遵义地区儿童感染性腹泻病原学及其sIL-2R诊断价值  

Etiological features of children with infectious diarrhea in Zunyi and diagnostic value of sIL-2R

作　　者：刘庆[1] 李茂花[1] 甘旭 蹇亚丹 杨蓓 LIU Qing;LI Mao-hua;GAN Xu;JIAN Ya-dan;YANG Bei(Zunyi First People's Hospital(The Third Affiliated Hospital of Zunyi Medical College),Zunyi,Guizhou 563000,China)

机构地区：[1]遵义市第一人民医院(遵义医学院第三附属医院)儿科,贵州遵义563000

出　　处：《中华医院感染学杂志》2020年第23期3668-3672,共5页Chinese Journal of Nosocomiology

基　　金：贵州省科研基金资助项目(2017NJ479)。

摘　　要：目的分析遵义地区感染性腹泻患儿病原学特点及血清C-反应蛋白(CRP)、白细胞介素-17(IL-17)、可溶性白介素-2R(sIL-2R)对感染的预测价值。方法选择2019年1月-2019年12月经遵义第一人民医院儿科门诊诊断为急性感染性腹泻的347例患儿为感染组,以同期本单位收治的100例非感染性腹泻患儿为非感染组。无菌采集患儿新鲜粪便标本进行病原菌分离鉴定和轮状病毒(RV)抗原检查,对分离菌株进行药敏试验。采用酶联免疫吸附法(ELISA)检测血清CPR、IL-17和sIL-2R水平;ROC分析血清CPR、IL-17和sIL-2R对感染性腹泻的预测价值。结果 347例感染性腹泻患儿中病原菌检出率为23.92%,RV病毒检出率为15.56%,主要分离病原菌沙门菌属、志贺菌属和大肠埃希菌对氨苄西林、哌拉西林等均具有较高的耐药率,对亚胺培南最敏感,金黄色葡萄球菌对青霉素G、氨苄西林、哌拉西林等均具有较高的耐药性,对万古霉素耐药性最低。感染组血清CRP、IL-17和sIL-2R水平高于非感染组(P<0.05);血清CRP、IL-17和sIL-2R诊断小儿感染性腹泻的AUC依次为0.735、0.720、0.752,联合预测的AUC为0.867。结论小儿感染性腹泻的病原体主要为RV病毒、沙门菌属、志贺菌属等,临床可联合检测血清CRP、IL-17和sIL-2R预测感染性腹泻的发生。OBJECTIVE To analyze etiological features of children with infectious diarrhea in Zunyi and to evaluate the predictive value of serum C-reactive protein(CRP), interleukin-17(IL-17) and soluble interleukin-2 R(sIL-2 R) in infection. METHODS A total of 347 children who were confirmed with acute infectious diarrhea in the pediatrics outpatient of Zunyi first people’s Hospital from Jan. 2019 to Dec. 2019 were enrolled as the infection group, and 100 children without infectious diarrhea who were admitted to the unit in the same period were enrolled as the non-infection group. Fresh stool samples from children were collected aseptically for pathogens isolation and identification and rotavirus(RV) antigen examination. The drug sensitivity tests were performed on the isolated strains. The levels of serum CPR, IL-17 and sIL-2 R were detected by enzyme linked immunosorbent assay(ELISA). Their predictive value in infectious diarrhea was analyzed by ROC curves. RESULTS Among 347 children with infectious diarrhea, detectable rates of pathogens and RV were 23.92% and 15.56%, respectively. The drug resistance rates of main isolated pathogens such as Salmonella, Shigella and Escherichia coli to ampicillin and piperacillin were high, but pathogens were most sensitive to imipenem. The drug resistance rates of Staphylococcus aureus to penicillin G, ampicillin and piperacillin were high, with the lowest drug resistance rate to vancomycin. The levels of serum CRP, IL-17 and sIL-2 R of the infection group were significantly higher than those of the non-infection group(P<0.05). The areas under ROC curves(AUCs) of serum CRP, IL-17 and sIL-2 R in the diagnosis of infectious diarrhea were 0.735, 0.720 and 0.752. And AUC of their combined detection was 0.867. CONCLUSION The main pathogens in children with infectious diarrhea included RV, Salmonella, Shigella, etc. Clinically, combination detection of serum CRP, IL-17 and sIL-2 R can predict occurrence of infectious diarrhea.

关 键 词：感染性腹泻 病原体 C-反应蛋白 白细胞介素-17 可溶性白介素-2R 

分 类 号：R725.1[医药卫生—儿科]