重组人白介素-11诱导C反应蛋白升高与细菌性感染鉴别的病例对照研究  

Discriminating recombinant human interleukin-11-induced fever and C-reactive protein elevation from bacterial infection: a case-control study

作　　者：刘衡[1] 杨振中 王予川[1] 吴悦[1] 

机构地区：[1]贵州省人民医院儿科,贵阳550002

出　　处：《实用药物与临床》2018年第2期182-186,共5页Practical Pharmacy and Clinical Remedies

摘　　要：目的总结重组人白介素-11(rh IL-11)诱导发热及CRP升高的临床特点,评估降钙素原(PCT)与IL-6等指标早期鉴别细菌感染与rh IL-11治疗反应的价值。方法回顾性分析2013年9月至2017年3月我科ALL化疗后接受rh IL-11治疗患儿的临床资料。化疗期间每1~3 d监测血象、CRP,出现感染或疑似感染表现后24 h内测定降钙素原(PCT)、IL-6、ESR。根据临床表现及辅查资料综合判断,将患儿分为细菌感染组(48例)与非细菌感染组(30例),比较两组发热及CRP升高情况。将非细菌感染组中CRP升高者定义为rh IL-11反应组(19例),比较其与细菌感染组抗菌疗程及上述实验室指标的差别,对差异有统计学意义的指标,绘制ROC曲线评估诊断效能。结果细菌感染组与非细菌感染组发热、CRP升高比例比较差异无统计学意义(P>0.05)。细菌感染组PCT、IL-6高于rh IL-11反应组(P<0.01),粒细胞绝对数(ANC)低于rh IL-11反应组(P<0.01);两组CRP、ESR、Hgb、BPC比较差异无统计学意义(P>0.05)。ANC、IL-6、PCT的ROC曲线下面积(AUC)分别为0.684、0.784、0.820。PCT+IL-6的AUC为0.814,与PCT、IL-6比较差异无统计学意义(P>0.05)。细菌感染组、rh IL-11反应组抗菌治疗中位天数分别为12.5 d(8.0~18.0 d)、5.0 d(4.0~7.0 d)(P<0.05)。结论接受rh IL-11治疗的患者不宜采用CRP指导抗菌治疗。PCT、IL-6对早期鉴别细菌感染与rh IL-11治疗反应具有重要价值。综合临床表现、PCT、IL-6及其他实验室检查,正确识别rh IL-11治疗反应,有助于减少抗生素使用。Objective To summarize the characteristics of recombinant human interleukin-11（ rhIL-11） induced fever and C-reactive protein（ CRP） elevation,and evaluate the role of procalcitonin（ PCT） and Interleukin-6（ IL-6） in discriminating the therapeutic efficacy of rhIL-11 from bacterial infection. Methods The clinical data of patients receiving rhIL-11 treatment from September 2013 to March 2017 were retrospectively reviewed. Blood routine examination and CRP were monitored every 1 - 3 d. Procalcitonin（ PCT）,IL-6 and ESR were measured within 24 h after infection or suspected infection. The patients were divided into bacterial infection group（ n = 48） and non-bacterial infection group（ n = 30） according to final diagnosis based on clinical manifestation and laboratory findings. The CRP and incidence of fever were compared between the two groups. Patients with elevated CRP in non-bacterial infection group were included as rhIL-11 reaction group（ n = 19）. The treatment course with antibacterial agents and the above laboratory parameters were compared between rhIL-11 reaction group and infection group,and the diagnostic performance was assessed by using receiver operating characteristic curves（ ROCs） for indexes with significant differences.Results There was no significant difference in the incidences of fever or CRP elevation between bacterial infection group and non-bacterial infection group（ P〈0. 05）. Compared with rhIL-11-reaction group,the levels of PCT and IL-6 in bacterial infection group were higher（ P〈0. 05）,while the absolute neutrophil count（ ANC） was lower（ P〈0. 01）; no difference was found in the levels of CRP,ESR,Hgb or BPC between the two groups（ P〉0. 05）. The area under ROC curves（ AUC） of ANC,IL-6,PCT and PCT ＋ IL-6 was 0. 684,0. 784,0. 820 and 0. 814,respectively,there being no significant difference between the AUC of PCT ＋ IL-6 and that of PCT or IL-6. The median duration of antibiotic therapy in bacterial infection group was longer

关 键 词：重组人白介素-11 C反应蛋白 降钙素原 白介素-6 细菌感染 

分 类 号：R725.1[医药卫生—儿科]