白细胞和C反应蛋白及红细胞压积在成人急性感染性腹泻中的应用价值

杨荻; 黄育红; 张斌

doi:10.16766/j.cnki.issn.1674-4152.001814

白细胞和C反应蛋白及红细胞压积在成人急性感染性腹泻中的应用价值

doi: 10.16766/j.cnki.issn.1674-4152.001814

合肥市第三人民医院感染性疾病科，安徽合肥 230022

基金项目:

安徽省自然科学基金项目 1708085MH0117

详细信息

通讯作者:
杨荻，E-mail：jms014@163.com

中图分类号: R442.2 R446
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- 文章访问数: 150
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- 被引次数: 0
出版历程
- 收稿日期: 2020-03-26
- 网络出版日期: 2022-02-19

Application value of white blood cell, C-reactive protein and hematocrit in adult acute infectious diarrhea

Department of Infectious Diseases, the Third People's Hospital of Hefei, Hefei, Anhui 230022, China

摘要

摘要: 目的探讨白细胞(WBC)、C反应蛋白(CRP)及红细胞压积(HCT)在成人急性感染性腹泻中的应用价值。方法收集2014年4月—2018年10月合肥市第三人民医院收治的急性感染性腹泻患者共90例，根据疾病导致的脱水症状分轻、中、重3组(各30例)，患者均进行抗生素治疗，检查治疗前后WBC、CRP、HCT水平以及腹痛、恶心呕吐、发热、乏力发生率。用Pearson法分析3项指标与脱水程度、止泻时间的关系。结果 3组治疗前WBC、CRP及HCT差异均有统计学意义(F=23.092、3.998、8.905，均P＜0.05)，其中轻度组WBC、CRP及HCT水平最低，重度组水平最高(P＜0.05)。3组治疗后WBC、CRP及HCT差异均有统计学意义(F=13.966、4.031、5.435，均P＜0.05)，其中轻度组WBC、CRP及HCT水平最低，重度组水平最高(P＜0.05)。重度组止泻时间[(10.57±4.36)d]、抗生素治疗时间[(10.71±3.92)d]最长，且重度组的腹痛、恶心呕吐、发热、乏力的发生率最高(P＜0.05)。WBC与脱水程度、止泻时间均为正相关(r=0.767、0.813，均P＜0.05)；CRP与脱水程度、止泻时间均为正相关(r=0.829、0.802，均P＜0.05)；HCT与脱水程度、止泻时间均为正相关(r=0.886、0.823，P＜0.05)。结论 WBC、CRP及HCT可以预测细菌培养阴性的急性感染性腹泻患者脱水程度及预后情况，为指导治疗和避免抗生素过度使用提供参考。
- 腹泻 /
- 白细胞 /
- 红细胞压积 /
- C反应蛋白
Abstract: Objective To explore the application value of white blood cell (WBC), C-reactive protein (CRP) and hematocrit (HCT) in adult's acute infectious diarrhea. Methods A total of 90 patients with acute infectious diarrhea admitted to our hospital from April 2014 to October 2018 were collected. According to the dehydration symptoms caused by the disease, they were divided into three groups of mild, medium and severe group (30 cases each). All patients were treated with antibiotics. WBC, CRP, HCT, abdominal pain, nausea and vomiting, fever and fatigue were examined before and after treatment. Pearson's method was used to analyze the relationship among the three indexes, dehydration degree and antidiarrheal time. Results The differences of WBC, CRP and HCT in the three groups before treatment were statistically significant (F=23.092, 3.998, 8.905, all P < 0.05). Among them, the WBC, CRP and HCT levels were the lowest in the mild group and the highest in the severe group (P < 0.05). The differences of WBC, CRP and HCT in the three group after treatment were statistically significant (F=13.966, 4.031, 5.435, all P < 0.05). Among them, the WBC, CRP and HCT levels were the lowest in the mild group, and the highest in the severe group (P < 0.05). The antidiarrheal time [(10.57±4.36) d] and antibiotic treatment time [(10.71±3.92) d] were the longest in the severe group, and the incidence of abdominal pain, nausea and vomiting, fever and fatigue were the highest in the severe group (P < 0.05). WBC was positively correlated with dehydration degree and antidiarrheal time (r=0.767, 0.813, all P < 0.05), CRP was positively correlated with dehydration degree and antidiarrheal time (r=0.829, 0.802, all P < 0.05), HCT was positively correlated with dehydration degree and antidiarrheal time (r=0.886, 0.823, all P < 0.05). Conclusion WBC, CRP and HCT can predict the dehydration degree and prognosis of patients with negative bacterial culture, and provide reference for guiding treatment and avoiding excessive use of antibiotics.
- Diarrhea /
- White blood cell /
- Hematocrit /
- C-reactive protein

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表 1 3组急性感染性患者基线情况 (x ±s)

组别	例数	性别(例)		年龄 (岁)	腹泻时间 (d)
组别	例数	女性	男性	年龄 (岁)	腹泻时间 (d)
轻度组	30	21	9	49.21±20.94	4.52±1.34
中度组	30	19	11	49.83±20.26	4.60±1.27
重度组	30	21	9	50.17±19.55	4.93±1.46
统计量		0.634^a		0.017^b	0.767^b
P值		0.728		0.983	0.468
注：^a为χ²值，^b为F值。

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表 2 3组急性感染性腹泻患者治疗前后WBC、CRP及HCT比较 (x ±s)

组别	例数	WBC		CRP(mg/L)		HCT(%)
组别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
轻度组	30	10.46±2.47	9.21±2.39^c	30.83±15.23	12.68±5.23^c	39.66±4.39	38.38±4.27^c
中度组	30	11.03±2.44	9.28±2.32^c	33.12±16.21	12.72±6.18^c	40.09±3.67	38.86±4.38^c
重度组	30	14.42±2.41^ab	12.01±2.31^abc	41.80±16.10^ab	16.42±6.12^abc	43.78±4.37^ab	41.61±3.59^abc
F值		23.092	13.966	3.998	4.031	8.905	5.435
P值		<0.001	<0.001	0.022	0.021	<0.001	0.006
注：与轻度组比较，^aP＜0.05；与中度组比较，^bP＜0.05。与治疗前比较，^cP < 0.05。

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表 3 不同脱水程度的急性感染性腹泻患者治疗情况 (例)

组别	例数	止泻时间 (x±s，d)	抗生素治疗时间 (x±s，d)	腹痛		恶心呕吐		发热		乏力
组别	例数	止泻时间 (x±s，d)	抗生素治疗时间 (x±s，d)	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
轻度组	30	5.54±1.30	4.68±1.24	10^b	2^b	8^b	2^b	3^b	1	11^b	2^b
中度组	30	7.62±2.45^a	5.83±1.85^a	21^a	7^a	15^a	6^a	6^a	2	24^a	8^a
重度组	30	10.57±4.36^a	10.71±3.92^a	28^a	8^a	21^a	7^a	10^a	4^a	30^a	8^a
统计量		21.532^c	45.382^c	10.784^d	7.448^d	9.506^d	7.198^d	8.197^d	4.971^d	13.636^d	8.758^d
P值		＜0.001	＜0.001	0.001	0.006	0.002	0.007	0.004	0.026	0.001	0.003
注：与轻度组比较，^aP＜0.05；与中度组比较，^bP＜0.05。^c为F值；^d为χ²值。

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参考文献(15)

[1]	JIA L, LIN C, GAO Z, et al. Prevalence and factors associated with different pathogens of acute diarrhea in adults in Beijing, China[J]. J Infect Dev Ctries, 2016, 10(11): 1200-1207. doi: 10.3855/jidc.6831
[2]	SHANE A L, MODY R K, CRUMP J A, et al. 2017 Infectious Diseases Society of America Clinical Practice Guidelines for the Diagnosis and Management of Infectious Diarrhea[J]. Clin Infect Dis, 2017, 65(12): e45-e80. doi: 10.1093/cid/cix669
[3]	SHIN H J, KANG S H, MOON H S, et al. Serum procalcitonin levels can be used to differentiate between inflammatory and non-inflammatory diarrhea in acute infectious diarrhea[J]. Medicine(Baltimore), 2018, 97(32): e11795. http://www.ncbi.nlm.nih.gov/pubmed/30095641
[4]	RIDDLE M S, DUPONT H L, CONNOR B A. ACG clinical guideline: diagnosis, treatment, and prevention of acute diarrheal infections in adults[J]. Am J Gastroenterol, 2016, 111(5): 602-622. doi: 10.1038/ajg.2016.126
[5]	RIDDLE M S, MARTIN G J, MURRAY C K, et al. Management of acute diarrheal illness during deployment: a deployment health guideline and expert panel report[J]. Mil Med, 2017, 182(S2): 34-52. doi: 10.7205/MILMED-D-17-00077
[6]	缪晓辉, 冉陆, 张文宏, 等. 成人急性感染性腹泻诊疗专家共识[J]. 中华传染病杂志, 2013, 31(12): 705-714. doi: 10.3760/cma.j.issn.1000-6680.2013.12.001
[7]	姜天俊, 张秀, 范荣, 等. 口服补液盐治疗成人急性感染性腹泻脱水的效果分析[J]. 临床合理用药, 2011, 4(29): 101-103. doi: 10.3969/j.issn.1674-3296.2011.29.089
[8]	ARASARADNAM R P, BROWN S, FORBES A, et al. Guidelines for the investigation of chronic diarrhoea in adults: British Society of Gastroenterology, 3rd edition[J]. Gut, 2018, 67(8): 1380-1399. doi: 10.1136/gutjnl-2017-315909
[9]	CHEN C, WANG L P, YU J X, et al. Prevalence of enteropathogens in outpatients with acute diarrhea from urban and rural areas, Southeast China, 2010-2014[J]. Am J Trop Med Hyg, 2019, 101(2): 310-318. doi: 10.4269/ajtmh.19-0171
[10]	CHANG Z, ZHANG J, RAN L, et al. The changing epidemiology of bacillary dysentery and characteristics of antimicrobial resistance of Shigella isolated in China from 2004-2014[J]. BMC Infect Dis, 2016, 16(1): 685. doi: 10.1186/s12879-016-1977-1
[11]	HERBINGER K H, HANUS I, SCHUNK M, et al. Elevated values of C-Reactive protein induced by imported infectious diseases: a controlled cross-sectional study of 11, 079 diseased german travelers returning from the tropics and subtropics[J]. Am J Trop Med Hyg, 2016, 95(4): 938-944. doi: 10.4269/ajtmh.16-0387
[12]	TELLO L, PEREZ-FREYTES R. Fluid and electrolyte therapy during vomiting and diarrhea[J]. Vet Clin North Am Small Anim Pract, 2017, 47(2): 505-519. doi: 10.1016/j.cvsm.2016.09.013
[13]	李静丹, 王晶, 宋智心, 等. 血清C反应蛋白水平在鉴别不同类型腹泻中的意义[J]. 贵州医科大学学报, 2016, 41(12): 1452-1454, 1458.
[14]	ROWLEY N M, SMITH M D, LAMB J G, et al. Hippocampal betaine/GABA transporter mRNA expression is not regulated by inflammation or dehydration post-status epilepticus[J]. J Neurochem, 2011, 117(1): 82-90. doi: 10.1111/j.1471-4159.2011.07174.x
[15]	GARCIA-ARROYO F E, CRISTOBAL M, ARELLANO-BUENDIA A S, et al. Rehydration with soft drink-like beverages exacerbates dehydration and worsens dehydration-associated renal injury[J]. Am J Physiol Regul Integr Comp Physiol, 2016, 311(1): R57-R65. doi: 10.1152/ajpregu.00354.2015