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【摘要】 目的 通过测定血清C-反应蛋白(CRP)及末梢血中性白细胞,确定感染性质,并为临床判断疗效及合理使用抗生素提供依据。方法 患儿194例末梢血白细胞总数小于10×109/L，测血清CRP，异常者经治疗后复查,并进行统计学分析。结果 全部病例中CRP异常者65例,占32.5%;中性白细胞异常者37例,占19.2%,说明CRP能更好地反映细菌感染的存在; CRP异常者65例经过治疗后进行复查,临床症状好转,CRP恢复正常。CRP可以作为感染恢复的监控指标, 与末梢血中性白细胞数比较在统计学上差异有显著性(P＜0.01)。结论 CRP较末梢血中性白细胞能更好地反映和检测细菌感染的存在,并为临床判断疗效及合理使用抗生素提供依据。
【关键词】 C-反应蛋白； 中性白细胞； 细菌感染
【Abstract】 Objective To ensure bacterial infection by examines C-reactive protein (CRP) and neutrophil leukocytes count (WBC) in order to find out bacterial infection and afford evidence in clinical treatment and in reasonable using antibiotic. Methods In 194 cases with WBC lower than 10×109/L, CRP were examined in； 65cases of them were high and were rechecked after treatment and compare CRP and neutrophil leukocytes count (WBC) by statistics.Results The level of CRP was increased in 65cases and retio of neutrophil in 37cases, their ratio were 32.5% and 19.2%, respectively. It is proved that CRP had much more value than the ratio of neutrophil in finding bacterial infection. After being treated, 65 cases were examined and the level of CRP was recovered. CRP can be regarded as an index in the recovery of infection. There were significantly different between CRP and retio of neutrophil in leukocytes (WBC) (P<0.01). Conclusion CRP was more value than retio of neutrophil in WBC in finding and examining bacterial infection, and a reasonable evidence in clinical treatment and in using antibiotics.
【Key words】 C-reactive protein； neutrophil leukocyte； bacterial infection
C-反应蛋白(简称CRP)是一种急性时相蛋白,当细菌感染引发炎症或组织损伤和术后,其浓度明显升高。炎症6～12h就可以检测到,与末梢血中性白细胞一起为临床医师评估细菌感染及抗生素合理应用提供实验依据。
1 资料与方法
1.1 一般资料 取2004年11月～2005年2月间住院及门诊留观的急性上呼吸道感染患儿194例,男99例,女95例,年龄6～14岁。临床表现为不同程度发热、咳嗽、咽痛、胸痛、头晕、呕吐等症状,所有病例末梢血白细胞小于10×109/L，测定血清CRP,并进行统计学分析,其中对65例CRP异常者治疗后复查。全部病例不同程度使用抗生素治疗。
1.2 方法 用胶乳法测定血清CRP,正常值小于10μg/L, 大于10μg/L 为异常。自动分析仪测定末梢血白细胞。正常值(4～10)×109/L,中性粒细胞大于65% 为异常。
1.3 统计学方法 配对计数资料χ2检验,P＜0.05为差异有显著性。
2 结果
194例患儿中,CRP异常者65例,占32.5%;末梢血白细胞中性粒细胞异常者37例,占19.2%, 二者比较在统计学上存在差异显著性,P＜0.01(见表1) 。说明CRP能更好地反映细菌感染的存在。CRP异常者65例经过治疗后复查,临床症状好转,CRP恢复正常。表明CRP可以作为感染恢复的监控指标。表1 194例末梢血中性粒细胞比例与血清CRP分析比较
3 讨论
CRP是一种典型的急性时相蛋白,用以描述急性感染病人血清中某些蛋白组分的变化,随着感染状态消失组织修复及功能复原,急性时相蛋白浓度逐渐恢复正常。CRP在细菌感染时增加迅速,6h即升高,12h后明显升高。如果感染未得到控制,CRP可持续处于高峰状态;若病情好转后再恶化,则CRP也会出现相应下降后再度升高的现象。
CRP可判断炎性反应综合征是否由感染所致［1］;判断不明原因发热病人的感染性质［2］;区分细菌感染还是病毒感染［3］;判断细菌性咽炎,还是非细菌性咽炎,使抗生素使用更加准确［4］。65例CRP异常者,给予静脉或口服抗生素治疗,临床症状好转, CRP恢复正常，CRP能更好地反映感染存在的程度并判断疗效。CRP及末梢血中性粒细胞比例均正常者应慎用或不用抗生素,做相关检查以明确病源,避免抗生素滥用,减少耐药性产生。
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作者单位： 1 134001 吉林通化，通化市人民医院儿科
2 100020 北京，首都儿科研究所
3 012000 内蒙古乌兰察布，乌兰察布市中心医院儿科
(编辑：若 木)