可溶解形TREM-1及CXC細胞趨化激素IP-10在小於四個月大嬰兒嚴重細菌感染之診斷價值評估

Soluble form of the triggering receptor expressed on myeloid cells-1 (sTREM-1) and CXC chemokine IP-10 as diagnostic markers of serious bacterial infection in infants younger than 4 months of age

陳秀玲(Hsiu-Lin Chen)

指導教授 ： 楊瑞成

高雄醫學大學/醫學院/醫學研究所/碩士(2007年)

https://doi.org/10.6832/KMU.2007.00103

摘要

中文摘要
背景:在小於4個月以下小嬰兒的細菌感染，以病人臨床表現及實驗室檢查都不足以完全預測有無嚴重細菌感染(serious bacterial infection, SBI)。本研究的目的是評估可溶解形TREM-1(sTREM-1)及 CXC細胞趨化激素interferon inducible protein of 10kDa (IP-10)，在小於四個月大嬰兒嚴重細菌感染之診斷價值。
方法: 研究對象為年齡小於四個月的嬰兒因臨床上懷疑有嚴重細菌感染而住入高雄醫學大學附設醫院小兒科新生兒加護病房或中重度病房的病人。在入院時抽血測一般血液檢查、CRP、sTREM-1或IP-10濃度，並作血液、尿液或腦脊髓液細菌培養。sTREM-1及IP-10濃度的測定是使用ELISA kits。病人依細菌培養之結果將病人分成SBI及non-SBI兩組來比較各類變項。
結果: 共有118位病嬰入院時作sTREM-1的測量，SBI組共有39位，而non-SBI組共有79位。無論是總白血球數、ANC、IT ratio、或是CRP，在SBI及non-SBI兩組都沒有差異性。以ANCOVA將年齡作共變分析後，sTREM-1在SBI組比起non-SBI組仍呈現有意義的升高(299.8±555.4 vs. 15.4±19.7，p=0.003)。將sTREM-1之cutoff value設在55.2 ng/mL時，則在鑑別有無細菌感染症方面，其敏感度為64% (95%信賴區間為55%-73%)，但其特異性可達97% (95%信賴區間為94%-100%)，positive likelihood ratio為21.3，negative likelihood ratio為0.37，diagnostic odds ratio為57.5。另外，有60位病嬰入院時作IP-10的測量。SBI組共有21位，而non-SBI組共有39位。總白血球數、ANC、IT ratio、或是CRP，在SBI及non-SBI兩組都沒有差異性。IP-10在SBI及non-SBI兩組中之mean±SD分別為 320.1±497.9 vs. 11.6±23.7。以ANCOVA將年齡作共變分析後，仍具顯著差異，p=0.016。將IP-10 cutoff value設在48.2 ng/mL，則在鑑別有無細菌感染症方面，其敏感度為81% (95%信賴區間為71%-90%)，但其特異性可達95% (95%信賴區間為89%-100%)，positive likelihood ratio為15.9，negative likelihood ratio為0.2，diagnostic odds ratio為79.3。
結論: sTREM-1或是IP-10在早期鑑別小於四個月的小嬰兒有無細菌性感染，比起CRP、IT ratio與Corrected WBC count等目前常用之實驗室診斷數據來說是有其診斷價值的。未來也許可應用在臨床作早期診斷細菌性感染。

關鍵字

可溶解形TREM-1 ； CXC細胞趨化激素IP-10 ； 嚴重細菌感染 ； 嬰兒

並列摘要

英文摘要
Background: Early diagnosis of serious bacterial infection (SBI) in young infants is a difficult problem by using clinical symptoms and signs. The goal of this study is to evaluate to diagnostic value of newly discovered inflammatory mediators: soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) or CXC chemokine IP-10 level for early diagnosis of SBI in infants younger than 4 months of age.
Methods: We enrolled pediatric patients who were less than 4 months of age with a suspicion to have SBI and admitted in neonatal intensive care unit or complete nursing unit of pediatric department of Kaohsiung Medical University hospital. Peripheral blood was drawn for measurement of complete blood count, CRP, sTREM-1 or IP-10 levels at admission. Positive blood, CSF, or urine culture was considered to have SBI. Soluble TREM-1 and IP-10 were detected by commercial ELISA kits.
Results: There were 118 patients to have sTREM-1 measurement. The SBI group (n=39) have higher plasma sTREM-1 level than non-SBI group (n=79) (299.8±555.4 v.s. 15.4±19.7，p=0.003 after adjusting age by ANCOVA analysis). Plasma sTREM-1 level higher than 55.2 ng/mL was more accurate than WBC count, absolute neutrophils counts, IT ratio, and CRP for indicating SBI in infants.[sensitivity 64.1% (95% CI, 55%-73%); specificity 97% (95% CI, 94%-100%); positive likelihood ratio 21.3; negative likelihood ratio 0.37; diagnostic odds ratio 57.5]。Sixty patients were collected to have measurement of IP-10. Plasma IP-10 level had significantly increase in SBI group [320.1±497.9 v.s. 11.6±23.7, p=0.016, after adjusting age by ANCOVA analysis] 。Plasma IP-10 level higher than 48.2 ng/mL had best diagnostic accuracy for indicating SBI. [sensitivity 81% (95% CI, 71%-90%); specificity 95% (95% CI 89%-100%); positive likelihood ratio 15.9，negative likelihood ratio 0.2; diagnostic odds ratio 79.3]。
Conclusion: In infants who were less than 4 months old, plasma sTREM-1 or IP-10 level might play a potential role in early identification of serious bacterial infection.

並列關鍵字

soluble TREM-1 ； CXC chemokine IP-10 ； serious bacterial infection ； infants

參考文獻

參考文獻

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