儿童血流感染病原菌分布情况及mNAP、Presepsin、TREM-1的早期预测价值  

Distribution of pathogenic bacteria in children with bloodstream infection and the early predictive value of mNAP,Presepsin and TREM-1

作　　者：刘新光[1] 李清涛[2] 张玉东 贾永萍 Liu Xinguang;Li Qingtao;Zhang Yudong;Jia Yongping(Department of Laboratory Medicine,Hebei Children's Hospital,Shijiazhuang 050031,China;不详)

机构地区：[1]河北省儿童医院检验科,石家庄050031 [2]河北省儿童医院呼吸科,石家庄050031 [3]河北省儿童医院新生儿科,石家庄050031

出　　处：《疑难病杂志》2021年第4期378-382,共5页Chinese Journal of Difficult and Complicated Cases

基　　金：河北省医学科学研究重点课题计划(20180645)。

摘　　要：目的探讨儿童血流感染的病原菌分布情况及中性粒细胞膜碱性磷酸酶(mNAP)、可溶性白细胞分化抗原14亚型(Presepsin)、髓系细胞触发受体-1(TREM-1)的早期预测价值。方法收集2018年5月—2019年5月在河北省儿童医院住院的血流感染患儿207例作为血流感染组,分析其血培养阳性率及病原菌分布情况。根据血培养结果分为阳性亚组(107例)和阴性亚组(100例);另纳入健康体检儿童100例作为健康对照组。分析各组患儿血清降钙素原(PCT)、C反应蛋白(CRP)、mNAP、Presepsin、TREM-1水平的差异。采用受试者工作特征曲线(ROC)分析血清mNAP、Presepsin、TREM-1水平对儿童血流感染的预测价值。结果血流感染组患儿血清PCT、CRP、mNAP、Presepsin、TREM-1水平均显著高于健康对照组(t=300.40,97.29,308.60,78.74,59.84,P均<0.05),且阳性亚组患儿血清PCT、CRP、mNAP、Presepsin、TREM-1水平高于阴性亚组(t=14.89,37.72,8.81,43.05,11.09,P均<0.05);细菌培养阳性亚组中,革兰阴性菌38例(35.51%),革兰阳性菌69例(64.49%),革兰阴性菌感染患儿血清PCT、CRP、mNAP、Presepsin、TREM-1水平高于革兰阳性菌感染患儿(t=4.58,5.21,15.23,7.07,3.86,P均<0.05)。ROC曲线显示,血清mNAP、Presepsin、TREM-1水平预测儿童血流感染的AUC分别为0.861(95%CI 0.813~0.909)、0.792(95%CI 0.731~0.853)和0.894(95%CI 0.849~0.940)。结论儿童血流感染以革兰阳性菌占多数,较高的mNAP、Presepsin、TREM-1水平对血流感染的确诊具有早期预警价值。Objective To investigate the distribution of pathogenic bacteria in children with bloodstream infection and the early predictive value of mNAP,Presepsin and TREM-1.Methods 207 children with bloodstream infection in Hebei children's Hospital from May 2018 to May 2019 were collected as bloodstream infection group,and the positive rate of blood culture and distribution of pathogenic bacteria were analyzed.According to the results of blood culture,they were divided into positive subgroup(107 cases)and negative subgroup(100 cases);another 100 healthy children were included as healthy control group.To analyze the differences of serum procalcitonin(PCT),C-reactive protein(CRP),alkaline phosphatase on the neutrophils membrane surface(mNAP),presepsin and triggering receptor-1 expressed on myeloid cells(TREM-1)levels in children with different pathogen infection.Receiver operating characteristic(ROC)curve was used to analyze the predictive value of mNAP,presepsin and TREM-1 levels in children with bloodstream infection.Results The serum levels of PCT,CRP,mNAP,presepsin and TREM-1 in bloodstream infection group were significantly higher than those in healthy control group(t=300.4,97.29,308.60,78.74,59.84,P<0.05),and the levels of PCT,CRP,mNAP,Presepsin and TREM-1 in positive subgroup were higher than those in negative subgroup(t=14.89,37.72,8.81,43.05,11.09,P<0.05).There were 38 cases(35.51%)of Gram-negative bacteria and 69 cases(64.49%)of Gram-positive bacterias in the bloodstream infection group.The levels of PCT,CRP,mNAP,presepsin and TREM-1 in children with Gram-negative bacteria were generally higher than those in children with Gram-positive bacteria(t=4.58,5.21,15.23,7.07,3.86,P<0.05).ROC curve showed that the mNAP,presepsin and TREM-1 levels had early predictive value for bloodstream infection in children.AUC were 0.861(95%CI 0.813-0.909),0.792(95%CI 0.731-0.853)and 0.894(95%CI 0.849-0.940).Conclusion Gram-positive bacteria is the majority of bloodstream infections in children,and higher levels of mNAP,presepsin and

关 键 词：血流感染 革兰阳性菌 革兰阴性菌 中性粒细胞膜碱性磷酸酶 可溶性白细胞分化抗原14亚型 髓系细胞触发受体-1 儿童 

分 类 号：R446.11[医药卫生—诊断学]