clinical data about patients who had streptococcal infection in October 2010, including serum concentrations of IL-6, white blood cell counts, neutrophil percentage, CRP and PCT were determined and compared after clinical treatment, in order to analyze the causes of changing in inflammatory factors. Results The number of leukocyte, neutrophil percentage and the level of IL-6 increased significantly during clinical treatment, and they all decreased after 2 d clinical treatment （11.6 ± 3.2） ×10^9 vs （6.5 ± 1.9）× 10^9, （79% ± 10% vs 61% ± 8%）, 25.1（16.9,39.2） ng/L vs 1.5（1.5,1.5） ng/L], the difference was of statistically significant （P=0.000）. The level of CRP 0.7（0.3, 1.6） mg/L vs 2.7（0.9, 4.7） mg/L] increased significantly after medical treatment, and the positive rate of PCT had no significant differences between before and after treatment. Conclusion The reaction of IL-6 is rapid in the early time of bacterial infection, and it has a consistent trend with WBC and N%. The increase of CRP level is lagging behind, and PCT shows no significant increase in acute focal bacterial infection. IL-6, WBC and N% are the diagnostic clues in the early diagnosis of hemolytic streptococcal infection.