Knudsen Troels Bygum, Larsen Klaus, Kristiansen Thomas Birk, Møller Holger Jon, Tvede Michael, Eugen-Olsen Jesper, Kronborg Gitte
Department of Infectious Diseases, Copenhagen University Hospitals, Hvidovre, Denmark.
Scand J Infect Dis. 2007;39(6-7):542-53. doi: 10.1080/00365540601113685.
The aim of the study was to evaluate and compare the diagnostic value of sCD163 serum levels with CRP and PCT in meningitis and bacterial infection. An observational cohort study was conducted between February 2001 and February 2005. The study population comprised 55 patients suspected of meningitis on admission to a 27-bed infectious disease department at a Danish university hospital. Biomarker serum levels on admission were measured. Sensitivity and specificity were evaluated at pre-specified cut-off values and overall diagnostic accuracies were compared using receiver-operating characteristic AUCs (areas under curves). Patients were classified by 2 sets of diagnostic criteria into: A) purulent meningitis, serous meningitis or non-meningitis, and B) systemic bacterial infection, local bacterial infection or non-bacterial disease. An elevated serum level of sCD163 was the most specific marker for distinguishing bacterial infection from non-bacterial disease (specificity 0.91; sensitivity 0.47). However, the overall diagnostic accuracy of CRP (AUC =0.91) and PCT (AUC =0.87) were superior (p<0.02 and p<0.06) compared to that of sCD163 (AUC =0.72). For the diagnosis of systemic bacterial infection, the AUC of sCD163 (0.83) did not differ significantly from those of CRP or PCT. All markers had AUCs <0.75 for differentiating between purulent meningitis and other conditions. In conclusion, CRP and PCT had high diagnostic value and were superior as markers of bacterial infection compared to sCD163. However, sCD163 may be helpful in rapid identification of patients with systemic bacterial infection. If used as an adjunct to lumbar puncture, PCT and CRP had very high diagnostic accuracy for distinguishing between bacterial and viral infection in patients with spinal fluid pleocytosis. However, none of the markers was useful as an independent tool for the clinical diagnosis of patients with purulent meningitis.
本研究的目的是评估并比较可溶性CD163（sCD163）血清水平与C反应蛋白（CRP）和降钙素原（PCT）在脑膜炎和细菌感染中的诊断价值。2001年2月至2005年2月期间进行了一项观察性队列研究。研究对象包括丹麦一家大学医院27张床位的传染病科收治的55例疑似脑膜炎患者。测定入院时生物标志物的血清水平。在预先设定的临界值处评估敏感性和特异性，并使用受试者操作特征曲线下面积（AUC）比较总体诊断准确性。患者根据两组诊断标准分为：A）化脓性脑膜炎、浆液性脑膜炎或非脑膜炎，以及B）全身性细菌感染、局部细菌感染或非细菌性疾病。血清sCD163水平升高是区分细菌感染与非细菌性疾病的最具特异性的标志物（特异性0.91；敏感性0.47）。然而，与sCD163（AUC =0.72）相比，CRP（AUC =0.91）和PCT（AUC =0.87）的总体诊断准确性更高（p<0.02和p<0.06）。对于全身性细菌感染的诊断，sCD163的AUC（0.83）与CRP或PCT的AUC无显著差异。所有标志物在区分化脓性脑膜炎和其他情况时的AUC均<0.75。总之，CRP和PCT具有较高的诊断价值，作为细菌感染的标志物优于sCD163。然而，sCD163可能有助于快速识别全身性细菌感染患者。如果作为腰椎穿刺的辅助手段，PCT和CRP在区分脑脊液细胞增多患者的细菌和病毒感染方面具有非常高的诊断准确性。然而，没有一种标志物可作为化脓性脑膜炎患者临床诊断的独立工具。
