Park Yoonseon, Son Minji, Jekarl Dong Wook, Choi Hyun Yoo, Kim Sang Yong, Lee Seungok
Department of Pediatrics, Incheon St. Mary's Hospital, School of Medicine, The Catholic University of Korea, Incheon, Korea.
Department of Laboratory Medicine, Incheon St. Mary's Hospital, School of Medicine, The Catholic University of Korea, Incheon, Korea.
Pediatr Gastroenterol Hepatol Nutr. 2019 Jul;22(4):369-376. doi: 10.5223/pghn.2019.22.4.369. Epub 2019 Jun 18.
The aim of this study was to evaluate the clinical significance of inflammatory biomarkers in acute infectious diarrhea among children.
Clinical parameters including fever, bacterial and viral etiology based on stool culture and multiplex polymerase chain reaction, and nine biomarkers including C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and leukocytes in blood and calprotectin, lactoferrin, myeloperoxidase, polymorphonuclear elastase, leukocytes, and occult blood in feces were evaluated in children who were hospitalized due to acute diarrhea without underlying disease.
A total of 62 patients were included. Among these patients, 33 had fever, 18 showed bacterial infections, and 40 patients were infected with 43 viruses. Of all the biomarkers, CRP was significantly correlated with fever (<0.001). CRP, ESR, calprotectin, lactoferrin, myeloperoxidase, fecal leukocytes, and occult blood were significantly associated with infection with bacterial pathogens (<0.001, =0.04, =0.03, =0.003, =0.02, =0.03, =0.002, respectively). The combination of CRP and fecal lactoferrin at their best cut-off values (13.7 mg/L and 22.8 µg/mL, respectively) yielded a sensitivity of 72.2%, and a specificity of 95.5% for bacterial etiology compared with their individual use.
Blood CRP is a useful diagnostic marker for both fever and bacterial etiology in acute pediatric diarrhea. The combination of CRP and fecal lactoferrin yields better diagnostic capability for bacterial etiology than their use alone for acute diarrhea in children without underlying gastrointestinal disease.
本研究旨在评估炎症生物标志物在儿童急性感染性腹泻中的临床意义。
对因急性腹泻住院且无基础疾病的儿童评估临床参数，包括发热情况、基于粪便培养和多重聚合酶链反应的细菌和病毒病因，以及九种生物标志物，包括血液中的C反应蛋白（CRP）、红细胞沉降率（ESR）和白细胞，粪便中的钙卫蛋白、乳铁蛋白、髓过氧化物酶、多形核弹性蛋白酶、白细胞和潜血。
共纳入62例患者。其中，33例有发热，18例显示细菌感染，40例患者感染了43种病毒。在所有生物标志物中，CRP与发热显著相关（<0.001）。CRP、ESR、钙卫蛋白、乳铁蛋白、髓过氧化物酶、粪便白细胞和潜血与细菌病原体感染显著相关（分别为<0.001、=0.04、=0.03、=0.003、=0.02、=0.03、=0.002）。CRP和粪便乳铁蛋白在其最佳临界值（分别为13.7mg/L和22.8μg/mL）时联合使用，与单独使用相比，对细菌病因的敏感性为72.2%，特异性为95.5%。
血液CRP是儿童急性腹泻中发热和细菌病因的有用诊断标志物。对于无基础胃肠道疾病的儿童急性腹泻，CRP和粪便乳铁蛋白联合使用对细菌病因的诊断能力优于单独使用。
