Tejani N R, Chonmaitree T, Rassin D K, Howie V M, Owen M J, Goldman A S
Department of Pediatrics, University of Texas Medical Branch at Galveston 77555-0371, USA.
Pediatrics. 1995 May;95(5):664-9.
The objectives of this investigation were: (1) to determine degree of elevation of serum C-reactive protein (CRP) in uncomplicated acute otitis media (AOM); (2) to compare serum CRP levels in bacterial and viral otitis media; and (3) to determine whether a single serum CRP level, obtained early in the course of AOM, could be used to differentiate between viral and bacterial otitis media.
Sera were obtained from otherwise healthy infants and children with AOM who were 3 months to 7 years of age between 1989 and 1991. Tympanocentesis, bacterial and viral studies of the middle ear fluids, virologic studies of nasal wash specimens, measurements of serum antibody titers to respiratory viruses, blood counts, and quantitation of serum CRP concentrations were performed. After the initial tympanocentesis, an oral antibiotic was given for the next 10 days. The patients were clinically reevaluated over next 4 weeks.
Serum CRP concentrations were compared among subjects with AOM who were divided into four groups based on the results of bacteriologic and virologic studies: group I, Bacterial infection (n = 82); group II, bacterial and viral infections (n = 69); group III, viral infection (n = 12); and group IV, no identifiable pathogen (n = 22).
There was no statistical difference in serum CRP values among the four groups. The ranges of CRP were less than 0.6 to 22.8, less than 0.6 to 17.8, less than 0.6 to 2.0, and less than 0.6 to 6.8 mg/dL in groups I through IV, respectively. However, when CRP values in bacteria-positive cases were compared with CRP concentrations in bacteria-negative cases (1.58 +/- 3.16 vs 0.64 +/- 1.24 mg/dL), the difference was statistically significant. Furthermore, a significantly higher proportion of bacteria-positive cases had serum CRP concentrations greater than 2 mg/dL, compared with those in bacteria-negative cases. There was no correlation between initial CRP values and clinical findings and/or the clearance of bacteria from the middle ear. After 10 days of antibiotic treatment, CRP values returned to normal (< 0.6 mg/dL) in all cases.
In AOM, the range of serum CRP varied from less than 0.6 to 22.8 mg/dL. High CRP values (> 2.0 mg/dL) were associated with 22% of cases of bacterial AOM but only with 6% of nonbacterial AOM. High levels of serum CRP were found to be very specific in detecting bacterial AOM, and no cases of viral AOM without a concurrent bacterial infection were found to exhibit high serum levels of CRP.
本研究的目的是：（1）确定单纯性急性中耳炎（AOM）患者血清C反应蛋白（CRP）的升高程度；（2）比较细菌性和病毒性中耳炎患者的血清CRP水平；（3）确定在AOM病程早期获得的单次血清CRP水平是否可用于区分病毒性和细菌性中耳炎。
1989年至1991年间，从3个月至7岁患有AOM的健康婴儿和儿童中采集血清。进行了鼓膜穿刺术、中耳液的细菌和病毒学研究、鼻腔冲洗标本的病毒学研究、呼吸道病毒血清抗体滴度测量、血细胞计数以及血清CRP浓度定量。在首次鼓膜穿刺术后，接下来10天给予口服抗生素。在接下来的4周内对患者进行临床重新评估。
根据细菌学和病毒学研究结果，将患有AOM的受试者分为四组，比较各组的血清CRP浓度：第一组，细菌感染（n = 82）；第二组，细菌和病毒感染（n = 69）；第三组，病毒感染（n = 12）；第四组，未发现病原体（n = 22）。
四组之间的血清CRP值无统计学差异。第一组至第四组的CRP范围分别为小于0.6至22.8、小于0.6至17.8、小于0.6至2.0和小于0.6至6.8mg/dL。然而，当将细菌阳性病例的CRP值与细菌阴性病例的CRP浓度进行比较时（1.58±3.16对0.64±1.24mg/dL），差异具有统计学意义。此外，与细菌阴性病例相比，细菌阳性病例中血清CRP浓度大于2mg/dL的比例显著更高。初始CRP值与临床发现和/或中耳细菌清除情况之间无相关性。抗生素治疗10天后，所有病例的CRP值均恢复正常（<0.6mg/dL）。
在AOM中，血清CRP范围为小于0.6至22.8mg/dL。高CRP值（>2.0mg/dL）与22%的细菌性AOM病例相关，但仅与6%的非细菌性AOM病例相关。发现高血清CRP水平在检测细菌性AOM方面具有很高的特异性，未发现无并发细菌感染的病毒性AOM病例表现出高血清CRP水平。
