血清PCT在小儿细菌性和病毒性脑膜炎鉴别诊断中的应用

摘要

Objective To explore the application of serum PCT in differential diagnosis of bacterial and viral meningitis in children.Methods A total of 148 children with bacterial meningitis hospitalized in pediatric department of Ankang Hospital of Traditional Chinese Medicine from February 2015 to May 2016 were selected into bacteria group, and 103 children with viral meningitis were selected in virus group.At the same time 68 healthy children undergoing physical check were selected in control group.Venous blood was extracted from all patients in fasting state with strict aseptic operation on first day after admission.Serum procalcitonin (PCT), erythrocyte sedimentation rate (ESR), white blood-cell count (WBC) and C reactive protein (CRP) of patients in bacteria group, virus group and control groups were compared and analyzed.Pathogenic examination results were observed in bacteria group and virus groups.Results Levels of PCT (t=8.756), CRP (t=53.751) and WBC (t=46.954) in bacteria group were higher than those in virus group but ESR (t=28.049) level in bacteria group was lower than that in virus group, and all differences were statistically significant (all P<0.05).Positive rates of PCT (χ2=200.091) and WBC (χ2=31.619) in bacteria group were higher than those in virus group, and differences were statistically significant (both P<0.05).With increase of PCT concentration, number of children in bacteria group increased gradually, and number of patients in virus group decreased gradually.PCT of patients in bacteria group was higher, but that in virus group was lower.There was significant difference in PCT levels of patients in two groups (χ2=210.744, P<0.01).Conclusion When clinical examination of cerebrospinal fluid can not be done timely because of various reasons, serum PCT detection has important significance in differential diagnosis of bacterial and viral meningitis in children.If combined with detection of WBC, ESR and CRP, the time of diagnosis can be effectively shortened for timely targeted treatment.It is worthy of further clinical observation and promotion.%目的 探讨血清PCT的检测在小儿细菌性和病毒性脑膜炎鉴别诊断中的应用.方法 选取2015年2月至2016年5月在安康市中医医院儿科住院的细菌性脑膜炎患儿148例为细菌组,病毒性脑膜炎患儿103例为病毒组,同时选取68例进行体检的健康儿童为对照组,所有患儿均在入院第1天空腹状态下及严格无菌操作中抽取静脉血液,比较分析细菌组、病毒组、对照组患儿的血清降钙素原(PCT)、红细胞沉降率(ESR)、白细胞计数(WBC)、C-反应蛋白(CRP),观察细菌组和病毒组患儿病原学检查结果.结果 细菌组患儿的PCT(t=8.756)、CRP(t=53.751)、WBC(t=46.954)水平均高于病毒组,ESR(t=28.049)水平则低于病毒组,差异均有统计学意义(均P<0.05);细菌组PCT(χ2=200.091)、WBC(χ2=31.619)阳性率均高于病毒组,差异均有统计学意义(均P<0.05);随着PCT浓度上升,细菌组患儿人数逐渐增加,病毒组人数逐渐减少,细菌组患儿PCT较高,而病毒组PCT浓度较低,两组患儿PCT水平分布比较,差异有统计学意义(χ2=210.744,P<0.01).结论 当临床中因为各种原因不能及时进行脑脊液检查时,血清PCT的检测在小儿细菌性和病毒性脑膜炎的鉴别诊断中有重要意义,如果再联合检测WBC、ESR和CRP等,则能有效缩短诊断时间,及时采取针对性治疗,值得在临床中进一步观察和选择性推广.