C-反应蛋白对感染性和非感染性发热鉴别价值

Differential diagnosis of infectious and non-infectious fever by C-reactive protein

目的:探讨C反应蛋白(C-reactive,CRP)鉴别感染性与非感染性发热作用的价值。方法:初诊拟诊为发热待查的患者552例,进行系列检查,并在入院第1个24 h内,采用免疫比浊法测定CRP,以ROC曲线和曲线下面积判断鉴别价值。结果:552例患者确诊感染性发热412例,占74.6%;非感染性发热140例,占25.4%。感染性发热组CRP值高于非感染发热组CRP值(t=14.257,P=0.000 1)。CRP对感染性发热诊断的ROC曲线下面积为0.752,95%的CI为0.650～0.854。以CRP为8 mg/L作为鉴别的界值,则灵敏度、特异度、准确度、阳性预测值、阴性预测值、阳性似然比和阴性似然比分别为90.3%、68.6%、84.8%、89.4%、68.6%、2.88和0.14。结论:CRP的检测能够鉴别感染性发热与非感染性发热;当CRP≥8 mg/L时,应及时应用抗生素。

Objective：To investigate the value of C-reactive protein（CRP） for differential diagnosis of infectious and non-infectious fever.Methods：552 patients with initial diagnosed as fever of unknown were enrolled in this study.CRP was determined within the first 24h of hospitalization by immune turbidimetry.The ROC and area under the curve were used for analyses the differential diagnosis value.Results：412 patients were diagnosed as infectious fever in 552 patients（74.6%）;140 patients as non-infectious fever（25.4%）.The CRP in infectious fever group were higher than that in non-infected group（t=14.257,P=0.000 1）.The area under ROC for CRP diagnosis of infectious fever was 0.752,95% of the CI,0.650～0.854.The cut-off value was 8 mg/L with the sensitivity,specificity, accuracy,positive predictive value,negative predictive value,positive likelihood ratio and negative likelihood ratio were 90.3%,68.6%,84.8%,89.4 %,68.6%,2.88 and 0.14,respectively. Conclusion：CRP test can identify fever with infection or non-infectious;It should be timely antibiotics when CRP ≥ 8mg/L.