ROC曲线评价血清人软骨糖蛋白39在儿童社区获得性肺炎诊断和预测并发症中的应用

Serum YKL-40 detection in children with community acquired pneumonia and its clinical significance

目的：研究儿童社区获得性肺炎（CAP）患者外周血人软骨糖蛋白39（又称YKL-40）检测的临床意义.方法：采用ELISA法检测118例CAP患儿、80例其它呼吸系统疾病患儿和31例健康对照儿童外周血YKL-40水平.CAP的诊断按2007年中华医学会儿科学分会制订的儿童CAP管理指南标准,并根据该指南判断患者是否存在并发症.利用受试者工作特征（ROC）曲线法分析YKL-40对CAP的诊断以及并发症的预测价值.结果：CAP患儿血清YKL-40水平显著高于其它呼吸系统疾病的患儿和健康对照.YKL-40诊断CAP的曲线下面积为0.75（95％ CI为0.68 ～0.81）.当取值为96.5μg·L^-1时,诊断敏感性为0.77（95％ CI为0.68 ～0.84）,特异性为0.66（95％ CI为0.57 ～0.75）.当取值为128.0 μg·L^-1时,预测CAP相关并发症的敏感性为0.80（95％ CI为0.61 ～0.92）,特异性为0.57（95％CI为0.46 ～0.67）.结论：血清YKL-40是CAP诊断和病情判断的有益指标.

Objective：To investigate the clinical significance of serum YKL-40 measurement in children with community acquired pneumonia（CAP）.Methods：The serum concentration of YKL-40 in 118 children with CAP,80 with other respiratory disease and 31 healthy controls were detected by ELISA.The guideline established by Chinese Pediatric Societ,Chinese Medical Association was used for CAP diagnosis and complication status verification.The diagnostic efficiency,as well as prediction performance for CAP related complications,was estimated by receiver operating characteristic （ROC） curve.Results：Increased serum YKL-40 level was observed in CAP children.The area under cure for YKL-40 in CAP diagnosis was 0.75 （95 ％ CI 0.68-0.81）,and the sensitivity and specificity was 0.77 （95％ CI 0.68-0.84） and 0.66 （95％ CI 0.57-0.75）,respectively,at the optimal threshold of 96.5 μg · L^-1.The AUC for CAP related complications prediction was 0.75 （95％ CI 0.68-0.81）,with the sensitivity of 0.80 （95 ％ CI 0.61-0.92） and specificity of 0.57 （95 ％ CI 0.46-0.67）,at the optimal threshold of 128.0 μg · L^-1.Conclusion：Serum YKL-40 is a useful biomarker for CAP diagnosis and disease assessment.