Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
Kaohsiung J Med Sci. 2009 Dec;25(12):633-9. doi: 10.1016/S1607-551X(09)70568-6.
Early diagnosis of serious bacterial infections (SBI) in febrile young infants based on clinical symptoms and signs is difficult. This study aimed to evaluate the diagnostic values of circulating chemokines and C-reactive protein (CRP) levels in febrile young infants < 3 months of age with suspected SBI. We enrolled 43 febrile young infants < 3 months of age with clinically suspected SBI who were admitted to the neonatal intensive care unit or complete nursing unit of the pediatric department of Kaohsiung Medical University Hospital between December 2006 and July 2007. Blood was drawn from the patients at admission, and complete blood counts, plasma levels of CRP, granulocyte colony-stimulating factor (G-CSF), and chemokines, including interleukin-8 (IL-8), macrophage inflammatory protein-1alpha, macrophage inflammatory protein-1beta, monokine induced by interferon-gamma, and monocyte chemotactic protein-1 were measured. Patients symptoms and signs, length of hospital stay, main diagnosis, and results of routine blood tests and microbiological culture results were recorded. Twenty-six infants (60.5%) were diagnosed with SBI, while 17 (39.5%) had no evidence of SBI based on the results of bacterial cultures. CRP, IL-8 and G-CSF levels were significantly higher in the infants with SBI than in those without SBI Plasma levels of other chemokines were not significantly different between the groups. The area under the receiver-operating characteristic (ROC) curve for differentiating between the presence and absence of SBI was 0.79 for CRP level. Diagnostic accuracy was further improved by combining CRP and IL-8, when the area under the ROC curve increased to 0.91. CRP levels were superior to IL-8 and G-CSF levels for predicting SBI in febrile infants at initial survey. IL-8 levels could be used as an additional diagnostic tool in the initial evaluation of febrile young infants, allowing clinicians to treat these patients more appropriately.
早期诊断发热小于 3 个月的婴儿严重细菌性感染（SBI）基于临床症状和体征较为困难。本研究旨在评估循环趋化因子和 C 反应蛋白（CRP）水平对疑似 SBI 的发热小于 3 个月婴儿的诊断价值。我们招募了 2006 年 12 月至 2007 年 7 月期间因临床疑似 SBI 入住高雄医学大学附设中和纪念医院新生儿加护病房或儿科完整护理病房的 43 名发热小于 3 个月的婴儿。入院时采集患者血液，检测全血细胞计数、CRP、粒细胞集落刺激因子（G-CSF）和趋化因子（包括白细胞介素-8 [IL-8]、巨噬细胞炎症蛋白-1alpha、巨噬细胞炎症蛋白-1beta、干扰素-γ诱导的单核细胞因子和单核细胞趋化蛋白-1）。记录患者的症状和体征、住院时间、主要诊断以及常规血液检查和微生物培养结果。根据细菌培养结果，26 名婴儿（60.5%）被诊断为 SBI，17 名婴儿（39.5%）无 SBI 证据。SBI 组的 CRP、IL-8 和 G-CSF 水平显著高于非 SBI 组。两组间其他趋化因子的血浆水平无显著差异。CRP 水平区分 SBI 存在与否的受试者工作特征（ROC）曲线下面积为 0.79。当 ROC 曲线下面积增加至 0.91 时，CRP 和 IL-8 联合可进一步提高诊断准确性。CRP 水平在初始检查时优于 IL-8 和 G-CSF 水平预测发热婴儿的 SBI。IL-8 水平可作为发热小于 3 个月婴儿初始评估的附加诊断工具，使临床医生能够更适当地治疗这些患者。
