血清降钙素原联合可溶性髓样细胞触发受体-1对儿童细菌性腹泻和病毒性腹泻的鉴别诊断价值

Value of serum procalcitonin combined with soluble triggering receptor expressed on myeloid cells-1 in the differential diagnosis of bacterial and viral diarrhea in children

摘要:

目的 探讨血清降钙素原（PCT）联合可溶性髓样细胞触发受体-1（STREM-1）对儿童细菌性腹泻与病毒性腹泻的鉴别价值。方法 回顾性分析2018年2月至2019年5月入院接受治疗的细菌感染性腹泻患儿73例（细菌组）、病毒感染性腹泻患儿68例（病毒组）的临床资料。采用受试者工作特征（ROC）曲线分析血清PCT和STREM-1对细菌感染性腹泻与病毒感染性腹泻的诊断效能。结果 细菌组患儿粪便红细胞及脓液检出率分别为79%、51%，高于病毒组的43%、19%（P < 0.05）。细菌组患儿血清PCT和STREM-1水平均显著高于病毒组（P < 0.05）。ROC分析结果显示，血清PCT、STREM-1对儿童细菌性感染与病毒性感染腹泻鉴别的截断值分别为0.97?ng/mL、15.66?ng/mL；曲线下面积（AUC）分别为0.792、0.889。二者联合诊断的AUC为0.955，其诊断效能高于两单独指标（P < 0.05）。结论 细菌性腹泻患儿血清PCT和STREM-1水平高于病毒性腹泻患儿；血清PCT和STREM-1均可作为儿童细菌性腹泻与病毒性腹泻的鉴别指标，二者联合检测可提高鉴别诊断效能。

Abstract:

Objective To study the value of serum procalcitonin (PCT) combined with soluble triggering receptor expressed on myeloid cells-1 (STREM-1) in the differential diagnosis of bacterial diarrhea and viral diarrhea in children. Methods A retrospective analysis was performed on the medical data of 73 children with bacterial infectious diarrhea (bacteria group) and 68 children with viral infectious diarrhea (virus group) who were treated from February 2018 to May 2019. The receiver operating characteristic (ROC) curve was used to analyze the diagnostic efficacy of serum PCT and STREM-1 for bacterial infectious diarrhea and viral infectious diarrhea. Results Compared with the virus group, the bacteria group had significantly higher detection rates of fecal red blood cells (79% vs 43%, P < 0.05) and pus (51% vs 19%, P < 0.05), as well as significantly higher serum levels of PCT and STREM-1 (P < 0.05). The ROC curve analysis showed that in the differential diagnosis of bacterial infectious diarrhea and viral infectious diarrhea, serum PCT had a cut-off value of 0.97 ng/mL and an area under the ROC curve (AUC) of 0.792, and STREM-1 had a cut-off value of 15.66 ng/mL and an AUC of 0.889. Serum PCT combined with STREM-1 had an AUC of 0.955, which was significantly higher than that of each index alone (P < 0.05). Conclusions Children with bacterial diarrhea have increased serum levels of PCT and STREM-1 than those with viral diarrhea. Both serum PCT and STREM-1 can be used as the indices for the differential diagnosis of bacterial diarrhea and viral diarrhea in children, and the combined measurement of PCT and STREM-1 can improve the efficiency of differential diagnosis.