소아 세균감염증에서 혈청 procalcitonin의 임상적 유용성
Clinical Availability of Serum Procalcitonin in Children with Bacterical Infection
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목 적:소아 세균감염증에서 혈청 PCT 수치의 유용성를 알아보기 위하여 세균감염증 환자들의 PCT 수치와바이러스 감염증 및 비감염성 염증질환인 Juvenile rhematoid arthritis (JRA) 환자들의 PCT 수치를 비교하였다. 또한 PCT 검사의 유용성을 CRP 검사와 비교하여 평가하였다. 방 법: 2008년 4월부터 2009년 3월 사이에 소아청소년과에 입원치료 한 환자들 중 세균 감염이 확인된 10명, 바이러스 감염이 확인된 69명과 2007년 8월부터2009년 7월 사이에 JRA로 입원한 35명의 환아들을 대상으로 후향적으로 조사하였다. 대상 환아들의 PCT와CRP 수치를 분석하였고, 증상에 따라 추가되었던 배양검사와 바이러스검사 결과들로부터 환자들을 크게 세군감염군(I군)과 바이러스 감염군(II군), 비감염성 염증질환군(III군)으로 분류하여 각 군간의 PCT, CRP 수치를비교하여 통계적 유의성을 평가하였다. 결 과: I, II, III군의 CRP 평균값은 각각 62.07±28.97mg/L, 30.35±15.49 mg/L, 17.95±11.03 mg/L였고,PCT 평균값은 각각 5.56±1.99 ng/mL, 0.24±0.76 ng/mL, 0.06±1.06 ng/mL로 CRP와 PCT 모두 세 군 사이에 통계적으로 유의한 차이를 보였다(P <0.05). 두 군간의 CRP를 비교하였을 때, I군과 II군 사이에는 통계적으로 유의한 차이를 보였으나(P =0.0057) I과 III, II과 III 사이에서는 유의한 차이를 보이지 않았다(P >0.05). 반면 두 군간의 PCT를 비교하였을 때 I군과 II, I군과 III군모두 통계적으로 유의한 차이를 보였다(P <0.0001). PCT (Cutoff value=0.5 ng/mL)의 민감도와 특이도, 양성예측도와 음성예측도는 각각 60.0%, 92.3%, 42.9%, 96.0%였으며, CRP (Cutoff value=8 mg/L)의 민감도, 특이도, 양성예측도, 음성예측도는 각각 60.0%, 40.1%,10.0%. 92.6%였다. 결 론:소아 세균감염 환자에서의 PCT검사는 비세균성 질환과 감별에 있어 CRP에 비해 유용한 검사라 할 수있을 것이다.
Abstract
Purpose : The aim of this study was to identify clinical availability of serum procalcitonin (PCT) compared with C-reactive protein (CRP) in prediction of bacterial infection in children. Methods : A retrospective study was conducted with children who had been admitted to the Department of Pediatrics with bacterial and viral infection between April 2008 and March 2009 and children who were admitted with Juvenile rheumatoid arthritis (JRA) between August 2007 and July 2009. Serum PCT levels were measured using an enzyme-linked fluorescent assay. Results : The study population included 10 patients with bacterial infection (group I), 69 with viral infection (group II), and 35 with JRA (group III). Mean PCT levels were significantly higher in group I than in group II or group III (P <0.05). Mean CRP levels were significantly higher in group I than in group II (P <0.05); however, mean CRP levels were not significantly higher in group I than in group III (P >0.05). Using a cutoff of 0.5 ng/mL for PCT and 8 mg/L for CRP, sensitivity and specificity in distinguishing between group I and the other groups were 60.0% and 92.3% for PCT and 60.0% and 40.1% for CRP,respectively. Positive and negative predictive values were 42.9% and 96.0% for PCT and 10.0% and 92.6% for CRP, respectively. Conclusion : Measurement of PCT concentrations appears to be more useful than CRP for distinguishing between bacterial infection and non-bacterial diseases in children.
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