重症肺炎患儿血清细胞因子、C反应蛋白及白细胞的临床检测意义

摘要

目的：分析重症肺炎患儿血清细胞因子、C 反应蛋白及白细胞的临床检测意义。方法选取2014年3月至2015年3月凉山彝族自治州第一人民医院长安分院收治的肺炎患儿86例，根据病情严重程度分为重症肺炎组和普通肺炎组，各43例。观察两组患儿临床症状，比较血清细胞因子［肿瘤坏死因子α（TNF-α）、可溶性细胞间黏附分子1（sICAM-1）、白细胞介素（IL）6、IL-8］、C 反应蛋白（CRP）及白细胞（WBC）水平变化情况。结果重症肺炎组出现寒战或高热、呼吸困难、烦躁等临床症状的患儿比例均高于普通肺炎组，差异有统计学意义（P ＜0．01）。急性期，重症肺炎组患儿的TNF-α、sICAM-1、IL-6、IL-8、CRP 及WBC 水平均高于普通肺炎组［（52．7±5．4） ng／L 比（36．0±5．5） ng／L，（41．6±4．2） pg／L 比（25．7±3．6） pg／L，（45．4±4．3） ng／L 比（23．6±2．5） ng／L，（40．4±5．5） ng／L 比（28．6±3．5） ng／L，（32．6±4．2） mg／L 比（12．2±1．6） mg／L，（12．0±1．3）×109／L 比（9．1±1．4）×109／L］，差异有统计学意义（P ＜0．01）。恢复期，两组患儿的TNF-α、sICAM-1、IL-6、IL-8、CRP 及WBC 水平较急性期均降低；且重症肺炎组患儿的TNF-α、sICAM-1、IL-6、IL-8、CRP及WBC 水平均显著高于普通肺炎组［（27．4±3．2） ng／L 比（12．4±1．4） ng／L，（22．6±3．3） pg／L 比（9．0±1．1） pg／L，（25．6±1．2） ng／L 比（10．7±1．6 ng／L），（20．8±3．4） ng／L 比（11．2±1．5） ng／L，（10．4±1．0） mg／L 比（5．3±0．6） mg／L，（8．4±1．2）×109／L 比（7．3±1．0）×109／L］，差异有统计学意义（P ＜0．01）。结论重症肺炎患儿TNF-α、sICAM-1、IL-6、IL-8、CRP 及WBC 的检测，对临床治疗有指导作用，可以采取及时、准确的治疗，从而提高重症肺炎患儿治疗的有效率，也有助于预后评估。%Objective To analyze the clinical detection significance of serum cytokines,C reactive pro-tein (CRP) and white cell(WBC) of children with severe pneumonia.Methods Total of 86 children with pneumonia in the First People′s Hospital of Liangshan Yi Autonomous Prefecture Chang′an Branch from Mar.2014 to Mar.2015 were included in the study,according to the severity of pneumonia they were divided into a severe pneumonia group and an ordinary pneumonia group,43 patients each.Clinical symptoms were observed and serum cytokines[tumor necrosis factor-α(TNF-α),soluble intercellular adhesion molecule-1 (sICAM-1),interleukin(IL)-6,IL-8],CRP and WBC level changes were compared.Results The propor-tions of children with symptoms of fever or chills,difficult breathing,irritability,etc.of the severe pneumonia group were higher than the ordinary pneumonia group, the differences were statistically significant ( P <0.01).In acute stage,the level of TNF-α,sICAM-1,IL-6,IL-8,CRP and WBC of the severe pneumonia group were higher the ordinary pneumonia group [ ( 52.7 ±5.4 ) ng/L vs ( 36.0 ±5.5 ) ng/L, ( 41.6 ± 4.20) pg/L vs (25.7 ±3.6) pg/L,(45.4 ±4.3) ng/L vs (23.6 ±2.5) ng/L,(40.4 ±5.5) ng/L vs (28.6 ±3.5) ng/L,(32.6 ±4.2) mg/L vs (12.2 ±1.6) mg/L,(12.0 ±1.3) ×109/L vs (9.1 ± 1.4) ×109/L],the differences were statistically significant(P <0.01).In the recovery stage,the TNF-α, sICAM-1,IL-6,IL-8,CRP and WBC levels of both groups were lower than the acute stage;and the severe pneumonia group were significantly higher than the ordinary pneumonia group[(27.4 ±3.2) ng/L vs (12.4 ± 1.4) ng/L,(22.6 ±3.3) pg/L vs ( 9.0 ±1.1) pg/L,(25.6 ±1.2) ng/L vs (10.7 ±1.6) ng/L, (20.8 ±3.4) ng/L vs (11.2 ±1.5) ng/L,(10.4 ±1.0) mg/L vs (5.3 ±0.6) mg/L,(8.4 ±1.2) × 109/L vs (7.3 ±1.0) ×109/L],the differences were statistically significant(P<0.01).Conclusion The detection of TNF-α,sICAM-1,IL -6,IL-8,CRP and WBC of children with severe pneumonia,can guide the clinical treatment,to implement timely and accurate treatment,to improve the effectiveness of the treatment, and help to assess the prognosis.