降钙素原在幼年特发性关节炎诊断中的临床意义

Significance of procalcitonin in the diagnosis of juvenile idiopathic arthritis.

目的检测幼年特发性关节炎(JIA)血清降钙素原(PCT)改变,探讨PCT在JIA诊断中的临床意义。方法检测2011年1月至2012年12月湖北省武汉市妇女儿童医疗保健中心风湿免疫科150例JIA患儿血清PCT和C反应蛋白(CRP)值,比较PCT和CRP对诊断JIA细菌感染的敏感度、特异度、阳性预测值、阴性预测值。同时,检测PCT在JIA各种临床类型的表达情况。结果 JIA细菌感染组血清PCT与CRP值,均明显高于JIA病毒感染组、JIA活动不伴感染组及对照组,差异均有统计学意义(P均<0.05)。以PCT≥0.5μg/L及CRP≥8 mg/L为诊断细菌感染的阳性阈值,两指标敏感度分别为76.2%、85.7%,特异度分别为87.6%、51.9%,阳性预测值分别为50.0%、21.2%,阴性预测值分别为95.8%、95.4%,阳性似然比6.14、1.65,阴性似然比0.27、0.30。ROC曲线下面积:PCT为0.928,优于CRP(0.714),差异有统计学意义(u=2.19,P<0.05)。98.99%(98/99)JIA活动不伴感染组PCT值<0.5μg/L,中位数为0.2μg/L。66.7%(66/99)JIA活动不伴感染组PCT值<0.1μg/L。结论血清PCT值对JIA并发细菌感染具有重要鉴别意义,其预测感染价值优于CRP。推荐PCT值>0.5μg/L作为诊断JIA合并感染临界值。

ObjectiveTo study the relationship between procalcitonin（PCT）and the pathogenesis of juvenile idiopathic arthritis（JIA）.MethodsWe tested the values of PCT and CRP of 150 JIA cases. To find the diagnostic value ofPCT and CRP in JIA with bacterial infection,we compared the clinical value of PCT and that of CRP,including sensitivity,specificity,positive predictive value and negative predictive value. Besides,we tested the level of PCT in various patterns of JIA.ResultsPCT value in cases of JIA with bacterial infection was（3.56±0.84）,which was markedly higherthan that in JIA cases with virus infection（0.05±0.01）（P〈0.05）and that in JIA disease activited without infection group（0.19±0.01）（P〈0.05）and that in control group.However,there wasn＇t significant difference between JIA cases withvirus infection and control group. If we considered diagnostic positive threshold of JIA cases without virus infection asPCT≥0.5 μg/L,then its sensitivity,specificity,positive predictive value,negative predictive value,positive likelihoodratio and negative likelihood ratio were 76.2%,87.6%,50.0%,95.8%,6.14 and 0.27,respectively. In 98.99% of the JIAactivity without infection group PCT value was0.5 μg/L,the median was 0.2 μg/L. In 66.7% of the JIA activity withoutinfection group,PCT0.1 μg/L.ConclusionTesting PCT value has significant role in diagnosing JIA with bacterial infection,and the prediction value is superior to CRP infection. It can be considered to recommend PCT0.5 μg/L as thediagnosis of JIA infection in patients with critical value.