儿童细菌性脓毒症中富含组氨酸糖蛋白血浆浓度及其诊断价值
| 作者: |
1徐莎,
1肖俊
1 武汉市金银潭医院感染科，武汉 430000 |
| 通讯: |
徐莎
Email: shaxudoctor@sina.com |
| DOI: | 10.3978/j.issn.2095-6959.2019.11.023 |
摘要
目的：探讨血浆富含组氨酸糖蛋白(histidine-rich glycoprotein，HRG)、降钙素原(procalcitonin，PCT)和C反应蛋白(C-reactive protein，CRP)浓度在儿童细菌性脓毒症中的诊断价值。方法：收集2018年1月至12月于武汉市金银潭医院传染病科住院就诊的60例细菌性脓毒症患儿为观察组，同期年龄和性别相匹配的60例健康儿童为对照组。检测并比较观察组治疗前后血浆HRG，PCT和CRP浓度差异，并与对照组进行比较，受试者工作特征(receiver operating characteristic，ROC)曲线分析三者诊断效能。结果：治疗前，观察组血浆HRG浓度显著低于对照组[(28.7±11.3) μg/mL vs (53.0±21.0) μg/mL，P<0.001]；治疗后，HRG浓度升至(38.6±9.7) μg/mL。观察组血浆PCT [(10.9±4.6) μg/L vs (0.5±0.2) μg/L，P<0.01]和CRP [(19.4±6.5) mg/L vs (0.2±0.3) mg/L，P<0.05]浓度均显著高于对照组。治疗后PCT和CRP浓度均较治疗前显著下降(P<0.05)。当截断值为33.2 μg/mL时，血浆HRG浓度诊断脓毒症ROC曲线下面积(area under the curve，AUC)为0.910 (95% CI 0.840~0.940，P<0.001)，优于PCT (AUC 0.754)和CRP (AUC 0.654)。三种标志物联合应用可提高诊断效能，其敏感度和特异度分别为94.6%和96.8%。治疗前血浆HRG与PCT浓度显著正相关(r=0.76，P<0.001)。结论：细菌性脓毒症患儿血浆HRG浓度显著下降，PCT和CRP浓度显著升高，HRG对细菌性脓毒症患儿诊断效能优于PCT和CRP，是细菌性脓毒症的潜在诊断标志物。
关键词：
富含组氨酸糖蛋白；脓毒症；细菌感染；诊断价值
Plasmic concentration of histidine-rich glycoprotein in pediatric bacterial sepsis and its diagnosis value
CorrespondingAuthor: XU Sha Email: shaxudoctor@sina.com
DOI: 10.3978/j.issn.2095-6959.2019.11.023
Abstract
Objective: To investigate the diagnosis value of plasma histidine-rich glycoprotein (HRG), procalcitonin (PCT) and C-reactive protein (CRP) concentrations in pediatric bacterial sepsis. Methods: Sixty pediatric patients diagnosed with bacterial sepsis admitted to the Infectious Disease Department of Jinyintan Hospital of Wuhan from January 2018 to December 2018 were enrolled as an observation group. Sixty healthy children with matched age and sex were selected as a control group. Plasma concentrations of HRG, PCT and CRP before and after treatment in the observation group were detected and compared with those in the control group. The receiver operating characteristic (ROC) curve was used to analyze the diagnosis efficacy of the three markers. Results: Before the treatment, plasma concentration of HRG in the observation group was significantly lower than that in the control group [(28.7±11.3) μg/mL vs (53.0±21.0) μg/mL, P<0.001]. After the treatment, HRG concentration increased to (38.6±9.7) μg/mL. Plasma concentrations of PCT [(10.9±4.6) μg/L vs (0.5±0.2) μg/L, P<0.01] and CRP [(19.4±6.5) mg/L vs (0.2±0.3) mg/L, P<0.05] were significantly higher in the observation group than those in the control group. When the cut-off value was 33.2 μg/mL, the area under the ROC curve (AUC) for sepsis diagnosis by HRG plasma concentration was 0.910 (95% CI 0.840–0.940, P<0.001), superior to those of PCT (AUC 0.754) and CRP (AUC 0.654). Combined application of the three markers significantly improved the diagnosis efficacy, with diagnostic sensitivity and specificity of 94.6% and 96.8%, respectively. Before the treatment, there was significant positive correlation between plasma concentrations of HRG and PCT (r=0.76, P<0.001). Conclusion: In children with bacterial sepsis, plasma concentration of HRG is significantly decreased while concentrations of PCT and CRP are significantly increased. The diagnosis efficacy of HRG is superior to those of PCT and CRP and could be a potential marker for the diagnosis of bacterial sepsis.
Keywords：
histidine-rich glycoprotein; sepsis; bacterial infection; diagnosis value