炎性指标诊断发热待查感染性疾病的价值

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Abstract Objective To study the effect of inflammatory markers on patients with infectious diseases presenting fever of unknown origin (FUO).Methods Patients with FUO were enrolled into this study in Xuanwu Hospital between January 1, 2016 and December 1, 2018. These patients with infectious diseases were divided into the viral infection group, bacterial infection group (tuberculosis infection, brucellosis, bacterial endocarditis, lung and urine tract infection), and fungi infection group. Clinical variables included the patients’ general condition and duration of fever. The serum WBC( white blood cell), ESR(erythrocyte sedimentation rate), CRP(c-reactive protein), PCT(procalcitonin)levels were recorded upon admission.Results A total of 300 patients with FUO were enrolled. There were 64(21.3%) patients with infectious diseases, including 13 patients with viral infections, 39 patients with bacterial infections (11 patients with tuberculosis, 6 patients with brucellosis, 12 patients with bacterial endocarditis, 10 patients with lung or urine tract infections) and 12 patients with fungi infections. There was significant deference between the serum ESR levels in bacterial infection patients[(62.6±33.3)mm/h] and those of fungi infection patients [(26.6±32)mm/h] (P=0.03). The serum CRP levels[(54.8±43)mg/L] in bacterial infection patients and viral infection patients[(32.1±31.7)mg/L] were significantly different, as with bacterial infection patients and fungi infection patients (P=0.03). The serum WBC levels and PCT levels were not significantly dfferent between the three groups. The serum WBC, ESR, CRP and PCT levels were not significantly different between the bacterial infection groups. The sensitivity of CRP for distinguishing bacterial infections from viral infections was 77.1%. Its cut-off value was 84.5 mg/L, compared with 84.4% and 45 mm/h for ESR when used for distinguishing fungi infections from bacterial infections.Conclusions ESR and CRP can help distinguish different types of infections in FUO patients, but the serum PCT and WBC are of limited significance.

Key words： fever of unknown origin inflammatory marker viral infection bacterial infection fungi infection

Received: 10 September 2019

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http://journal08.magtechjournal.com/Jwk_wjyx/EN/ OR http://journal08.magtechjournal.com/Jwk_wjyx/EN/Y2020/V31/I1/26

[1]	张文宏,李太生. 发热待查专家共识[J]. 中华传染病杂志, 2017, 35(11): 641-654.
[2]	Christ-Crain M, Jaccard-Stolz D, Bingisser R, et al. Effect of procalcitonin-guided treatment on antibiotic use and outcome in lower respiratory tract infections: cluster-randomised, single-blinded intervention trial [J]. Lancet, 2004, 363(9409):600.
[3]	Christ-Crain M, Jaccard-Stolz D,Bingisser R, et al. Procalcitonin guidance of antibiotic therapy in community-acquired pneumonia: a randomized trial [J]. Am J Respir Crit Care Med, 2006, 174(1): 84.
[4]	Zhai Y Z, Chen X, Liu X, et al, Clinical analysis of 215 consecutive cases with fever of unknown origin[J]. Medicine, 2018, 97(24): e10986.
[5]	Shi X C, Liu X Q, Zhou B T, et al. Major causes of fever of unknown origin at Peking Union Medical College Hospital in the past 26 years[J]. Chin Med J (Engl), 2013, 126(5): 808-812.
[6]	Self W H, Balk R A, Grijalva C G, et al. Procalcitonin as a marker of etiology in adults hospitalized with community-acquired pneumonia[J]. Clin Infect Dis, 2017,65(2):183-190.
[7]	Kamat I S, Ramachandran V, Eswaran H, et al. Low procalcitonin, community acquired pneumonia, and antibiotic therapy [J]. Lancet Infect Dis, 2018,18(5):496-497.
[8]	Korkmaz P, Koak H, OnbaK, et al. The role of serum procalcitonin, interleukin-6, and fibrinogen levels in differential diagnosis of diabetic foot ulcer infection[J]. J Diabetes Res, 2018(2):1-7.
[9]	Verlinden A, De Vroey V, Goossens H, et al. Comparison of the power of procalcitonin and c-reactive protein to discriminate between different aetiologies of fever in prolonged profound neutropenia: a single-center prospective observational study[J]. Mediterr J Hematol Infect Dis, 2019, 11(1): e2019023.
[10]	Linssen C F, Bekers O, Drent M, et al. C-reactive protein and procalcitonin concentrations in bronchoalveolar lavage fluid as a predictor of ventilator-associated pneumonia [J]. Ann Clin Biochem, 2008,45(5): 293-298.
[11]	Christensen A M, Thomsen M K, Ovesen T, et al. Are procalcitonin or other infection markers useful in the detection of group A streptococcal acute tonsillitis? [J]. Scand J Infect Dis, 2014, 46(5): 376-383.
[12]	Pallin D J, Bry L, Dwyer R C, et al. Toward an objective diagnostic test for bacterial cellulitis[J]. PLoS One, 2016, 11(9): e162947.
[13]	Marnell L, Mold C, Du Clos TW. C-reactive protein: ligands, receptors and role in inflammation [J]. Clin Immunol, 2005, 117(2):104-111.
[14]	Vanderschueren S, Deeren D, Knockaert D C, et al. Extremely elevated C-reactive protein[J]. Eur J Intern Med, 2006, 17(6): 430-433.
[15]	Krüger S, Ewig S, Papassotiriou J, et al. Inflammatory parameters predict etiologic patterns but do not allow for individual prediction of etiology in patients with CAP: results from the German competence network CAPNETZ[J]. Respir Res, 2009, 10(1): 65-75.
[16]	Fincher R M, Page M I. Clinical significance of extreme elevation of the erythrocyte sedimentation rate[J]. Arch Intern Med, 1986, 146(8):1581-1583.