降钙素原联合C-反应蛋白在儿童细菌性肺炎诊断中的价值
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摘要
目的探讨降钙素原联合C-反应蛋白(CRP)在儿童细菌性肺炎诊断中的价值。方法将张家口市第一医院2015年1—12月收治的细菌性肺炎患儿根据病原体的不同分为细菌组(43例),病毒组(29例)和支原体组(23例),选取同期来院体检的健康儿童35例作为对照组,均检测降钙素原(PCT)和CRP的水平,并比较四组PCT和CRP水平是否有差异;根据PCT、CRP、PCT/CRP串联试验和PCT/CRP并联试验阳性判定标准分别评价其在儿童细菌性肺炎诊断中的价值。结果细菌组PCT水平为(5.42±1.41)μg/L,CRP水平为(26.25±10.08)mg/L,均高于支原体组[(0.36±0.15)μg/L和(17.14±6.02)mg/L]、病毒组[(0.23±0.10)μg/L和(3.25±0.74)mg/L]和对照组[(0.18±0.06)μg/L和(2.78±0.88)mg/L],差异有统计学意义(P<0.001);PCT单独检测和PCT/CRP串联试验中细菌组阳性率分别为86.05%和69.77%,均高于支原体组(43.48%和21.74%)和病毒组(27.59%和13.79%),差异有统计学意义(P<0.001),但是在CRP单独检测和PCT/CRP并联试验中,病毒组与支原体组比较差异无统计学意义(P>0.017);四种评估策略中,PCT/CRP并联试验的灵敏度最高为90.70%,PCT/CRP串联试验的特异度最高为82.69%,且PCT/CRP串联试验具有最高的Youden指数为0.51。结论 PCT和PCT/CRP串联试验对儿童细菌性肺炎有较好的诊断特异度,可以作为儿童细菌性肺炎临床诊断的依据之一。
Objective To investigate the clinical value of procalcitonin(PCT) and C-reactive protein(CRP) in the diagnosis of bacterial pneumonia in children.Methods The children with bacterial pneumonia who were treated in the Number One Hospital of Zhangjiakou from January to December 2015 were selected and assigned into three groups according to the different pathogens:the bacterial group(43 cases),the virus group(29 cases) and the mycoplasma group(23 cases).And 35 healthy children having physical examination in the same period were selected as the control group.The levels of PCT and CRP in the four groups were measured and compared.The diagnosis value of PCT and CRP in children with bacterial pneumonia was evaluated respectively according to the positive criteria of the PCT,CRP,PCT/CRP series test and the PCT/CRP parallel test.Results In the bacterial group,the level of PCT was(5.42±1.41) μg/L and the level of CRP was(26.25±10.08) mg/L,which were significantly higher(P<0.001) than those in the mycoplasma group [(0.36±0.15) μg/L and(17.14±6.02) mg/L],the virus group [(0.23±0.10) μg/L and(3.25±0.74) mg/L] and the control group [(0.18±0.06) μg/L and(2.78±0.88) mg/L].In the PCT and PCT/CRP series test,the positive rates of the bacterial group were 86.05% and 69.77%,higher than those in the mycoplasma group(43.48% and 21.74%,P<0.001) and the virus group(27.59% and 13.79%,P<0.001).However,in the CRP and PCT/CRP parallel test,there was no statistically difference between the virus group and the mycoplasma group(P>0.017).Among the four assessment strategies,the sensitivity of PCT/CRP parallel test was 90.70%,which was the highest.The specificity of PCT/CRP series test was the highest,which was 82.69%.Also,the Youden index of PCT/CRP series test was 0.51,which was higher than the others.Conclusions The PCT and PCT/CRP series test have good diagnostic specificity for children's bacterial pneumonia,which can be used as a basis for clinical diagnosis of bacterial pneumonia in children.
Objective To investigate the clinical value of procalcitonin(PCT) and C-reactive protein(CRP) in the diagnosis of bacterial pneumonia in children.Methods The children with bacterial pneumonia who were treated in the Number One Hospital of Zhangjiakou from January to December 2015 were selected and assigned into three groups according to the different pathogens:the bacterial group(43 cases),the virus group(29 cases) and the mycoplasma group(23 cases).And 35 healthy children having physical examination in the same period were selected as the control group.The levels of PCT and CRP in the four groups were measured and compared.The diagnosis value of PCT and CRP in children with bacterial pneumonia was evaluated respectively according to the positive criteria of the PCT,CRP,PCT/CRP series test and the PCT/CRP parallel test.Results In the bacterial group,the level of PCT was(5.42±1.41) μg/L and the level of CRP was(26.25±10.08) mg/L,which were significantly higher(P<0.001) than those in the mycoplasma group [(0.36±0.15) μg/L and(17.14±6.02) mg/L],the virus group [(0.23±0.10) μg/L and(3.25±0.74) mg/L] and the control group [(0.18±0.06) μg/L and(2.78±0.88) mg/L].In the PCT and PCT/CRP series test,the positive rates of the bacterial group were 86.05% and 69.77%,higher than those in the mycoplasma group(43.48% and 21.74%,P<0.001) and the virus group(27.59% and 13.79%,P<0.001).However,in the CRP and PCT/CRP parallel test,there was no statistically difference between the virus group and the mycoplasma group(P>0.017).Among the four assessment strategies,the sensitivity of PCT/CRP parallel test was 90.70%,which was the highest.The specificity of PCT/CRP series test was the highest,which was 82.69%.Also,the Youden index of PCT/CRP series test was 0.51,which was higher than the others.Conclusions The PCT and PCT/CRP series test have good diagnostic specificity for children's bacterial pneumonia,which can be used as a basis for clinical diagnosis of bacterial pneumonia in children.
引文
[1] 缑梦帆,窦冉,刘娟.血清降钙素原在小儿肺炎诊断中的临床意义[J].山西职工医学院学报,2016,26(6):24-26.
[2] 任甡,姚丛月,韦炫江,等.降钙素原联合 C-反应蛋白在儿童肺炎早期诊断中的意义[J].中国妇幼健康研究,2016,27(7):864-865,874.
[3] 李庆富,方文,王成新,等.C 反应蛋白及降钙素原对儿童细菌感染性肺炎的早期诊断价值研究[J].国际检验医学杂志,2015,36(11):1586-1588.
[4] 胡亚美.诸福棠实用儿科学[M].7版.北京:人民卫生出版社,2002:1174-1185.
[5] 方积乾.卫生统计学[M].6版.北京:人民卫生出版社,2008:195-197.
[6] 张珍,白威峰.降钙素原与 C 反应蛋白联合检测在儿童支气管肺炎及细菌性肺炎中的应用评价[J].淮海医药,2016,34(2):155-156.
[7] 李静,蔡木发,梁任,等.降钙素原在感染性肺炎鉴别诊断中的价值[J].齐齐哈尔医学院学报,2012,33(4):435-436.
[8] 饶鸣皋.儿童不同病因肺炎超敏C反应蛋白、降钙素原的变化及意义[J].安徽医药,2013,17(10):1746-1747.
[9] 徐静.血清降钙素原、C反应蛋白及白细胞计数在儿童感染性疾病中的诊断价值 [D].合肥:安徽医科大学,2014.
[10] 朱小生,方长太,白兆青.降钙素原对呼吸机相关性肺炎的诊断意义[J].安徽医学,2010,31(12):1435-1436.
[11] 郑志辉,陈嗣源,林红霞.外周血超敏 C-反应蛋白、降钙素原、细胞免疫状况与儿童肺部感染的关系研究[J].中华医院感染学杂志,2014,24(7):1779-1781.
[12] 薛邦禄,刘新涛.血清降钙素原和C-反应蛋白联合检测在儿童肺炎支原体肺炎中的应用[J].国际检验医学杂志,2011,32(2):187-188.
[13] 李容芳,周睿,张碧惠.血清降钙素原(PCT)检测在小儿感染性肺炎诊断中的应用效果观察[J].吉林医学,2016,37(1):150-151.
[14] 夏振雄,高春娜,曾沛丰,等.探讨不同病原体致小儿肺炎中的降钙素原改变[J].中国医学创新,2014,11(3):67-69.
[15] 茆政.血清降钙素原和C反应蛋白联合检测在儿童急性肺炎诊断中的应用价值[J].中外医疗,2016,35(4):197-198.
[16] 伊忻,靳晶,陈纳纳,等.血清降钙素原联合C反应蛋白和IL-6检测在小儿感染性肺炎诊断中的应用效果[J].国际呼吸杂志,2016,36(14):1045-1048.
[17] 李虹光,徐晓军,杨建荣,等.肺炎合并脓毒症患儿血清降钙素原水平变化的临床意义[J].解放军预防医学杂志,2016,34(5):709-711.
[18] 肖平,罗毅.肺炎患儿血清降钙素原和C反应蛋白水平变化和意义[J].中国基层医药,2015,22(12):1866-1869.
[19] POURAKBARI B,MAMISHI S,ZAFARI J,et al.Evaluation of procalcitonin and neopterin level in serum of patients with acute bacterial infection[J].Braz J Infect Dis,2010,14(3):252-255.
[20] DíEZ-PADRISA N,BASSAT Q,MACHEVO S,et al.Procalcitonin and C-reactive protein for invasive bacterial pneumonia diagnosis among children in mozambique,a malaria-endemic area[J].PLoS One,2010,5(10):e13226.DOI:10.1371/journal.pone.0013226.
[21] 张茂好.降钙素原检测在小儿细菌性肺炎早期诊断中的意义[J].中国感染控制杂志,2016,15(10):800-801.
[22] 李立明.流行病学[M].6版.北京:人民卫生出版社,2007:170-176.
[2] 任甡,姚丛月,韦炫江,等.降钙素原联合 C-反应蛋白在儿童肺炎早期诊断中的意义[J].中国妇幼健康研究,2016,27(7):864-865,874.
[3] 李庆富,方文,王成新,等.C 反应蛋白及降钙素原对儿童细菌感染性肺炎的早期诊断价值研究[J].国际检验医学杂志,2015,36(11):1586-1588.
[4] 胡亚美.诸福棠实用儿科学[M].7版.北京:人民卫生出版社,2002:1174-1185.
[5] 方积乾.卫生统计学[M].6版.北京:人民卫生出版社,2008:195-197.
[6] 张珍,白威峰.降钙素原与 C 反应蛋白联合检测在儿童支气管肺炎及细菌性肺炎中的应用评价[J].淮海医药,2016,34(2):155-156.
[7] 李静,蔡木发,梁任,等.降钙素原在感染性肺炎鉴别诊断中的价值[J].齐齐哈尔医学院学报,2012,33(4):435-436.
[8] 饶鸣皋.儿童不同病因肺炎超敏C反应蛋白、降钙素原的变化及意义[J].安徽医药,2013,17(10):1746-1747.
[9] 徐静.血清降钙素原、C反应蛋白及白细胞计数在儿童感染性疾病中的诊断价值 [D].合肥:安徽医科大学,2014.
[10] 朱小生,方长太,白兆青.降钙素原对呼吸机相关性肺炎的诊断意义[J].安徽医学,2010,31(12):1435-1436.
[11] 郑志辉,陈嗣源,林红霞.外周血超敏 C-反应蛋白、降钙素原、细胞免疫状况与儿童肺部感染的关系研究[J].中华医院感染学杂志,2014,24(7):1779-1781.
[12] 薛邦禄,刘新涛.血清降钙素原和C-反应蛋白联合检测在儿童肺炎支原体肺炎中的应用[J].国际检验医学杂志,2011,32(2):187-188.
[13] 李容芳,周睿,张碧惠.血清降钙素原(PCT)检测在小儿感染性肺炎诊断中的应用效果观察[J].吉林医学,2016,37(1):150-151.
[14] 夏振雄,高春娜,曾沛丰,等.探讨不同病原体致小儿肺炎中的降钙素原改变[J].中国医学创新,2014,11(3):67-69.
[15] 茆政.血清降钙素原和C反应蛋白联合检测在儿童急性肺炎诊断中的应用价值[J].中外医疗,2016,35(4):197-198.
[16] 伊忻,靳晶,陈纳纳,等.血清降钙素原联合C反应蛋白和IL-6检测在小儿感染性肺炎诊断中的应用效果[J].国际呼吸杂志,2016,36(14):1045-1048.
[17] 李虹光,徐晓军,杨建荣,等.肺炎合并脓毒症患儿血清降钙素原水平变化的临床意义[J].解放军预防医学杂志,2016,34(5):709-711.
[18] 肖平,罗毅.肺炎患儿血清降钙素原和C反应蛋白水平变化和意义[J].中国基层医药,2015,22(12):1866-1869.
[19] POURAKBARI B,MAMISHI S,ZAFARI J,et al.Evaluation of procalcitonin and neopterin level in serum of patients with acute bacterial infection[J].Braz J Infect Dis,2010,14(3):252-255.
[20] DíEZ-PADRISA N,BASSAT Q,MACHEVO S,et al.Procalcitonin and C-reactive protein for invasive bacterial pneumonia diagnosis among children in mozambique,a malaria-endemic area[J].PLoS One,2010,5(10):e13226.DOI:10.1371/journal.pone.0013226.
[21] 张茂好.降钙素原检测在小儿细菌性肺炎早期诊断中的意义[J].中国感染控制杂志,2016,15(10):800-801.
[22] 李立明.流行病学[M].6版.北京:人民卫生出版社,2007:170-176.