Roles of MxA，CRP and WBC count in the differential diagnosis of acute respiratory tract viral and bacterial infections

doi:10.3969/j.issn.1673-8640.2022.010.007

Abstract

Abstract:

Objective To investigate the clinical application values of myxovirus resistance protein A（MxA），C-reactive protein（CRP） and white blood cell（WBC） count in the differential diagnosis of acute respiratory tract viral infection and bacterial infection. Methods The viral infection group（350 cases），bacterial infection group（244 cases） and healthy control group（100 cases） were enrolled for determining MxA，CRP and WBC count. The diagnostic efficacy of the 3 indexes in each group was analyzed by receiver operating characteristic（ROC） curve. Results The MxA level in viral infection group was higher than those in bacterial infection group and healthy control group（P<0.05，P<0.01），and that in bacterial infection group was higher than that in healthy control group（P<0.05）. The CRP level and WBC count were higher in bacterial infection group than those in viral infection group and healthy control group（P<0.05，P<0.01），and that in viral infection group was higher than that in healthy control group（P<0.05）. ROC curve analysis showed that the areas under curves（AUC） of MxA，CRP，WBC count single determinations and combined determination were 0.829，0.703，0.665 and 0.850 for the differential diagnosis of viral infection and bacterial infection，respectively. The differential diagnostic performance of combined determination was better than those of single determinations（P<0.01）. Conclusions MxA，CRP and WBC count have good clinical application value in acute respiratory tract infectious diseases. MxA is superior to CRP and WBC count in distinguishing viral infection and bacterial infection，and the differential diagnostic performance of combined determination is better.

Key words: Myxovirus resistance protein A, C-reactive protein, White blood cell count, Acute respiratory tract infection

LIU Chunxiao, YI Changlin, WANG Xiaoshan, ZHU Yongzhen, LUO Aner, CHEN Changqiang. Roles of MxA，CRP and WBC count in the differential diagnosis of acute respiratory tract viral and bacterial infections[J]. Laboratory Medicine, 2022, 37(10): 944-947.

Figures/Tables 3

References 10

[1]	童永清, 赵志军, 徐万洲, 等. 急性呼吸道感染病原体的临床检验诊断路径[J]. 中华检验医学杂志, 2020, 43(7):687-690.
[2]	ZAV'YALOV V P, HÄMÄLÄINEN-LAANAYA H, KORPELA T K, et al. Interferon-inducible myxovirus resistance proteins:potential biomarkers for differentiating viral from bacterial infections[J]. Clin Chem, 2019, 65(6):739-750. DOI URL
[3]	HALLER O, KOCHS G. Human MxA protein:an interferon-induced dynamin-like GTPase with broad antiviral activity[J]. J Interferon Cytokine Res, 2011, 31(1):79-87. DOI URL
[4]	冼盈, 张扣兴. MxA抗病毒蛋白的研究进展[J]. 国际内科学杂志, 2009, 36(6):357-360.
[5]	TOIVONEN L, SCHUEZ-HAVUPALO L, RULLI M, et al. Blood MxA protein as a marker for respiratory virus infections in young children[J]. J Clin Virol, 2015, 62:8-13. DOI PMID
[6]	KAWAMURA M, KUSANO A, FURUYA A, et al. New sandwich-type enzyme-linked immunosorbent assay for human MxA protein in a whole blood using monoclonal antibodies against GTP-binding domain for recognition of viral infection[J]. J Clin Lab Anal, 2012, 26(3):174-183. DOI PMID
[7]	ENGELMANN I, DUBOS F, LOBERT P E, et al. Diagnosis of viral infections using myxovirus resistance protein A(MxA)[J]. Pediatrics, 2015, 135(4):e985-e993.
[8]	SELF W H, ROSEN J, SHARP S C, et al. Diagnostic accuracy of FebriDx:a rapid test to detect immune responses to viral and bacterial upper respiratory infections[J]. J Clin Med, 2017, 6(10):94. DOI URL
[9]	CLARK T W, BRENDISH N J, POOLE S, et al. Diagnostic accuracy of the FebriDx host response point-of-care test in patients hospitalised with suspected COVID-19[J]. J Infect, 2020, 81(4):607-613. DOI PMID
[10]	LAGI F, TREVISAN S, PICCICA M, et al. Use of the FebriDx point-of-care test for the exclusion of SARS-CoV-2 diagnosis in a population with acute respiratory infection during the second(COVID-19) wave in Italy[J]. Int J Infect Dis, 2021, 108:231-236. DOI URL

组别	例数	MxA/（ng/mL）	CRP/（mg/L）	WBC计数/（×10⁹/L）
病毒感染组	350	147.38（78.33~257.50）^**#	30.36（12.34~61.28）^*#	8.77（6.82~10.85）^*#
细菌感染组	244	45.46（22.52~75.53）^*	55.79（38.48~97.75）^**	11.31（8.98~13.65）^*
正常对照组	100	6.43（5.40~9.03）	2.89（1.23~5.39）	5.85（5.10~6.87）
U值		267.295	182.175	149.612
P值		0.000	0.000	0.000

组别	例数	MxA/（ng/mL）	CRP/（mg/L）	WBC计数/（×10⁹/L）
病毒感染组	350	147.38（78.33~257.50）^**#	30.36（12.34~61.28）^*#	8.77（6.82~10.85）^*#
细菌感染组	244	45.46（22.52~75.53）^*	55.79（38.48~97.75）^**	11.31（8.98~13.65）^*
正常对照组	100	6.43（5.40~9.03）	2.89（1.23~5.39）	5.85（5.10~6.87）
U值		267.295	182.175	149.612
P值		0.000	0.000	0.000

项目	AUC（95%可信区间）	最佳临界值	敏感性/%	特异性/%	Youden指数
CRP	0.703（0.661~0.744）^*	40.81 mg/L	72.5	64.3	0.368
WBC计数	0.665（0.620~0.710）^*	10.62×10⁹/L	60.7	74.0	0.347
MxA	0.829（0.796~0.862）^*	75.95 ng/mL	78.3	75.4	0.537
联合检测模型	0.850（0.819~0.881）	0.423	82.0	76.0	0.580

项目	AUC（95%可信区间）	最佳临界值	敏感性/%	特异性/%	Youden指数
CRP	0.703（0.661~0.744）^*	40.81 mg/L	72.5	64.3	0.368
WBC计数	0.665（0.620~0.710）^*	10.62×10⁹/L	60.7	74.0	0.347
MxA	0.829（0.796~0.862）^*	75.95 ng/mL	78.3	75.4	0.537
联合检测模型	0.850（0.819~0.881）	0.423	82.0	76.0	0.580

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