Differentiation of bacterial and viral community-acquired pneumonia in children
Differentiation of bacterial and viral community-acquired pneumonia in children
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DOI：
10.1111/j.1442-200x.2008.02678.x
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发表时间：
2009-02-01
影响因子：
1.4
通讯作者：
Canciani, Mario
中科院分区：
文献类型：
--
作者：
Don, Massimiliano;Valent, Francesca;Canciani, Mario
儿科社区获得性肺炎（CAP）的微生物特异性诊断以及典型细菌、非典型细菌和病毒性病例之间的区分是困难的。为探讨血清4种非特异性炎症标志物及其联合检测在小儿CAP病原学筛查中的作用，对101例CAP患儿进行了血清降钙素原（PCT）、C反应蛋白（CRP）、血沉（ESR）和白色细胞（WBC）检测，都在胸片上得到了证实68例患者（67%）主要通过血清学检测组（包括15种病原体）获得病因学证据。对于CRP > 100 mg/L、WBC计数> 15 x 10（9）/L、PCT > 1.0 ng/mL和ESR > 65 mm/h的组合，阳性检测结果（LR+）的似然比在肺炎球菌和病毒性CAP之间为2.7，在非典型和病毒性CAP之间为3.9。如果这四个参数中有一个值较高（CRP > 200 mg/L，WBC计数> 22 x 10（9）/L，PCT > 18 ng/mL或ESR > 90 mm/h），LR+变为>= 3.4，这意味着从测试前到测试后疾病概率显著增加。与间质性浸润相比，肺泡放射学浸润与非特异性炎症标志物的较高值相关，但放射学和病因学发现之间无显著相关性。CRP、WBC计数、PCT和ESR或其组合在细菌和病毒儿科CAP之间的筛选中作用有限。如果所有或大部分这些标志物升高，细菌病因是高度可能的，但低值不排除细菌病因。
Microbe-specific diagnosis of pediatric community-acquired pneumonia (CAP) and the distinction between typical-bacterial, atypical-bacterial and viral cases are difficult. The aim of the present study was to evaluate the role of four serum non-specific inflammatory markers and their combinations, supplemented by chest radiological findings, in the screening of bacterial etiology of pediatric CAP.Serum procalcitonin (PCT), serum C-reactive protein (CRP), blood erythrocyte sedimentation rate (ESR) and white blood cell (WBC) counts were determined in 101 children with CAP, all confirmed on chest radiograph. Evidence of etiology was achieved in 68 patients (67%) mainly using a serologic test panel including 15 pathogens.For the combination of CRP > 100 mg/L, WBC count > 15 x 10(9)/L, PCT > 1.0 ng/mL and ESR > 65 mm/h, the likelihood ratio for a positive test result (LR+) was 2.7 in the distinction between pneumococcal and viral CAP and 3.9 between atypical and viral CAP. If there was a higher value in one of these four parameters (CRP > 200 mg/L, WBC count > 22 x 10(9)/L, PCT > 18 ng/mL or ESR > 90 mm/h) LR+ changed to >= 3.4, which means a significant increase from pre-test to post-test disease probability. An alveolar radiological infiltration was associated with higher values in non-specific inflammatory markers when compared with interstitial infiltrates, but there were no significant associations between radiological and etiological findings.CRP, WBC count, PCT and ESR or their combinations have a limited role in screening between bacterial and viral pediatric CAP. If all or most of these markers are elevated, bacterial etiology is highly probable, but low values do not rule out bacterial etiology.