血清淀粉样蛋白 A 蛋白和可溶性细胞间黏附分子 1 在小儿呼吸机相关性肺炎中的诊断效能。

Diagnostic Efficacy of Serum Amyloid A Protein and Soluble Intercellular Adhesion Molecule 1 in Pediatric Ventilator-Associated Pneumonia.

机构信息

1 Pediatric Intensive Care Unit, Faculty of Medicine, Pediatric Department, Tanta University, Gharbia Governorate, Tanta, Egypt.

2 Clinical Pathology Department, Tanta University, Gharbia Governorate, Tanta, Egypt.

出版信息

J Intensive Care Med. 2019 Jun;34(6):503-510. doi: 10.1177/0885066617702598. Epub 2017 Apr 13.

DOI:10.1177/0885066617702598

PMID:28403662

Abstract

OBJECTIVES

Study of inflammatory biomarkers which may aid in early detection of ventilator-associated pneumonia (VAP) in children and predicting their outcome.

PATIENTS

Thirty-five children, aged 2 months to 13 years, needed mechanical ventilation (MV) for more than 48 hours due to causes other than pneumonia.

METHODS

Measurement of serum amyloid A (SAA) protein, soluble intercellular adhesion molecule 1 (sICAM-1), and C-reactive protein (CRP), modified clinical pulmonary infection score (CPIS) and performing culture of endotracheal aspirate at the start and on the third day of MV.

RESULTS

Ventilator-associated pneumonia was diagnosed by CPIS in 6 (17.1%) of 35 patients. On the third day of MV, there was a significant increase in serum mean levels of SAA, sICAM-1, and CRP in comparison to the start of MV ( P = .005, .004, and .01, respectively). Three (50%) of 6 patients with VAP died, while 4 (14.28%) of 28 patients without VAP died. The sensitivity of serum SAA, sICAM-1, and CPIS were 100% for predicting VAP, while specificity was highest for CPIS (96.55%) followed by SAA (93.1%). Combination of CPIS and SAA increased the specificity to 100%. For predicting nonsurvival, serum SAA and sICAM-1 had a sensitivity of 100% and a specificity of 92.86% and 89.29%, respectively.

CONCLUSION

Serum amyloid A and sICAM-1 may be considered as reliable markers for detection of VAP. Combination of serum SAA with CPIS increased the specificity to 100%. Measurement of SAA in patients with VAP also had a good predictive value for nonsurvival in such patients.

摘要

目的

研究炎症生物标志物，以帮助早期发现儿童呼吸机相关性肺炎（VAP）并预测其结果。

患者

35 名年龄在 2 个月至 13 岁的儿童，因肺炎以外的原因需要机械通气（MV）超过 48 小时。

方法

测量血清淀粉样蛋白 A（SAA）蛋白、可溶性细胞间黏附分子 1（sICAM-1）和 C 反应蛋白（CRP），修正的临床肺部感染评分（CPIS），并在 MV 开始和第 3 天进行气管内抽吸物培养。

结果

根据 CPIS 诊断 35 例患者中的 6 例（17.1%）为呼吸机相关性肺炎。在 MV 的第 3 天，与 MV 开始时相比，血清 SAA、sICAM-1 和 CRP 的平均水平显著升高（P=0.005、0.004 和 0.01）。6 例 VAP 患者中有 3 例（50%）死亡，而 28 例无 VAP 患者中有 4 例（14.28%）死亡。血清 SAA、sICAM-1 和 CPIS 预测 VAP 的敏感性均为 100%，而 CPIS 的特异性最高（96.55%），其次是 SAA（93.1%）。CPIS 和 SAA 的联合应用可将特异性提高到 100%。对于预测非生存，血清 SAA 和 sICAM-1 的敏感性为 100%，特异性分别为 92.86%和 89.29%。