学龄前儿童细菌性腹泻的病原学特征及PCT、CD64和sTREM-1测定的临床意义

目的:分析学龄前儿童细菌性腹泻的病原学特征及血清中降钙素原(PCT)、中性粒细胞分化群64(CD64)和髓样细胞触发受体-1(s TREM-1)检测的临床意义。方法:选择2017年1月～2018年3月南方医科大学附属东莞市人民医院收治的214例学龄前感染性腹泻患儿为研究对象,包括细菌性腹泻(细菌组,n=101)和病毒性腹泻(病毒组,n=113),以同期入院行儿童保健的113例健康学龄前儿童为对照组。统计细菌组患儿的病原菌种类,比较两组腹泻患儿与对照组儿童血清PCT、CD64和s TREM-1水平的差异、三种血清学指标的阳性率及三种指标对细菌性腹泻患儿的诊断效能。结果:101例细菌性腹泻患儿粪便培养的细菌菌株中,共培养菌株213株,大肠埃希菌、志贺菌属和沙门菌属阳性率最高,分别占41.78%、23.01%和15.96%;细菌组的血清PCT、CD64和s TREM-1水平及阳性率均高于病毒组和对照组,且病毒组的s TREM-1水平高于对照组(P0.05);三种指标的灵敏度、特异度、阳性预测值和阴性预测值比较,差异无统计学意义(P0.05)。结论:学龄前儿童细菌性腹泻的致病菌主要为革兰阴性菌,PCT、CD64和s TREM-1均可作为判断细菌性腹泻的早期敏感指标。

Etiology Characteristics and Clinical Significance of PCT, CD64 and sTREM-1 in Preschool Children with Bacterial Diarrhea

ABSTRACT Objective: To analyze the etiology characteristics and the clinical significance of serum procalcitonin (PCT), cluster of differentiation 64 (CD64) and soluble triggering receptors expressed on myeloid cells-1 (sTREM-1) in preschool children with bacterial diarrhea. Methods: 214 children with infectious diarrhea who were admitted to Dongguan People''s Hospital Affiliated to Southern Medical University from January 2017 to March 2018 were selected as research subjects. It included bacterial diarrhea (bacterial group,n=101) and viral diarrhea (viral group, n=113), and 113 healthy school age children who were admitted to hospital during the same period were selected as control group. The types of pathogens in the bacterial group were counted, and the differences of serum PCT,CD64 and sTREM-1 levels between the two groups of diarrhea children and the control group were compared, and the positive rates of three serological indicators and the diagnostic efficacy of the three indicators for children with bacterial diarrhea were also compared. Results: Among the 101 Bacterial diarrhea in children, 213 bacterial strains were cultured in feces. The positive rates of Escherichia coli,Shigella and Salmonella were the highest, accounting for 41.78%, 23.01% and 15.96% respectively. The levels and positive rates of serum PCT, CD64 index and sTREM-1 in bacterial group were higher than those in viral group and control group, and the sTREM-1 level in viral group was higher than those in control group (P<0.05). The sensitivity, specificity, positive predictive value and negative predictive value of the three indexes were compared, the differences were not statistically significant (P>0.05). Conclusion: The main pathogens in preschool children with bacterial diarrhea are Gram-negative bacteria.The PCT, CD64 index and sTREM-1 could be used as early sensitive indicators for judging bacterial diarrhea.