血清降钙素原在儿童社区获得性肺炎诊断中的意义

The diagnosis significance of serum procalcitonin in children with community-acquired pneumonia

目的探讨血清降钙素原(PCT)在儿童社区获得性肺炎(CAP)细菌性感染和病毒性感染中的鉴别诊断价值,并进一步比较C反应蛋白(CRP)、红细胞沉降率(ESR)、白细胞(WBC)计数在诊断中的准确性和用途。方法选取79例CAP患儿(大叶性肺炎20例、支气管肺炎59例)和正常对照者21名,检测PCT、CRP、ESR和WBC计数,并绘制受试者工作特征(ROC)曲线。将79例CAP患儿按年龄分为<2岁(31例)、2～5岁(18例)、>5岁(30例),比较各项指标。结果 CAP患者血清PCT、CRP、ESR和WBC明显高于正常对照组(P=0.000、P<0.01),大叶性肺炎组PCT、CRP、ESR明显高于支气管肺炎组(P<0.01);>5岁组PCT水平明显高于<2岁组(P=0.000),而CRP、ESR和WBC在不同年龄组中均无差异(P>0.05)。PCT的ROC曲线下面积为0.97[95%可信区间(CI):0.93～1.00],明显高于CRP[0.91(95%CI:0.78～0.99)]和ESR[0.87(95%CI:0.78～0.96)](P<0.01)。但与WBC[0.95(95%CI:0.91～0.98)]比较差异无统计学意义(P=0.14);PCT最佳诊断Cut-off值为1 ng/mL,敏感性和特异性分别为94.1%、82.3%。结论血清PCT在CAP患儿中的鉴别诊断价值优于CRP和ESR,可为临床医师早期诊断及合理使用抗菌药物提供可靠依据。

Objective To investigate the differential diagnosis significance of senlm procalcitonin （PCT） in children with bacterial and viral infected community-acquired pneumonia （CAP）, and compare the accuracies and application of C reactive protein （CRP）, erythrocyte sedimentation rate （ESR） and white blood cell （WBC） count. Methods A total of 79 patients with CAP （20 cases with lobar pneumonia and 59 cases with bronchopneumonia） and 21 healthy controls were enrolled. PCT,CRP,ESR and WBC count were determined. Receiver operating characteristic （ROC） curve analysis was performed. The 79 patients with CAP were classified into 〈 2 years old group （31 patients）, 2-5 years old group （18 patients） and 〉 5 years old group （30 patients） according to their ages, and their PCT, CRP, ESR and WBC counts were compared. Results Serum PCT, CRP, ESR and WBC count were significantly higher in CAP group than in control group （ P = 0. 000, P 〈 0.01 ）. Sermn PCT, CRP, ESR and WBC count in lobar pneumonia group were higher than those in bronchopneumonia group （P 〈 0. 01 ）. The level of PCT in 〉 5 years old group were higher than that in 〈 2 years old group （ P = 0. 000） , and the levels of CRP, ESR and WBC count had no statistical significance among the different age groups （ P 〉 0.05 ）. The area under receiver operating characteristic （ROC） curve of PCT was 0.97 [95% confidence interval （C1） ： 0.93-1.00], whieh was higher than those of CRP [0.91 （95% CI： 0.78-0.99）] and ESR [0.87 （95% CI：0.78-0.96）1（P〈0.01）. The area of WBC count ~0.95 （0.95%CI： 0.91- 0.98） ] had no statistical significance （P = 0.14）. The best cut-off value of PCT was 1 ng/mL, and the sensitivity and specificity were 94.1% and 82.3%. Conclusions Serum PCT level is a better marker than CRP and ESR for the diagnosis of CAP in children,and can be used as a reliable indicator of the early diagnosis tor clinicians and rational use of antibiotics.