在PERCH研究中，5岁以下儿童C反应蛋白与细菌性及呼吸道合胞病毒相关性肺炎的关联
Association of C-Reactive Protein With Bacterial and Respiratory Syncytial Virus-Associated Pneumonia Among Children Aged <5 Years in the PERCH Study.
作者信息
Higdon Melissa M, Le Tham, O'Brien Katherine L, Murdoch David R, Prosperi Christine, Baggett Henry C, Brooks W Abdullah, Feikin Daniel R, Hammitt Laura L, Howie Stephen R C, Kotloff Karen L, Levine Orin S, Scott J Anthony G, Thea Donald M, Awori Juliet O, Baillie Vicky L, Cascio Stephanie, Chuananon Somchai, DeLuca Andrea N, Driscoll Amanda J, Ebruke Bernard E, Endtz Hubert P, Kaewpan Anek, Kahn Geoff, Karani Angela, Karron Ruth A, Moore David P, Park Daniel E, Rahman Mohammed Ziaur, Salaudeen Rasheed, Seidenberg Phil, Somwe Somwe Wa, Sylla Mamadou, Tapia Milagritos D, Zeger Scott L, Deloria Knoll Maria, Madhi Shabir A
机构信息
Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, and.
Department of Pharmaceutical Health Services Research, University of Maryland, Baltimore.
出版信息
Clin Infect Dis. 2017 Jun 15;64(suppl_3):S378-S386. doi: 10.1093/cid/cix150.
BACKGROUND.: Lack of a gold standard for identifying bacterial and viral etiologies of pneumonia has limited evaluation of C-reactive protein (CRP) for identifying bacterial pneumonia. We evaluated the sensitivity and specificity of CRP for identifying bacterial vs respiratory syncytial virus (RSV) pneumonia in the Pneumonia Etiology Research for Child Health (PERCH) multicenter case-control study.
METHODS.: We measured serum CRP levels in cases with World Health Organization-defined severe or very severe pneumonia and a subset of community controls. We evaluated the sensitivity and specificity of elevated CRP for "confirmed" bacterial pneumonia (positive blood culture or positive lung aspirate or pleural fluid culture or polymerase chain reaction [PCR]) compared to "RSV pneumonia" (nasopharyngeal/oropharyngeal or induced sputum PCR-positive without confirmed/suspected bacterial pneumonia). Receiver operating characteristic (ROC) curves were constructed to assess the performance of elevated CRP in distinguishing these cases.
RESULTS.: Among 601 human immunodeficiency virus (HIV)-negative tested controls, 3% had CRP ≥40 mg/L. Among 119 HIV-negative cases with confirmed bacterial pneumonia, 77% had CRP ≥40 mg/L compared with 17% of 556 RSV pneumonia cases. The ROC analysis produced an area under the curve of 0.87, indicating very good discrimination; a cut-point of 37.1 mg/L best discriminated confirmed bacterial pneumonia (sensitivity 77%) from RSV pneumonia (specificity 82%). CRP ≥100 mg/L substantially improved specificity over CRP ≥40 mg/L, though at a loss to sensitivity.
CONCLUSIONS.: Elevated CRP was positively associated with confirmed bacterial pneumonia and negatively associated with RSV pneumonia in PERCH. CRP may be useful for distinguishing bacterial from RSV-associated pneumonia, although its role in discriminating against other respiratory viral-associated pneumonia needs further study.
背景
缺乏用于鉴定肺炎细菌和病毒病因的金标准限制了对C反应蛋白（CRP）用于鉴定细菌性肺炎的评估。在儿童健康肺炎病因研究（PERCH）多中心病例对照研究中，我们评估了CRP用于鉴别细菌性与呼吸道合胞病毒（RSV）肺炎的敏感性和特异性。
方法
我们测量了世界卫生组织定义的重度或极重度肺炎病例以及一部分社区对照者的血清CRP水平。我们评估了CRP升高对于“确诊”细菌性肺炎（血培养阳性或肺穿刺或胸腔积液培养阳性或聚合酶链反应[PCR]阳性）相对于“RSV肺炎”（鼻咽/口咽或诱导痰PCR阳性且无确诊/疑似细菌性肺炎）的敏感性和特异性。构建受试者工作特征（ROC）曲线以评估CRP升高在区分这些病例中的表现。
结果
在601例人类免疫缺陷病毒（HIV）阴性的检测对照者中，3%的CRP≥40mg/L。在119例确诊细菌性肺炎的HIV阴性病例中，77%的CRP≥40mg/L，而556例RSV肺炎病例中有17%的CRP≥40mg/L。ROC分析得出曲线下面积为0.87，表明区分能力非常好；37.1mg/L的切点能最好地区分确诊细菌性肺炎（敏感性77%）与RSV肺炎（特异性82%）。与CRP≥40mg/L相比，CRP≥100mg/L显著提高了特异性，不过敏感性有所降低。
结论
在PERCH研究中，CRP升高与确诊细菌性肺炎呈正相关，与RSV肺炎呈负相关。CRP可能有助于区分细菌性与RSV相关性肺炎，尽管其在鉴别其他呼吸道病毒相关性肺炎中的作用需要进一步研究。
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