Relationship between hs-CRP，CCL2，CCL3 and Neonatal Bacterial Infection and Their Predictive Value for Efficacy
-
摘要:
目的 探讨超敏C反应蛋白（hs-CRP）、趋化因子CC基序配体（CCL）、CCL3与新生儿细菌感染病情关系及疗效预测价值。 方法 选取2021年1月至2023年1月廊坊市人民医院收治的70例新生儿细菌感染患儿作为细菌感染组，另按照1∶1比例选取70例新生儿病毒感染患儿、70例非感染性新生儿分别作为病毒感染组、对照组。比较3组及细菌感染组不同病情程度患儿入院时血清hs-CRP、CCL2、CCL3，比较细菌感染组不同疗效患儿血清各指标，绘制受试者工作特征曲线（ROC）分析血清各指标对治疗效果预测效能，用相对危险度（RR）分析血清各指标不同表达对新生儿细菌感染治疗效果的影响。 结果 细菌感染组、病毒感染组入院时血清hs-CRP、CCL2、CCL3表达均高于对照组（P < 0.05）；细菌感染中重症患儿入院时血清hs-CRP、CCL2、CCL3表达高于轻症患儿（P < 0.05），入院时及入院24 h、第3 天、第5 天无效亚组血清hs-CRP、CCL2、CCL3表达均高于有效亚组（P < 0.05）；入院时及入院24 h、第3 天、第5 天血清hs-CRP、CCL2、CCL3联合预测新生儿细菌感染疗效价值优于各时间点的单一指标预测效能，其中入院24 h各指标联合预测AUC最大；以入院24 h各指标截断值为界分为高表达、低表达，hs-CRP、CCL2、CCL3高表达患儿治疗无效风险是低表达患儿的3.577倍、3.357倍、2.630倍。 结论 在新生儿细菌感染血清中hs-CRP、CCL2、CCL3高表达，且与患儿病情程度、治疗效果密切相关，3者血清各指标联合在预测患儿治疗效果中具有良好的参考价值。 Abstract:Objective To explore the application value of high-sensitivity C-reactive protein （hs-CRP）, chemokine CC motif ligand （CCL）, and CCL3 in the treatment of neonatal bacterial infections. Methods A total of 70 cases of neonatal bacterial infection admitted to the People's Hospital of Langfang City from January 2021 to January 2023 were selected as the bacterial infection group. In addition, 70 cases of neonatal viral infection and 70 cases of non-infected newborns were selected as the viral infection group and control group, respectively, at a ratio of 1∶1. The serum hs-CRP, CCL2, and CCL3 levels of the three groups and the bacterial infection group were compared at admission, the serum levels of each index were compared among the bacterial infection group with different therapeutic effects, and a receiver operating characteristic curve （ROC） was drawn to analyze the predictive efficacy of each serum index on therapeutic effects. The relative risk （RR） was used to analyze the impact of different expression of each serum index on the therapeutic effect of neonatal bacterial infection. Results The expressions of hs-CRP, CCL2 and CCL3 in the bacterial infection group and viral infection group at admission were higher than those in the control group （P < 0.05）. The expressions of hs-CRP, CCL2 and CCL3 in severe children with bacterial infection at admission were higher than those in mild children （P < 0.05）. The levels of hs-CRP, CCL2 and CCL3 in the ineffective subgroup were higher than those in the effective subgroup at admission, 24 h, 3rd day and 5th day （P < 0.05）. The combined effect of serum hs-CRP, CCL2 and CCL3 on neonatal bacterial infection at admission, 24 h, 3 d and 5 d was better than that of single index at each time point, and the combined prediction of AUC at 24 h was the largest. According to the cut-off value of each index 24 hours after admission, the risk of treatment failure in children with high expression of hs-CRP, CCL2 and CCL3 was 3.577 times, 3.357 times and 2.630 times higher than that in children with low expression. Conclusions hs-CRP, CCL2 and CCL3 are highly expressed in the serum of neonatal bacterial infection, and they are closely related to the severity of the disease and the therapeutic effect of the children. The combination of the three serum indicators has good reference value in predicting the therapeutic effect of the children. -
Key words:
- ROC curve /
- hs-CRP /
- Inflammatory chemokines /
- Neonatal bacterial infection /
- Therapeutic effect /
- Value
-
表 1 3组一般资料比较[n/（$ \bar x \pm s $）]
Table 1. Comparison of general information among the three groups[n/（$ \bar x \pm s $）]
组别 n 男/女 日龄（d） 出生体质量（kg） 孕周（周） 细菌感染组 70 34/36 12.10±2.41 3.30±0.34 38.88±0.93 病毒感染组 70 38/32 12.58±2.20 3.25±0.40 38.92±1.02 对照组 70 41/29 12.37±1.89 3.37±0.35 39.10±1.15 F/χ2 1.418 0.855 1.917 0.893 P 0.492 0.427 0.150 0.411 
下载: 导出CSV
表 2 3组血清各指标水平（$\bar x \pm s $）
Table 2. Serum levels of various indicators among the three groups （$\bar x \pm s $）
组别 n hs-CRP（mg/L） CCL2（pg/mL） CCL3（pg/mL） 细菌感染组 70 55.08±5.64 102.08±14.36 71.77±6.13 病毒感染组 70 53.91±6.95 100.92±15.15 70.84±6.65 对照组 70 12.12±3.30 69.62±8.89 56.65±5.58 F 1382.020 138.343 133.520 P <0.001* <0.001* <0.001* *P < 0.05。
下载: 导出CSV
表 3 细菌感染组不同病情程度患儿血清各指标水平（$\bar x \pm s $）
Table 3. Serum levels of various indicators in children with different degrees of bacterial infection（$\bar x \pm s $）
组别 n hs-CRP（mg/L） CCL2（pg/mL） CCL3（pg/mL） 轻症 40 50.42±4.46 74.74±9.43 60.66±6.44 中重症 30 61.30±5.78 138.53±20.24 86.58±8.13 t −8.894 −17.580 −14.886 P <0.001* <0.001* <0.001* *P < 0.05。
下载: 导出CSV
表 4 细菌感染组不同疗效患儿血清hs-CRP、CCL2、CCL3水平（$\bar x \pm s $）
Table 4. Serum hs-CRP，CCL2 and CCL3 levels in children with different therapeutic effects in bacterial infection group （$\bar x \pm s $）
项目 组别 n 入院时 入院24 h 入院第3 天 入院第5 天 出院当天 组间 时间点 交互 hs-CRP（mg/L） 无效亚组 20 59.62±5.13 65.65±6.42 55.54±4.46 30.32±3.18 15.22±3.38 F=8.924，
P < 0.001*F=7.658，
P < 0.001*F=11.324，
P < 0.001*有效亚组 50 56.66±4.48 58.12±4.38 45.03±4.15 24.46±3.35 14.41±4.05 CCL2（pg/mL） 无效亚组 20 126.64±34.80 130.32±36.18 110.11±20.24 88.86±9.79 73.35±5.54 F=6.512，
P < 0.001*F=8.741，
P < 0.001*F=7.580，
P < 0.001*有效亚组 50 92.26±18.18 93.24±17.76 86.79±10.16 80.42±8.89 72.79±6.64 CCL3（pg/mL） 无效亚组 20 90.94±20.88 99.53±24.41 87.74±8.12 70.74±6.63 55.24±5.20 F=8.118，
P < 0.001*F=10.321，
P < 0.001*F=9.087，
P < 0.001*有效亚组 50 64.10±9.44 65.24±10.13 79.42±6.38 60.12±5.38 54.26±5.38 *P < 0.05。
下载: 导出CSV
表 5 血清各指标预测新生儿细菌感染疗效价值
Table 5. Value of serum indicators in predicting the therapeutic effect of neonatal bacterial infection
项目 AUC（95%CI） 截断值 特异度（%） 敏感度（%） P 入院时 hs-CRP （mg/L） 0.763（0.646～0.856） >57.08 80.00 72.00 <0.001* CCL2 （pg/mL） 0.787（0.673～0.876） >95.22 75.00 80.00 <0.001* CCL3 （pg/mL） 0.752（0.634～0.847） >74.69 80.00 62.00 <0.001* 3者联合 0.893（0.796～0.954） − 75.00 95.00 <0.001* 入院24 h hs-CRP （mg/L） 0.847（0.741～0.922） >63.22 75.00 90.00 <0.001* CCL2 （pg/mL） 0.805（0.693～0.890） >123.51 70.00 82.00 <0.001* CCL3 （pg/mL） 0.803（0.691～0.888） >83.22 90.00 64.00 <0.001* 3者联合 0.926（0.838～0.975） − 80.00 94.00 <0.001* 3者联合 0.926（0.838～0.975） − 80.00 94.00 <0.001* *P < 0.05。
下载: 导出CSV
表 6 血清各指标不同表达对新生儿细菌感染疗效的影响
Table 6. The effect of different expressions of serum indicators on the therapeutic effect of neonatal bacterial infection
项目 n 无效 有效 U RR（95%CI） P hs-CRP （mg/L） 高表达 35 18 17 3.577 9.000（2.256～35.907） <0.001* 低表达 35 2 33 CCL2 （pg/mL） 高表达 30 16 14 3.357 5.333（1.986～14.326） <0.001* 低表达 40 4 36 CCL3 （pg/mL） 高表达 32 15 17 2.630 3.563（1.454～8730） <0.001* 低表达 38 5 33 *P < 0.05。
下载: 导出CSV
-
[1] Cohen R,Romain O,Tauzin M,et al. Neonatal bacterial infections: Diagnosis,bacterial epidemiology and antibiotic treatment[J]. Infect Dis Now,2023,53(8S):104793. [2] Korang S K,Nava C,Mohana S P,et al. Antibiotics for hospital-acquired pneumonia in neonates and children[J]. Cochrane Database Syst Rev,2021,11(11):CD013864. [3] Murless-Collins S,Kawaza K,Salim N,et al. Blood culture versus antibiotic use for neonatal inpatients in 61 hospitals implementing with the NEST360 Alliance in Kenya,Malawi,Nigeria,and Tanzania: A cross-sectional study[J]. BMC Pediatr,2023,23(Suppl 2):568. [4] Liu Y L,Sun X H,Wang Y Q,et al. Evaluation of associated markers of neonatal pathological jaundice due to bacterial infection[J]. Iran J Public Health,2021,50(2):333-340. [5] Ngwengi Y,Ngaba G P,Nida M,et al. Evaluation of CRP as a marker for bacterial infection and malaria in febrile children at the douala gyneco-obstetric and pediatric hospital[J]. PLoS One,2023,18(7):e0289012. doi: 10.1371/journal.pone.0289012 [6] 白鹏,韩桂珍,鲁丽. 支气管哮喘患儿痰液中CXCR2、CCR1、CCL3、CCL2表达及与肺功能和气道炎症的关系[J]. 河北医药,2019,41(23):3555-3558. doi: 10.3969/j.issn.1002-7386.2019.23.008 [7] 邵肖梅. 实用新生儿学[M]. 第4版. 北京: 人民卫生出版社,2011: 317-322. [8] 龚剑锋,万华,李秋红. 降阶梯疗法治疗新生儿细菌感染性肺炎的疗效及对血清PCT、WBC和CRP的影响[J]. 东南大学学报(医学版),2018,37(5):868-872. doi: 10.3969/j.issn.1671-6264.2018.05.024 [9] Li Z,Yuan T M. Neutrophil extracellular traps in adult diseases and neonatal bacterial infectious diseases: A review[J]. Heliyon,2023,10(1):e23559. [10] 王焕成. 全血C反应蛋白与血常规中白细胞计数联合检验在儿科感染性疾病中的诊断价值[J]. 中国实用医药,2020,15(12):105-107. [11] Russell N J,Stöhr W,Plakkal N,et al. Patterns of antibiotic use,pathogens,and prediction of mortality in hospitalized neonates and young infants with sepsis: A global neonatal sepsis observational cohort study (NeoOBS)[J]. PLoS Med,2023,20(6):e1004179. doi: 10.1371/journal.pmed.1004179 [12] Naramura T,Imamura H,Yoshimatsu H,et al. The predictive value of procalcitonin and high-sensitivity C-reactive protein for early bacterial infections in preterm neonates[J]. Neonatology,2021,118(1):28-36. doi: 10.1159/000512523 [13] Borowski S,Shchors I,Bar-Meir M. Time from symptom onset may influence C-reactive protein utility in the diagnosis of bacterial infections in the NICU[J]. BMC Pediatr,2022,22(1):715. doi: 10.1186/s12887-022-03783-4 [14] 刘琪,常文婧,孙祖俊,等. PCT、SAA、hs-CRP、Neu%和WBC检测对感染性疾病的临床诊断价值分析[J]. 国际检验医学杂志,2020,41(15):1835-1838,1843. doi: 10.3969/j.issn.1673-4130.2020.15.010 [15] Sabry A,Ibrahim M,Khashana A. Assessment of pentraxin 3 in a systemic inflammatory response occurring with neonatal bacterial infection[J]. J Neonatal Perinatal Med,2021,14(4):563-568. doi: 10.3233/NPM-200550 [16] Liang J W,Wang L L,Zhou W,et al. Value of procalcitonin in neonatal infection within 24 hours after birth: A retrospective cohort study[J]. Clin Lab,2019,65(7):181212. [17] Du XF,Li F,Zhang C,et al. Eosinophil-derived chemokine (hCCL15/23,mCCL6) interacts with CCR1 to promote eosinophilic airway inflammation[J]. Signal Transduct Target Ther,2021,6(1):91. doi: 10.1038/s41392-021-00482-x [18] Xiromerisiou G,Marogianni C,Lampropoulos IC,et al. Peripheral inflammatory markers TNF-α and CCL2 revisited: Association with Parkinson's disease severity[J]. Int J Mol Sci,2022,24(1):264. doi: 10.3390/ijms24010264 [19] de Oliveira N ó brega C G,do Nascimento W R C,Santos PDA,et al. Schistosoma mansoni infection is associated with decreased risk of respiratory allergy symptoms and low production of CCL2[J]. Trop Med Int Health,2021,26(9):1098-1109. doi: 10.1111/tmi.13639 [20] Hartog G D,Ederveen T H A,Venkatasubramanian P B,et al. Chemokine profiling in children and adults with symptomatic and asymptomatic respiratory viral infections[J]. J Infect,2021,83(6):709-737. [21] Yang Y L,Li X F,Song B,et al. The role of CCL3 in the pathogenesis of rheumatoid arthritis[J]. Rheumatol Ther,2023,10(4):793-808. doi: 10.1007/s40744-023-00554-0 [22] Antimicrobial Resistance Collaborators. Global burden of bacterial antimicrobial resistance in 2019: A systematic analysis[J]. Lancet,2022,399(10325):629-655. doi: 10.1016/S0140-6736(21)02724-0 [23] Silvestro E,Marino R,Cusenza F,et al. Antimicrobial stewardship experience in paediatrics: first-year activity report[J]. Eur J Clin Microbiol Infect Dis,2021,40(8):1727-1735. doi: 10.1007/s10096-021-04222-5 [24] 魏志堃. 抗生素降阶梯疗法对新生儿感染性肺炎血清PCT、CRP及WBC水平的影响[J]. 天津药学,2018,30(6):30-31. doi: 10.3969/j.issn.1006-5687.2018.06.010 [25] 赖家慧,苏增玲,陈文慧. 抗生素降阶梯疗法对新生儿感染性肺炎的临床疗效分析[J]. 国处方药,2022,20(9):111-113. -
点击查看大图
图(1) / 表(6)
计量
- 文章访问数: 300
- HTML全文浏览量: 661
- PDF下载量: 5
- 被引次数: 0
