血清铁蛋白对军团菌肺炎诊断价值的研究

The value of serum ferritin in the diagnosis of legionnaires pneumonia

目的:评价血清铁蛋白在军团菌肺炎中的诊断价值。方法:收集我院2011年7-12月疑似肺部感然的患者80例,最后经诊治后分为典型细菌性病原体所致肺炎组、军团菌肺炎组、病毒性肺炎组以及其他病原体肺炎组(包括支原体、衣原体、真菌等)。记录各组患者的外周血血常规、红细胞沉降率、C反应蛋白、血清铁蛋白、痰细菌培养、血培养等资料,所有病例均进行APACHEⅡ评分。铁蛋白的检测采用化学发光法。结果:典型细菌性病原体所致肺炎组、军团菌肺炎组、病毒性肺炎组以及其他病原体肺炎组铁蛋白水平分别为335(246～592)、1086(399～2513)、192(166～297)、189(147～283)ng/mL,差异有统计学意义(H=19.898,P<0.01);两两比较显示,军团菌肺炎组铁蛋白水平均显著高于典型细菌性病原体所致肺炎组、病毒性肺炎组以及其他病原体肺炎组(U值分别为0、18.000、81.000、20.000,P<0.01)。对诊断为军团菌肺炎组的铁蛋白和APACHEⅡ评分进行Pearson相关分析,r为0.599。取400ng/mL为临界值,铁蛋白诊断军团菌肺炎的敏感性为70.3%,特异性为63.3%;而临界值为600ng/mL时,敏感度为66.9%,特异度为100.0%,诊断正确率为66.9%。结论:血清铁蛋白在军团菌肺炎的诊断中具有一定价值。

Objective To evaluate the value of serum ferritin in the diagnosis of legionnaires pneumonia. Methods 80 patients with suspected pnemnonia from July to December 2011 were divided into 4 groups ： typical bacterial pneumonia group （Group A）, legionnaires pneumonia group （Group B）, viral pneumonia group （Group C）, ~other pathogens pneumonia group （Group D）. White blood cell count, erythrocyte sedimentation rate （ESR）, C-reactive protein （CRP）, ferritin, bacterial culture of both sputum and blood were measured, and acute physiology and chronic health evaluation （APACHE） Ⅱ score were recorded. The ferritin level were determined by chemiluminescence method. Results Mean ferritin levels in Group A, B, C, and D were 335 （246-592）, 1 086 （399-2 513）, 192 （166-297）, and 189 （147-283） ng/mL, respectively ; the differences were significant （H = 19.898, P〈 0.01）; and that in Group B was the highest （U = 0, 18.000, 81.000, 20.000, all P〈 0.01）. The r value of Pearson correlation analysis of ferritin levels and APACHE Ⅱ score was 0.599 in Group B. The sensitivity and specificity of the cut-off value of 400 ng/mL of ferritin were 70.3% and 66.3%, and were 66.9% and 100% when the cut-off value of 600 ng/mL. Conclusion Ferritin is a useful parameter for diagnosing legionnaires pneumonia.