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目的了解白细胞计数(WBC)、C-反应蛋白(CRP)、红细胞沉降率(ESR)和中性粒细胞计数(ANC)在筛查肺炎链球菌感染所致儿童肺炎(PNC)中的应用价值。方法收集2006年5月-2007年3月间在我院门诊和住院经影像学确诊为肺炎的患儿(161例)急性期和恢复期病人血清进行检测。急性期血标本用免疫比浊法测CRP,韦斯特伦法测ESR,全自动三分类血球计数仪测WBC,并采外周血计算ANC。恢复期血标本同样也用免疫比浊法测CRP,韦斯特伦法测ESR,全自动三分类血球计数仪测WBC,采外周血计算ANC。结果肺泡性肺炎患儿(53人)血清中CRP和ESR水平明显高于间质性肺炎患儿(108人)水平,PNC患儿(29人)血清CRP、ESR和ANC水平显著高于病毒性肺炎患儿(23人)水平,细菌和病毒混合感染型肺炎患儿血清CRP、ESR和ANC水平介于单纯细菌性肺部感染和单纯病毒性感染的患儿(17人)之间。将所有经特异性血清学检查确认为肺炎链球菌感染的病例(共46例)纳入诊断参数评估中,在细菌感染型肺炎病例中,当将CRP的正常最低阈值定为60mg/L时,CRP的诊断敏感性为26%,特异性为83%。结论检测血清CRP和ESR在细菌感染性肺炎和非细菌感染性肺炎鉴别诊断中的作用有限,而CRP被推荐为首选筛选指标,其正常最低阈值为60mg/L。
Objective To investigate the value of white blood cell count (WBC), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and neutrophil count (ANC) in the screening of children with pneumonia (PNC) Methods A total of 161 acute and convalescent sera from 161 outpatients and inpatients diagnosed as pneumonia in our hospital from May 2006 to March 2007 were collected. Acute phase of blood samples were measured by immunoturbidimetry CRP, Westerster test ESR, automatic three-class blood cell count WBC measured, and the calculation of peripheral blood ANC. Convalescent blood samples were also measured by immunoturbidimetry CRP, Westertron test ESR, automatic three-category blood cell count WBC, peripheral blood count ANC. Results Serum levels of CRP and ESR were significantly higher in children with alveolar pneumonia (n = 53) than those with interstitial pneumonia (n = 108). Serum levels of CRP, ESR and ANC were significantly higher in children with PNC than in those with viral pneumonia Serum levels of CRP, ESR and ANC in children with pneumonia (23), children with bacterial and viral mixed pneumonia were between those with bacterial pneumonia alone and those with viral infection alone (17). All the cases of confirmed S. pneumoniae infection by specific serological tests (46 cases) were included in the evaluation of diagnostic parameters. In the case of bacterial pneumonia, when the normal minimum threshold of CRP was 60 mg / L, CRP The diagnostic sensitivity was 26% and the specificity was 83%. Conclusion The detection of serum CRP and ESR in the differential diagnosis of bacterial pneumonia and non-bacterial pneumonia is limited, and CRP is recommended as the primary screening index with the normal minimum threshold of 60mg / L.