血清淀粉样蛋白A检测在手足口病中的诊断意义
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摘要
目的探讨血清淀粉样蛋白A(serum amyloid A protein,SAA)在儿童手足口病中的诊断意义。方法手足口病组为2017年8月-12月到广州市妇女儿童医疗中心就诊的手足口患儿107例,对照组为同期在该院作保健的健康儿童125例。采静脉血标本检测SAA、超敏C-反应蛋白(hs-CRP)、肌酸激酶(CK)、肌酸激酶同工酶(CKMB)、乳酸脱氢酶(LDH)、α-羟丁酸脱氢酶(HBDH)和白细胞(WBC)水平。比较2组间上述指标的差异;分析手足口病组SAA与其他指标的相关性;同时比较手足口病组SAA和hs-CRP、WBC的检测阳性率;利用ROC曲线分析SAA对手足口病的诊断效能。结果手足口病组血清SAA、hs-CRP、LDH、HBDH和WBC水平均高于对照组(P<0.05)。SAA与hs-CRP、WBC均呈正相关,相关系数分别为0.760和0.394(P<0.05)。SAA检测的阳性率(86.91%)高于hs-CRP(63.55%)和WBC(66.36%)的阳性率(P<0.05)。根据ROC曲线,最大尤登指数对应SAA的分界值为15.68 mg/L,AUC为0.944(95%CI为0.900～0.987),预测手足口病的灵敏度为83.6%,特异度为97.6%。结论检测血清SAA的水平对手足口病的诊断具有重要意义。
Objective To investigate the significance of serum amyloid A protein(SAA) level in diagnosing hand-foot-mouth disease(HFMD). Methods A total of 107 patients with hand-foot-mouth disease(HFMD group) were selected in Guangzhou Woman and Children′s Medical Center from August to December 2017. 125 healthy children were selected as control group at the same term. Venial blood was collected to detect the levels of SAA, hypersensitive C reactive protein(hs-CRP), creatine kinase(CK), creatine kinase isoenzyme(CKMB), actic dehydrogenase(LDH), alpha-hydroxybutyric dehydrogenase(HBDH) and white blood cell(WBC). The differences of the above items were compared between the two groups. The correlation of SAA with other items in the HFMD group was analyzed. The positive determination rates of SAA, hs-CRP and WBC were compared in the HFMD group. ROC curve was used to analyze the diagnostic value of SAA in HFMD. Results In HFMD group, the levels of serum SAA, hs-CRP, LDH, HBDH and WBC were significantly higher than those in control group(P<0.05). SAA was positively correlated with hs-CRP and WBC, with the correlation coefficients of 0.760 and 0.394(P<0.05). The positive determination rate of SAA(86.91%) was higher than that of hs-CRP(63.55%) and WBC(66.36%)(P<0.05). The area under curve of ROC was 0.944(95%CI: 0.900-0.987), and the cut-off point of serum SAA under the maximum Youden index was 15.68 mg/L. The sensitivity and specificity were respectively 83.6%, 97.6%. Conclusion It has great significance for the detection of HFMD to detect the serum level of SAA.
Objective To investigate the significance of serum amyloid A protein(SAA) level in diagnosing hand-foot-mouth disease(HFMD). Methods A total of 107 patients with hand-foot-mouth disease(HFMD group) were selected in Guangzhou Woman and Children′s Medical Center from August to December 2017. 125 healthy children were selected as control group at the same term. Venial blood was collected to detect the levels of SAA, hypersensitive C reactive protein(hs-CRP), creatine kinase(CK), creatine kinase isoenzyme(CKMB), actic dehydrogenase(LDH), alpha-hydroxybutyric dehydrogenase(HBDH) and white blood cell(WBC). The differences of the above items were compared between the two groups. The correlation of SAA with other items in the HFMD group was analyzed. The positive determination rates of SAA, hs-CRP and WBC were compared in the HFMD group. ROC curve was used to analyze the diagnostic value of SAA in HFMD. Results In HFMD group, the levels of serum SAA, hs-CRP, LDH, HBDH and WBC were significantly higher than those in control group(P<0.05). SAA was positively correlated with hs-CRP and WBC, with the correlation coefficients of 0.760 and 0.394(P<0.05). The positive determination rate of SAA(86.91%) was higher than that of hs-CRP(63.55%) and WBC(66.36%)(P<0.05). The area under curve of ROC was 0.944(95%CI: 0.900-0.987), and the cut-off point of serum SAA under the maximum Youden index was 15.68 mg/L. The sensitivity and specificity were respectively 83.6%, 97.6%. Conclusion It has great significance for the detection of HFMD to detect the serum level of SAA.
引文
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[11] 彭致平, 黄明兰, 隋红. 联合检测SAA和CRP对小儿感染性疾病的早期鉴别诊断[J]. 实验与检验医学, 2017, 35(3): 416-418.
[12] 潘喜梅, 潘俊泉, 吴新良, 等. 联合检测SAA、CRP和PCT检测对小儿急性期感染诊断的应用价值分析[J]. 实验与检验医学, 2016, 34(6): 751-753.
[13] 孙安民, 王伟. 外周血高敏C-反应蛋白和淀粉样蛋白A联合检测的临床价值[J]. 中国卫生检验杂志, 2015, 25(15): 2539-2540, 2544.
[14] 秦育滨, 徐孝伦, 李妙娜. 血清淀粉样蛋白 A 联合 C 反应蛋白检测在手足口病患儿中的临床应用研究[J]. 中国实用医药, 2017, 12(34): 68-70.
[15] 王爱朝. 几种心肌酶对心肌损伤性疾病的诊断价值[J]. 医学检验与临床, 2010, 21(6): 92-93.
[2] 宋春兰, 成怡冰, 陈丹, 等. 儿童危重型手足口病死亡的危险因素分析[J]. 中国当代儿科杂志,2014, 15(10): 1033-1036.
[3] 杨红玲, 郑磊, 周才, 等. 胶体金渗滤法检测血清淀粉样蛋白A方法评价及其在儿童感染性疾病诊断中的应用[J]. 中华检验医学杂志, 2014, 37(11): 836-841.
[4] 田月如, 李巍, 叶志成, 等. 血清淀粉样蛋白 A 和 C 反应蛋白检测在儿童感染性疾病诊断中的应用[J]. 检验医学, 2017, 32(5): 383-385.
[5] 中华人民共和国卫生部. 手足口病诊疗指南(2010年版)[J]. 国际呼吸杂志, 2010, 30(24): 1473-1475.
[6] 赵崇泉, 郭勇晖, 沈永棋, 等. 2014-2015年广州759例儿童肠道病毒感染病原谱调查[J]. 中华疾病控制杂志, 2017, 21(6): 567-571.
[7] 钭慧芳,陈栋,孙宝昌, 等. 2010年-2012年温州地区手足口病原监测结果分析[J]. 中国卫生检验杂志, 2014, 24(6): 1928-1930.
[8] Xing W, Liao Q, Viboud C, et al. Hand, foot, and mouth disease in China, 2008-12: an epidemiological study[J]. Lancet Infect Dis, 2014, 14(4): 308-318.
[9] 刘翠. 超敏C-反应蛋白检测对手足口病诊断的作用[J]. 国际检验医学杂志, 2017, 38(6): 841-842.
[10] Kisilevsky R, Manley PN. Acute-phase serum amyloid A: perspectives on its physiological roles[J]. Amyloid, 2012, 19(1): 5-14.
[11] 彭致平, 黄明兰, 隋红. 联合检测SAA和CRP对小儿感染性疾病的早期鉴别诊断[J]. 实验与检验医学, 2017, 35(3): 416-418.
[12] 潘喜梅, 潘俊泉, 吴新良, 等. 联合检测SAA、CRP和PCT检测对小儿急性期感染诊断的应用价值分析[J]. 实验与检验医学, 2016, 34(6): 751-753.
[13] 孙安民, 王伟. 外周血高敏C-反应蛋白和淀粉样蛋白A联合检测的临床价值[J]. 中国卫生检验杂志, 2015, 25(15): 2539-2540, 2544.
[14] 秦育滨, 徐孝伦, 李妙娜. 血清淀粉样蛋白 A 联合 C 反应蛋白检测在手足口病患儿中的临床应用研究[J]. 中国实用医药, 2017, 12(34): 68-70.
[15] 王爱朝. 几种心肌酶对心肌损伤性疾病的诊断价值[J]. 医学检验与临床, 2010, 21(6): 92-93.