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目的研究血清C-反应蛋白(CRP)、降钙素原(PCT)和免疫功能检测在儿童肺炎中的应用效果。方法选取2015年7月-2016年6月杭州市儿童医院儿童肺炎患儿88例,其中轻度肺炎45例为轻度肺炎组、重症肺炎43例为重症肺炎组。另选取同期健康体检儿童22例为对照组。比较3组儿童入院时、急性期和恢复期白细胞计数(WBC)、CRP、PCT和免疫功能指标(IgM、IgG、CD4~+、CD8~+、CD4~+/CD8~+)。结果入院时重症肺炎组、轻度肺炎组WBC、CRP、PCT水平高于对照组(P<0.05)。重症肺炎组入院时、急性期WBC、CRP、PCT水平高于轻度肺炎组(P<0.05)。重症肺炎组急性期WBC、CRP、PCT水平高于入院时,恢复期低于入院时(P<0.05);轻度肺炎急性期与入院时比较差异无统计学意义(P>0.05),恢复期低于入院时(P<0.05)。CRP、PCT敏感度与特异性、阳性预测值、阴性预测值均优于WBC,CRP、PCT曲线下面积0.790、0.829,截断值13.00 mg/L、11.10 ng/ml。入院时重症肺炎组、轻度肺炎组IgM、IgG高于对照组,CD4~+、CD4~+/CD8~+低于对照组,CD8~+高于对照组(P<0.05)。重症肺炎组,患儿急性期IgM、IgG、CD4~+、CD4~+/CD8~+低于入院时,CD8~+高于入院时(P<0.05),恢复期IgM、IgG、CD8~+低于入院时,CD4~+、CD4~+/CD8~+高于入院时(P<0.05);轻度肺炎组急性期与入院时比较差异无统计学意义(P>0.05),恢复期与入院时比较差异有统计学意义(P<0.05);重症肺炎组、轻度肺炎组恢复期与对照组比较差异无统计学意义(P>0.05)。结论 CRP、PCT联合检测有助于儿童肺炎早期诊断、病情评价、临床用药指导,且优于传统指标;同时免疫功能变化参与儿童肺炎疾病发生发展过程,为临床治疗使用免疫调节剂提供参考依据。
Objective To study the effect of serum C-reactive protein (CRP), procalcitonin (PCT) and immune function in children with pneumonia. Methods From July 2015 to June 2016, 88 children with pneumonia in Hangzhou Children’s Hospital were enrolled. Among them, 45 cases were mild pneumonia, 43 cases were severe pneumonia. The other 22 healthy children were selected as the control group. The WBC, CRP, PCT and immune function indexes (IgM, IgG, CD4 ~ +, CD8 ~ +, CD4 ~ + / CD8 ~ +) of acute and convalescent children were compared at admission. Results The admission of severe pneumonia group, mild pneumonia group WBC, CRP, PCT levels were higher than the control group (P <0.05). Severe pneumonia group admission, acute phase WBC, CRP, PCT levels were higher than mild pneumonia (P <0.05). The levels of WBC, CRP and PCT in patients with severe pneumonia were higher than those in patients admitted to hospital at admission (P <0.05). There was no significant difference between the mild pneumonia and admission (P> 0.05) Lower than admission (P <0.05). The sensitivity and specificity of CRP, PCT, positive predictive value and negative predictive value were all better than those of WBC and CRP. The area under the PCT curve was 0.790 and 0.829, the cutoff was 13.00 mg / L and 11.10 ng / ml, respectively. The levels of IgM and IgG in severe pneumonia group and mild pneumonia group were higher than those in control group on admission. CD4 ~ +, CD4 ~ + / CD8 ~ + were lower than those in control group, and CD8 ~ + was higher than that in control group (P <0.05). In severe pneumonia group, the levels of IgM, IgG, CD4 ~ +, CD4 ~ + / CD8 ~ + in acute stage were lower than admission, CD8 ~ + was higher than that at admission CD4 ~ +, CD4 ~ + / CD8 ~ + were lower than those at admission (P <0.05), but there was no significant difference between the mild pneumonia group and the admission stage (P> 0.05) There were significant differences at admission (P <0.05). There was no significant difference between the severe pneumonia group and the mild pneumonia group and the control group (P> 0.05). Conclusion Combined detection of CRP and PCT is helpful for the early diagnosis of pneumonia in children and the evaluation of the disease and guidance of clinical medication, which is superior to the traditional indicators. At the same time, the changes of immune function are involved in the development and progression of childhood pneumonia and provide a reference for the clinical treatment of immunomodulatory agents.