目的 探讨炎性指标在确诊感染性疾病的发热待查(fever of unknown origin,FUO)患者中的变化,为鉴别感染性疾病提供帮助。方法 选取2016-01至2018-01首都医科大学宣武医院以FUO入院,确诊感染性疾病的患者,包括病毒感染、细菌感染(结核感染、布氏杆菌病、细菌性心内膜炎、肺部感染及泌尿系感染等)和真菌感染患者。临床观察指标包括:患者的一般状况、发热持续时间,以及患者入院首次检测的外周血白细胞(WBC)、红细胞沉降率(ESR)、C-反应蛋白(CRP)及降钙素原(PCT)等指标水平。结果 共收集FUO患者300例,其中确诊感染性疾病患者64例(21.3%)。64例中,病毒感染13例,细菌感染39例(结核感染11例,布氏杆菌病6例,细菌性心内膜炎12例,肺部或泌尿道感染10例),真菌感染12例。ESR水平在细菌感染[(62.6±33.3)mm/h]与真菌感染[(26.6±32.0)mm/h]患者中差异有统计学意义(P=0.034);CRP在病毒感染[(32.1±31.7)mg/L]与细菌感染[(54.8±43.0)mg/L]、细菌感染[(54.8±43.0)mg/L]与真菌感染[(17.2±20.2)mg/L]患者中差异均具有统计学意义(P=0.03);WBC和PCT水平在病毒感染、细菌感染及真菌感染患者间差异无统计学意义。而在不同细菌感染疾病患者中,WBC、ESR、CRP及PCT等均无统计学差异。通过ROC曲线计算,CRP在鉴别细菌感染与病毒感染灵敏度为77.1%,阈值为84.5mg/L;ESR在鉴别细菌感染及真菌的灵敏度为84.4%,阈值为45 mm/h。结论 CRP与ESR水平在FUO患者鉴别不同感染具有一定临床意义,WBC水平意义不大,PCT水平需谨慎解读。
Abstract
Objective To study the effect of inflammatory markers on patients with infectious diseases presenting fever of unknown origin (FUO).Methods Patients with FUO were enrolled into this study in Xuanwu Hospital between January 1, 2016 and December 1, 2018. These patients with infectious diseases were divided into the viral infection group, bacterial infection group (tuberculosis infection, brucellosis, bacterial endocarditis, lung and urine tract infection), and fungi infection group. Clinical variables included the patients’ general condition and duration of fever. The serum WBC( white blood cell), ESR(erythrocyte sedimentation rate), CRP(c-reactive protein), PCT(procalcitonin)levels were recorded upon admission.Results A total of 300 patients with FUO were enrolled. There were 64(21.3%) patients with infectious diseases, including 13 patients with viral infections, 39 patients with bacterial infections (11 patients with tuberculosis, 6 patients with brucellosis, 12 patients with bacterial endocarditis, 10 patients with lung or urine tract infections) and 12 patients with fungi infections. There was significant deference between the serum ESR levels in bacterial infection patients[(62.6±33.3)mm/h] and those of fungi infection patients [(26.6±32)mm/h] (P=0.03). The serum CRP levels[(54.8±43)mg/L] in bacterial infection patients and viral infection patients[(32.1±31.7)mg/L] were significantly different, as with bacterial infection patients and fungi infection patients (P=0.03). The serum WBC levels and PCT levels were not significantly dfferent between the three groups. The serum WBC, ESR, CRP and PCT levels were not significantly different between the bacterial infection groups. The sensitivity of CRP for distinguishing bacterial infections from viral infections was 77.1%. Its cut-off value was 84.5 mg/L, compared with 84.4% and 45 mm/h for ESR when used for distinguishing fungi infections from bacterial infections.Conclusions ESR and CRP can help distinguish different types of infections in FUO patients, but the serum PCT and WBC are of limited significance.
关键词
发热待查 /
炎性指标 /
病毒感染 /
细菌感染 /
真菌感染
Key words
fever of unknown origin /
inflammatory marker /
viral infection /
bacterial infection /
fungi infection
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参考文献
[1] 张文宏,李太生. 发热待查专家共识[J]. 中华传染病杂志, 2017, 35(11): 641-654.
[2] Christ-Crain M, Jaccard-Stolz D, Bingisser R, et al. Effect of procalcitonin-guided treatment on antibiotic use and outcome in lower respiratory tract infections: cluster-randomised, single-blinded intervention trial [J]. Lancet, 2004, 363(9409):600.
[3] Christ-Crain M, Jaccard-Stolz D,Bingisser R, et al. Procalcitonin guidance of antibiotic therapy in community-acquired pneumonia: a randomized trial [J]. Am J Respir Crit Care Med, 2006, 174(1): 84.
[4] Zhai Y Z, Chen X, Liu X, et al, Clinical analysis of 215 consecutive cases with fever of unknown origin[J]. Medicine, 2018, 97(24): e10986.
[5] Shi X C, Liu X Q, Zhou B T, et al. Major causes of fever of unknown origin at Peking Union Medical College Hospital in the past 26 years[J]. Chin Med J (Engl), 2013, 126(5): 808-812.
[6] Self W H, Balk R A, Grijalva C G, et al. Procalcitonin as a marker of etiology in adults hospitalized with community-acquired pneumonia[J]. Clin Infect Dis, 2017,65(2):183-190.
[7] Kamat I S, Ramachandran V, Eswaran H, et al. Low procalcitonin, community acquired pneumonia, and antibiotic therapy [J]. Lancet Infect Dis, 2018,18(5):496-497.
[8] Korkmaz P, Koak H, OnbaK, et al. The role of serum procalcitonin, interleukin-6, and fibrinogen levels in differential diagnosis of diabetic foot ulcer infection[J]. J Diabetes Res, 2018(2):1-7.
[9] Verlinden A, De Vroey V, Goossens H, et al. Comparison of the power of procalcitonin and c-reactive protein to discriminate between different aetiologies of fever in prolonged profound neutropenia: a single-center prospective observational study[J]. Mediterr J Hematol Infect Dis, 2019, 11(1): e2019023.
[10] Linssen C F, Bekers O, Drent M, et al. C-reactive protein and procalcitonin concentrations in bronchoalveolar lavage fluid as a predictor of ventilator-associated pneumonia [J]. Ann Clin Biochem, 2008,45(5): 293-298.
[11] Christensen A M, Thomsen M K, Ovesen T, et al. Are procalcitonin or other infection markers useful in the detection of group A streptococcal acute tonsillitis? [J]. Scand J Infect Dis, 2014, 46(5): 376-383.
[12] Pallin D J, Bry L, Dwyer R C, et al. Toward an objective diagnostic test for bacterial cellulitis[J]. PLoS One, 2016, 11(9): e162947.
[13] Marnell L, Mold C, Du Clos TW. C-reactive protein: ligands, receptors and role in inflammation [J]. Clin Immunol, 2005, 117(2):104-111.
[14] Vanderschueren S, Deeren D, Knockaert D C, et al. Extremely elevated C-reactive protein[J]. Eur J Intern Med, 2006, 17(6): 430-433.
[15] Krüger S, Ewig S, Papassotiriou J, et al. Inflammatory parameters predict etiologic patterns but do not allow for individual prediction of etiology in patients with CAP: results from the German competence network CAPNETZ[J]. Respir Res, 2009, 10(1): 65-75.
[16] Fincher R M, Page M I. Clinical significance of extreme elevation of the erythrocyte sedimentation rate[J]. Arch Intern Med, 1986, 146(8):1581-1583.
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