CRP和PCT及血常规对成人不同类型感染的诊断价值

Diagnostic value of CRP,PCT and blood routine test in different types of infection in adults

目的探讨C反应蛋白(CRP)、降钙素原(PCT)、血常规在不同病原微生物感染中的诊断价值。方法选取2019年1-12月深圳市第三人民医院检测出的不同病原微生物患者499例,将其分为细菌非结核组(n=175)、病毒组228例(n=228)、结核组(n=96),同时选取同期体检健康者161名作为健康对照组,比较各组血常规中白细胞(WBC)、中性粒细胞(NEUT)、淋巴细胞(LYMPH)、中性粒细胞/淋巴细胞之比(NLR)、单核细胞(MONO)、嗜酸性粒细胞(EOS)、血小板(PLT),以及CRP、PCT指标之间的差异。采用受试者工作特征(ROC)曲线分析CRP、PCT和血常规指标对不同病原微生物感染的诊断价值。结果各组患者WBC、NEUT、LYMPH、NLR、MONO、EOS、PLT比较差异均有统计学意义(Z=22.380、39.470、140.690、116.740、65.350、100.680、69.020,P均<0.05)。与健康对照组比较,细菌非结核组的WBC、NEUT、LYMPH、NLR、MONO、EOS,病毒组的NEUT、LYMPH、NLR、MONO、EOS、PLT,结核组的NEUT、NLR、MONO、EOS、PLT,差异均有统计学意义(P均<0.05);细菌非结核组与病毒组的WBC、NEUT和NLR比较,差异均有统计学意义(P均<0.05)。细菌非结核组、病毒组和结核组CRP、PCT水平[22.86(13.36,39.00)、15.27(12.50,19.10)、22.30(11.58,61.99)mg/L,0.12(0.09,0.18)、0.07(0.05,0.15)、0.04(0.02,0.09)μg/L]均高于健康对照组[1.52(1.21,1.96)mg/L,0.04(0.03,0.05)μg/L],差异均有统计学意义(P均<0.05);细菌非结核组和结核组CRP、PCT水平均高于病毒组,差异均有统计学意义(P均<0.05)。ROC曲线分析显示,CRP预测细菌感染的曲线下面积(AUC)为0.911,其次为NLR(0.808)、LYMPH(0.786)、PCT(0.779)、血小板/淋巴细胞比值(PLR)(0.721)、NEUT(0.684)、WBC(0.621)、PLT(0.509)。结论血常规中的NLR和CRP、PCT对判断患者病原微生物感染类型具有较高诊断价值。

Objective To investigate the diagnostic value of C-reactive protein(CRP),procalcitonin(PCT),blood routine test in different pathogenic microbial infections.Methods The data of patients with different pathogenic microorganisms detected in the Third People's Hospital of Shenzhen from January to December in 2019 were divided into bacterial non-tuberculosis group(n=175),viral group(n=228)and tuberculosis group(n=96);at the same time,161 healthy persons were selected as healthy control group.The levels of white blood cell(WBC),neutrophils(NEUT),lymphocyte(LYMPH),neutrophil lymphocyte ratio(NLR),monocyte(MONO),eosinophils(EOS),platelets(PLT),CRP and PCT were compared.The diagnostic value of CRP,PCT and blood routine parameters for different pathogenic microorganism infection was analyzed by receiver operating characteristic(ROC)curve.Results There were significant differences in WBC,NEUT,LYMPH,NLR,MONO,EOS,PLT in all groups(Z=22.380,39.470,140.690,116.740,65.350,100.680,69.020,all P<0.05).Compared with healthy control group,there were significant differences in WBC,NEUT,LYMPH,NLR,MONO,EOS in bacterial non-tuberculosis group,NEUT,LYMPH,NLR,MONO,EOS,PLT in virus group and NEUT,NLR,MONO,EOS,PLT in tuberculosis group(all P<0.05).There were significant differences in WBC,NEUT and NLR between bacterial non-tuberculosis group and viral group(all P<0.05).The levels of CRP and PCT in bacterial non-tuberculosis group,viral group and tuberculosis group[(22.86(13.36,39.00),15.27(12.50,19.10),22.30(11.58,61.99)mg/L;0.12(0.09,0.18),0.07(0.05,0.15),0.04(0.02,0.09)μg/L]were higher than those in healthy control group[1.52(1.21,1.96)mg/L,0.04(0.03,0.05)μg/L];the differences were statistically significant(all P<0.05);the levels of CRP and PCT in bacteria non-tuberculosis group and tuberculosis group were significantly higher than those in virus group;the differences were statistically significant(all P<0.05).The area under curve(AUC)of CRP predicted bacterial infection was 0.911,followed by NLR(0.808),LYMPH(0.786),PCT(0.779),platelet-lymphocyte ratio(PLR)(0.721),NEUT(0.684),WBC(0.621),and PLT(0.509).Conclusion The NLR in blood routine examination and CRP and PCT had high diagnostic value in judging the type of pathogenic microorganism infection.