4项炎性指标在急性上呼吸道感染中的检测意义

Value of 4 inflammatory markers in acute upper respiratory tract infection

目的探讨白细胞计数(WBC),超敏C反应蛋白(hs-CRP),降钙素原(PCT)及白细胞介素-6(IL-6)等4项炎性指标在急性上呼吸道感染(AURTI)患者诊治中的价值。方法选取同济大学附属杨浦医院2012年10月至2013年10月AURTI患者282例,将其分为非细菌感染组和细菌感染组,并选择56名健康体检人员为健康对照组。分别检测WBC、hs-CRP、PCT和IL-6水平。应用受试者工作曲线评价各指标对AURIT的鉴别诊断价值。结果细菌感染组及非细菌感染组的4项炎性指标与健康对照组比较,差异均有统计学意义(P<0.05)。细菌感染组患者体内WBC、hs-CRP和PCT水平较非细菌感染组患者升高,差异有统计学意义(P<0.05);而两组患者的IL-6水平比较,差异无统计学意义(P>0.05)。对WBC、hs-CRP、PCT及IL-6均正常的91例患者,抗菌药物使用与否对5d内退热情况的影响比较,差异无统计学意义(P>0.05)。WBC、hs-CRP、PCT及IL-6的受试者工作曲线下面积分别为0.795、0.831、0.922及0.630。结论 4项炎性指标联合检测有利于门诊AURTI患者的早期诊断,可有效指导抗菌药物的合理应用。

Objective To explore the diagnostic significance of white blood cell （ WBC） count ,super C-reac-tive protein （hs-CRP） ,procalcitonin （PCT ） and interleukin-6 （IL-6） in acute upper respiratory tract infection （AUR-TI ） .Methods A total of 282 patients with AURTI in Yangpu Hospital Affiliated to Tongji University from Oct . 2012 to Oct .2013 were selected as subjects and divided into Fungal infection group and non-Fungal infection group . Other 56 healthy subjects were enrolled into control group .The levels of WBC count ,hs-CRP ,PCT and IL-6 were de-tected ,receiver operating characteristic （ROC） curve was used to evaluate the value of the four indicators referenced for diagnosis of AURTI .Results There were significant differences on the levels of WBC count ,hs-CRP ,PCT and IL-6 between the patients with AURTI and the subjects in the control group （P〈 0 .05） .The levels of WBC count , hs-CRP ,and PCT in the Fungal infection group were significant higher than that of the non-Fungal infection group （P〈 0 .05） ,but the level of the IL-6 had no significant difference between the two groups （P〉 0 .05） .The levels of WBC count ,hs-CRP and PCT in Fungal group were significant higher than those in the non-Fungal group .For 91 pa-tients with normal levels of hs-CRP ,WBC ,IL-6 and PCT ,whether antibiotics were used or not ,there were no signifi-cant differences on the impact of the fever （P〉 0 .05） .Area under ROC curve of WBC count ,hs-CRP ,PCT and IL-6 were 0 .795 ,0 .831 ,0 .922 and 0 .630 respectively .Conclusion Joint determination of 4 inflammatory markers is beneficial to the early diagnosis for AURTI ,which could effectively guide the rational use of antibiotics .