Esposito Susanna, Bianchini Sonia, Gambino Monia, Madini Barbara, Di Pietro Giada, Umbrello Giulia, Presicce Maria Lory, Ruggiero Luca, Terranova Leonardo, Principi Nicola
Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 9, 20122, Milan, Italy.
BMC Pulm Med. 2016 Jul 20;16(1):103. doi: 10.1186/s12890-016-0267-4.
In this study, we evaluated the lipocalin-2 (LIP2) and syndecan-4 (SYN4) levels in children who were hospitalized for radiologically confirmed CAP in order to differentiate bacterial from viral infection. The results regarding the LIP2 and SYN4 diagnostic outcomes were compared with the white blood cell (WBC) count and C reactive protein (CRP) levels.
A total of 110 children <14 years old who were hospitalized for radiologically confirmed CAP were enrolled. Serum samples were obtained upon admission and on day 5 to measure the levels of LIP2, SYN4, and CRP as well as the WBC. Polymerase chain reaction of the respiratory secretions and tests on blood samples were performed to detect respiratory viruses, Streptococcus pneumoniae, and Mycoplasma pneumoniae.
CAP was considered to be due to a probable bacterial infection in 74 children (67.3 %) and due to a probable viral infection in 16 children (14.5 %). Overall, 84 children (76.4 %) were diagnosed with severe CAP. The mean values of the WBC count and the LIP2 and SYN4 levels did not differ among the probable bacterial, probable viral, and undetermined cases. However, the CRP serum concentrations were significantly higher in children with probable bacterial CAP than in those with probable viral disease (32.2 ± 55.5 mg/L vs 9.4 ± 17.0 mg/L, p < 0.05). The WBC count was the best predictor of severe CAP, but the differences among the studied variables were marginal. The WBC count was significantly lower on day 5 in children with probable bacterial CAP (p < 0.01) and in those with an undetermined etiology (p < 0.01). The CRP and LIP2 levels were significantly lower 5 days after enrollment in all of the studied groups, independent of the supposed etiology of CAP (p < 0.01 for all comparisons). No statistically significant variation was observed for SYN4.
Measuring the LIP2 and SYN4 levels does not appear to solve the problem of the poor reliability of routine laboratory tests in defining the etiology and severity of pediatric CAP. Currently, the CRP levels and WBC, when combined with evaluation of clinical data, can be used to limit the overuse of antibiotics as much as possible and to provide the best treatment to the patient.
在本研究中，我们评估了因影像学确诊为社区获得性肺炎（CAP）而住院的儿童的脂联素-2（LIP2）和多配体蛋白聚糖-4（SYN4）水平，以区分细菌感染和病毒感染。将LIP2和SYN4的诊断结果与白细胞（WBC）计数及C反应蛋白（CRP）水平进行比较。
共纳入110名14岁以下因影像学确诊为CAP而住院的儿童。入院时及第5天采集血清样本，以检测LIP2、SYN4、CRP水平及WBC计数。对呼吸道分泌物进行聚合酶链反应，并对血样进行检测，以检测呼吸道病毒、肺炎链球菌和肺炎支原体。
74名儿童（67.3%）的CAP被认为可能是细菌感染所致，16名儿童（14.5%）的CAP被认为可能是病毒感染所致。总体而言，84名儿童（76.4%）被诊断为重症CAP。在可能为细菌感染、可能为病毒感染及病因未明的病例中，WBC计数、LIP2和SYN4水平的平均值无差异。然而，可能为细菌性CAP的儿童的CRP血清浓度显著高于可能为病毒性疾病的儿童（32.2±55.5mg/L对9.4±17.0mg/L，p<0.05）。WBC计数是重症CAP的最佳预测指标，但研究变量之间的差异很小。可能为细菌性CAP的儿童及病因未明的儿童在第5天的WBC计数显著降低（p<0.01）。所有研究组在入组5天后CRP和LIP2水平均显著降低，与CAP的假定病因无关（所有比较p<0.01）。SYN4未观察到统计学上的显著变化。
检测LIP2和SYN4水平似乎无法解决常规实验室检查在确定儿童CAP病因和严重程度方面可靠性差的问题。目前，CRP水平和WBC计数结合临床资料评估，可用于尽可能限制抗生素的过度使用，并为患者提供最佳治疗。
