Биомаркери за разграничаване на бактериални от вирусни остри респираторни инфекции при деца

Резюме

Острите респираторни инфекции (ОРИ) са водеща причина за заболеваемост и консултации с педиатър в детската възраст. Въпреки че преобладаващата част от ОРИ са с вирусна етиология, клиничното им разграничаване от бактериалните инфекции често е затруднено, което води до свръхупотреба на антибиотици и повишаване на антибиотичната резистентност. Настоящият обзор има за цел да представи съвременните лабораторни и биомаркерни подходи за диференциране на вирусни и бактериални респираторни инфекции при деца.

Разгледани са класическите лабораторни показатели – левкоцитен брой и диференциална кръвна картина, C-реактивен протеин (CRP) и прокалцитонин (PCT), както и техните ограничения при различни клинични сценарии, включително атипични бактериални инфекции и тежки вирусни заболявания като COVID-19 и грип. Представени са нови диагностични маркери и протеинови панели, включващи Myxovirus resistance protein A (MxA), TRAIL и IP-10, които показват висока чувствителност и специфичност за определяне на етиологията на инфекцията. Обсъдени са и комбинирани диагностични алгоритми и BV score, които демонстрират значително по-добра диагностична точност в сравнение с използването на единичен маркер.

Нито един лабораторен показател самостоятелно не е напълно надежден, а оптималният диагностичен подход изисква интеграция на клиничната картина, лабораторните данни и микробиологичните изследвания. Прилагането на комбинирани биомаркерни панели има потенциал да намали ненужната антибиотична терапия и да подобри клиничното поведение при деца с остри респираторни инфекции.

Ключови думи: С-реактивен протеин, прокалцитонин, серумен амилоид, комплексни панели, левкоцитоза

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Адрес за кореспонденция:

Г. Петрова,

Клиника по педиатрия

УМБАЛ „Александровска“, София

gal_ps@yahoo.co.uk