Butbul-Aviel Yonatan, Koren Ariel, Halevy Raphael, Sakran Waheeb
Pediatric Department B, Ha'Emek Medical Center, Afula, Israel.
Pediatr Emerg Care. 2005 Dec;21(12):828-32. doi: 10.1097/01.pec.0000190226.12610.24.
Plasma procalcitonin (PCT) increases rapidly during bacterial infections but remains low in viral infections and other inflammatory processes. High plasma PCT typically occurs in children with bacterial meningitis, severe bacterial infections, particularly in cases of septic shock or bacteremia, and in renal parenchymal damage. The aim of this study was to test the usefulness of plasma PCT analysis in the diagnosis of osteomyelitis, septic arthritis, and other skeletal inflammatory diseases in pediatric patients admitted because of fever and limping.
White blood cell count, erythrocyte sedimentation rate, C-reactive protein, and PCT levels were measured in children admitted to the pediatric department with fever, limping, and suspected osteomyelitis or septic arthritis. PCT levels were measured by an immunochromatography assay, based on monoclonal and polyclonal antibodies against katacalcin.
Forty-four children were evaluated: 12 (27.3%) were diagnosed with osteomyelitis, 11 (25%) had septic arthritis, 5 children (11.4%) were diagnosed as a soft tissue infection, and transient synovitis or reactive arthritis was diagnosed in another 6 children (13.6%). Four children (9.1%) were diagnosed as having juvenile rheumatoid arthritis, and 6 (13.6%) with different diseases. PCT value was elevated in 7 patients (58.3%) with osteomyelitis, and only 3 children (27.2%) with the diagnosis of septic arthritis had a mildly elevated value. Among the children with other diagnosis, there were no positive PCT values (P < 0.001 between skeletal infection and all other diagnosis).
In this study, PCT was found to be a useful marker in the diagnosis of osteomyelitis and not in septic arthritis. A larger group of patients needed to be studied to confirm our findings.
血浆降钙素原（PCT）在细菌感染期间迅速升高，但在病毒感染和其他炎症过程中保持较低水平。高血浆PCT通常见于患有细菌性脑膜炎、严重细菌感染的儿童，尤其是在脓毒性休克或菌血症病例以及肾实质损伤时。本研究的目的是检验血浆PCT分析在诊断因发热和跛行入院的儿科患者的骨髓炎、化脓性关节炎及其他骨骼炎症性疾病中的实用性。
对因发热、跛行且疑似骨髓炎或化脓性关节炎而入住儿科的儿童进行白细胞计数、红细胞沉降率、C反应蛋白和PCT水平检测。PCT水平通过基于抗降钙素单克隆和多克隆抗体的免疫层析法进行检测。
共评估了44名儿童：12名（27.3%）被诊断为骨髓炎，11名（25%）患有化脓性关节炎，5名儿童（11.4%）被诊断为软组织感染，另有6名儿童（13.6%）被诊断为短暂性滑膜炎或反应性关节炎。4名儿童（9.1%）被诊断为幼年类风湿关节炎，6名（13.6%）患有其他疾病。7名骨髓炎患者（58.3%）的PCT值升高，而诊断为化脓性关节炎的儿童中只有3名（27.2%）的PCT值轻度升高。在其他诊断的儿童中，PCT值均为阴性（骨骼感染与所有其他诊断之间P<0.001）。
在本研究中，发现PCT是骨髓炎诊断中的一个有用标志物，而在化脓性关节炎诊断中并非如此。需要研究更大规模的患者群体以证实我们的发现。
