Utility of Assessing Cytokine Levels for the Differential Diagnosis of Pneumonia in a Pediatric Population.
Utility of Assessing Cytokine Levels for the Differential Diagnosis of Pneumonia in a Pediatric Population.
复制标题
评估细胞因子水平在儿童肺炎鉴别诊断中的实用性。
DOI：
10.1097/pcc.0000000000001092
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发表时间：
2017
影响因子：
4.1
通讯作者：
Ye Qing
中科院分区：
文献类型：
--
作者：
Zhou Jian-Ming;Ye Qing
目的：肺炎虽易诊断，但由于病原菌检出率较低，导致病原鉴定困难。我们进行了一项前瞻性观察研究，以评估在儿科人群中测量炎症细胞因子水平以区分由典型细菌、呼吸道合胞病毒或肺炎支原体引起的肺炎的效用。设计：对三种不同病原微生物引起的肺炎在疾病早期的血清炎症细胞因子水平进行评估。单位：浙江大学医学院附属儿童医院。患者：细菌性肺炎166例，肺炎支原体182例，呼吸道合胞病毒肺炎167例。结果：典型细菌肺炎患者白细胞介素-6水平明显高于肺炎支原体或呼吸道合胞病毒（p< 0.001）。血清白细胞介素-6浓度曲线下面积为0.997。血清白细胞介素-6≥93.0 pg/mL对细菌性肺炎、呼吸道合胞病毒肺炎和肺炎支原体肺炎的敏感性为100.0%，特异性为99.14%。肺炎支原体肺炎患者白细胞介素-6水平高于呼吸道合胞病毒肺炎患者（p< 0.001）。同时白细胞介素-10水平低于呼吸道合胞病毒肺炎患者，白细胞介素-10水平与细菌性肺炎患者相当，说明肺炎支原体肺炎患者与呼吸道合胞病毒肺炎患者白细胞介素-6/白细胞介素-10比值存在显著差异（白细胞介素-6/白细胞介素-10比值中位数为2.5 vs 0.5, p< 0.001）。当最佳临界值为0.8时，白细胞介素-6/白细胞介素-10的敏感性为90.3%，特异性为88.0%。结论：白细胞介素-6是鉴别细菌性肺炎的良好生物标志物，白细胞介素-6/白细胞介素-10比值是鉴别肺炎支原体肺炎和呼吸道合胞病毒肺炎的有效生物标志物。
Objectives:Although pneumonia is easily diagnosed, determining the causative agent is difficult due to low pathogen detection rates. We performed a prospective observational study to evaluate the utility of measuring inflammatory cytokine levels to discriminate between pneumonia caused by typical bacteria, respiratory syncytial virus, or Mycoplasma pneumoniae in a pediatric population.Design:Serum inflammatory cytokine levels at early stages of the disease were evaluated for pneumonia caused by the three different pathogenic microorganisms.Setting:The Children’s Hospital of Zhejiang University School of Medicine, China.Patients:One hundred sixty-six patients with bacterial pneumonia, 182 with M. pneumonia, and 167 with respiratory syncytial virus pneumonia.Measurements and Main Results:The levels of interleukin-6 for pneumonia were significantly higher with typical bacteria than with either Mycoplasma pneumoniae or respiratory syncytial virus (p< 0.001). The area under the curve for serum concentrations of interleukin-6 was 0.997. A serum interleukin-6 level of greater than or equal to 93.0 pg/mL had 100.0% sensitivity and 99.14% specificity in discriminating bacterial pneumonia from respiratory syncytial virus pneumonia and Mycoplasma pneumoniae pneumonia. The interleukin-6 levels were higher in patients with Mycoplasma pneumoniae pneumonia than in those with respiratory syncytial virus pneumonia (p< 0.001). They also simultaneously had lower interleukin-10 levels than patients with respiratory syncytial virus pneumonia who had interleukin-10 levels comparable to those of patients with bacterial pneumonia, indicating a significant difference in the interleukin-6/interleukin-10 ratio between patients with Mycoplasma pneumoniae pneumonia and respiratory syncytial virus pneumonia (median interleukin-6/interleukin-10 ratio, 2.5 vs 0.5; p< 0.001). At an optimal cut-off value of 0.8, the interleukin-6/interleukin-10 ratio showed 90.3% sensitivity and 88.0% specificity.Conclusions:These results suggest that interleukin-6 is a good biomarker for identifying bacterial pneumonia and that the interleukin-6/interleukin-10 ratio is an effective biomarker for discriminating Mycoplasma pneumoniae pneumonia from respiratory syncytial virus pneumonia.