触珠蛋白、α1-酸性糖蛋白和C反应蛋白对细菌性及病毒性感染患儿的鉴别诊断价值

Significance of serum haptoglobin, α1-acid glycoprotein and C-reactive protein levels in the differential diagnosis of bacterial and viral infection in children

目的通过检测细菌性和病毒性感染患儿血清中触珠蛋白（haptoglobin，HPT）、α1-酸性糖蛋白（α1 acid glycoprotein，AAG）和C反应蛋白（C-reactive protein，CRP）水平，探讨其对患儿细菌性和病毒性感染的鉴别诊断价值。方法检测64例细菌性感染患儿、64例病毒性感染患儿急性期血清及31例正常对照组患儿血清中HPT、AAG、CRP水平。比较各炎症指标的灵敏度、特异度、阳性预测值、阴性预测值和约登指数，评价它们对细菌感染和病毒感染的早期诊断价值。结果（1）以HPT≥2g／L，AAG≥2g／L，CRP≥10mg／L为阳性标准，3指标对诊断细菌性和病毒性感染的灵敏度分别为82．82％、42．19％、98．44％；（2）细菌感染组和病毒感染组比较HPT[（2．70±0．99）g／L vs（1．42±0．75）g／L]、AAG[（0．91±0．38）g/L vs（0．30±0．08）g／L]、CRP[（6．40±0．89）mg／L vs（1．38±0．80）mg／L]水平显著升高（P〈0．05，P〈0．01）；细菌感染组与正常对照组比较亦显著升高（P〈0．05，P〈0．01）；而病毒感染组和正常对照组比较，差异无统计学意义（P〉0．05）。结论血清中HPT、AAG和CRP水平检测对患儿细菌性与病毒性感染的鉴别诊断有临床价值。所有检测指标中CRP的特异度、阳性预测值、阴性预测值、约登指数最高。

Objective To evaluate the value of haptoglobin （HPT）, α1-acid glycoprotein （AAG） and C-reactive protein （CRP） in the differential diagnosis of bacterial and viral infection in children. Methods Serum CRP,AAG and HPT levels were measured in 64 children with bacterial infection and 64 children with viral infection during acute stage. These indicators were also measured in 3 1 normal control children. The sensitivity, specificity, positive and negative predictive values, Youden＇s index for HPT, AAG and CRP were calculated. These values were compared among three groups. Their early diagnostic value on bacterial infection and virus infection was evaluated. Results （ 1 ） These markers were considered positive if HP ≥2 g/L, AAG≥2 g/L,CRP≥10 mg/L. （2） The serum CRP E （2.70 ±0.99） g/L vs （1.42 ±0.75） g/L],AAG [ （0. 91 ±0. 38） g/L vs （0. 30±0. 08） g/L] and HPT [（6.40 ±0. 89） mg/L vs （ 1.38±0. 80） mg/L] levels were significantly higher in children with bacterial infection compared with those with viral infection during the acute stage （P 〈0. 05 ,P 〈0. 01 ）. The serum CRP,AAG and HPT levels were significantly higher in children with bacterial infection compared with normal control children during the acute stage （ P 〈 0. 05 ） ; while the levels of these indicators showed no differences between viral infection children and normal control children （ P 〉 0. 05 ）. Conclusion The measurement of serum CRP, AAG and HPT levels has clinical value in the differential diagnosis of bacterial and viral infection in children. Among these indicators, CRP has the highest specificity, positive predictive, negative predictive values and Youden＇s index.