儿童支气管肺炎病原菌及血清IL-6和SAA水平  

Pathogens isolated from children with bronchopneumonia and levels of serum IL-6 and SAA

作　　者：周谨 谭志团 卓珠琳 陈秋丽 陈才女 ZHOU Jin;TAN Zhi-tuan;ZHUO Zhu-lin;CHEN Qiu-li;CHEN Cai-nyu(Haikou Hospital of the Maternal and Child Health,Haikou,Hainan 570100,China)

机构地区：[1]海口市妇幼保健院儿科,海南海口570100 [2]海口市妇幼保健院检验科,海南海口570100

出　　处：《中华医院感染学杂志》2020年第16期2540-2543,共4页Chinese Journal of Nosocomiology

基　　金：海南省自然科学基金资助项目(813265)。

摘　　要：目的研究血清白细胞介素-6(Interleukin-6,IL-6)、红细胞沉降率(Erythrocyte sedimentation rate,ESR),血清淀粉样蛋白A(Serum amyloid A,SAA)水平检测在儿童感染性支气管肺炎中的临床价值。方法选取2018年8月-2019年8月海口市妇幼保健院收治的500例小儿支气管肺炎患者设为试验组,另择50例同期入院体检的健康儿童作为对照组。两组均于清晨空腹状态抽取静脉血3~5 ml,采用酶联免疫吸附法(Enzyme-linked immunosorbent assay,ELISA)检测IL-6,采用魏氏检测法检测ESR,采用胶体金法检测SAA。用咽刷在咽后壁刮取适量分泌物放入无菌试管作为痰液标本进行送检或下呼吸道取痰标本。根据患儿症状严重程度将其500例支气管肺炎患儿分为轻度肺炎组(395例)和重度肺炎组(105例)。结果 500例支气管肺炎患儿共检出178株病原菌,其中革兰阳性菌92株占51.69%,革兰阴性菌86株占48.31%。试验组血清IL-6、ESR、SAA水平高于对照组(P<0.05)。重度肺炎组血清IL-6、ESR、SAA水平高于轻度肺炎组(P<0.05)。单独检测中,SAA的诊断效能优于ESR、IL-6,且三项联合检测敏感度、特异度、阳性预测值、阴性预测值和准确性均高于单项检测(P<0.05)。结论监测血清IL-6、ESR、SAA水平能够在一定程度上帮助临床早期诊断患儿发生肺部感染,提供指导治疗方案的方向。通过检测病原微生物,临床医师可对症、合理使用抗菌药物治疗小儿支气管肺炎。OBJECTIVE To investigate the clinical value of serum interleukin-6(IL-6), erythrocyte sedimentation rate(ESR) and serum amyloid A(SAA) levels in children with infectious bronchopneumonia. METHODS A total of 500 children with pediatric bronchopneumonia admitted to Haikou Maternal and Child Health Hospital from Aug. 2018 to Aug. 2019 were recruited as the experimental group, and another 50 healthy children under physical examination during the same period were enrolled as the control group. Enzyme linked immunosorbent assay(ELISA) was used to detect IL-6 level;widmanstatten method was used to detect ESR;gold immunochromatographic assay(ICA) was used to detect SAA. With pharyngeal brush, appropriate secretions were scraped from the posterior pharyngeal wall and put into sterile test tube as sputum specimen for examination or sputum specimen of lower respiratory tract. According to the severity of symptoms, 500 children with bronchopneumonia were divided into the mild pneumonia group(395 cases) and severe pneumonia group(105 cases). RESULTS A total of 178 strains of pathogenic bacteria were detected in 500 children with bronchopneumonia, of which 92 strains were gram-positive and 86 strains were gram-negative, which accounted for 51.69% and 48.31%, respectively. The serum levels of IL-6, ESR and SAA in the experiment group were significantly higher than that in the control group(P<0.05). The serum IL-6, ESR and SAA levels in the severe pneumonia group were significantly higher than that in the mild pneumonia group(P<0.05). The diagnostic efficiency of SAA was superior to that of ESR and IL-6;the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of the combination of the three tests were significantly higher than that of the single test(P<0.05). CONCLUSION Monitoring serum IL-6, ESR, and SAA levels can help to diagnose lung infection in children with early diagnosis, and provide guidance for treatment options. By detecting pathogenic microorganisms, clinicians can rational use

关 键 词：小儿支气管肺炎 白细胞介素-6 红细胞沉降率 血清淀粉样蛋白A 诊断价值 

分 类 号：R725.6[医药卫生—儿科]