Division of Haematology-Oncology, Children's Hospital of Zhejiang University School of Medicine, Hangzhou, China; Key Laboratory of Reproductive Genetics (Zhejiang University), Ministry of Education, Hangzhou, China.
Key Laboratory of Reproductive Genetics (Zhejiang University), Ministry of Education, Hangzhou, China.
Clin Microbiol Infect. 2016 Dec;22(12):996-1001. doi: 10.1016/j.cmi.2016.09.013. Epub 2016 Sep 22.
To evaluate the diagnostic power of the cytokine patterns and serum procalcitonin (PCT) level for predicting infection in paediatric haematology-oncology patients.
Retrospective study including hospitalized children with haematology-oncology disease was conducted and their serum T helper type 1/type 2 cytokines were measured by a flow cytometric method. According to clinical symptoms, imaging and microbiological findings, febrile episodes were divided into five diagnostic groups serving as reference standard; and also grouped according to disease severity. A control group consisted of afebrile children.
A total of 3023 samples (2819 febrile episodes and 204 control samples) derived from 992 children (including 164 afebrile control patients) were obtained. Interleukin-6 (IL-6) and IL-10 levels as well as their positivity rates were significantly higher among children with bacteraemia than for the viral infection and control groups. Among children with bacteraemia, 92.8% (297/320) and 82.2% (263/320) had increased IL-6 and IL-10 levels that exceeded the upper limit of the normal range, respectively. The positivity rates of PCT and C-reactive protein were only 33.8% (108/320) and 73.1% (234/320), respectively, significantly lower than those of IL-6 and IL-10 (p <0.01). Based on the receiver operating characteristic curves, PCT exhibited poorer sensitivity in the diagnosis of severe infection compared with IL-6 and IL-10 (p <0.01). Specificity of IL-6 and IL-10 was significantly higher than that of PCT in the diagnosis of Gram-negative bacteraemia.
Cytokine patterns of IL-6 and IL-10 showed higher diagnostic accuracy than PCT for bacteraemia and severe infections among febrile children with haematology/oncology disease.
评估细胞因子谱和血清降钙素原 (PCT) 水平对儿科血液肿瘤患者感染的诊断能力。
对患有血液肿瘤疾病的住院患儿进行回顾性研究，并通过流式细胞术测量其血清辅助性 T 细胞 1/2 细胞因子。根据临床症状、影像学和微生物学发现，发热发作分为五个诊断组作为参考标准；并根据疾病严重程度进行分组。对照组由不发热的儿童组成。
共获得 992 名儿童（包括 164 名不发热的对照组患者）的 3023 个样本（2819 个发热发作和 204 个对照组样本）。血流感染患儿的白细胞介素 6 (IL-6) 和白细胞介素 10 (IL-10) 水平及其阳性率明显高于病毒感染和对照组。在血流感染患儿中，92.8%（297/320）和 82.2%（263/320）的 IL-6 和 IL-10 水平超过正常范围上限，分别为增加。PCT 和 C 反应蛋白的阳性率仅为 33.8%（108/320）和 73.1%（234/320），明显低于 IL-6 和 IL-10（p<0.01）。基于受试者工作特征曲线，PCT 在诊断严重感染方面的敏感性明显低于 IL-6 和 IL-10（p<0.01）。IL-6 和 IL-10 在诊断革兰氏阴性菌血症方面的特异性明显高于 PCT。
细胞因子谱中 IL-6 和 IL-10 的诊断准确性高于 PCT，可用于诊断血液肿瘤疾病发热儿童的菌血症和严重感染。
