C反应蛋白和降钙素原检测在诊断早期宫内感染中的意义分析

Analysis of early diagnosis of C-reactive protein and reduce thesignificance of detection of calcium element in intrauterine infection

目的探讨降钙素原(PCT)和C反应蛋白(CRP)检测在诊断早期宫内感染中的临床价值及准确性,为临床及时诊断胎儿宫内感染并及时治疗赢得时间。方法选取2013年5月至2014年5月于本院产科就诊的宫内感染患者100例作为病例组,根据实验室检查和临床症状将病例组患者分为细菌感染组(38例)和病毒感染组(62例)。选取同期正常妊娠进行产前检查的孕妇100例作为对照组,比较三组研究对象CRP、PCT、白细胞(WBC)、白细胞介素(IL)-6水平及预后差异。比较CRP、PCT诊断宫内感染的灵敏度、特异度、诊断指数、Youden指数、阳性似然比、阴性似然比、ROC曲线下面积并观察引起宫内感染主要病原体情况。结果三组研究对象WBC、CRP、PCT及IL-6水平组间两两比较差异均具有显著性(P<0.05),细菌感染组患者上述指标水平均明显高于病毒感染组和对照组,病毒感染组各指标均高于对照组,差异均具有显著性(P<0.05)。采用CRP诊断的灵敏度为85%,特异度为93.33%,诊断指数为1.783>1.7,Youden指数为0.783,阳性似然比为6.67%,阴性似然比为15%,ROC曲线下面积Az为0.917>0.7。采用PCT诊断的灵敏度为82%,特异度为89.17%,诊断指数为1.712>1.7,阳性似然比为10.83%,阴性似然比为18%,Youden指数为0.712,ROC曲线下面积Az为0.873>0.7。表明采用CRP和PTC检测宫内感染均具有较高价值,CRP曲线下面积略大于PCT曲线下面积,说明CRP诊断价值高于PCT。病例组胎膜早破48例,明显多于对照组(34例),差异具有显著性(P<0.05)。检查结果显示引起宫内感染的主要病原体为粪大肠菌群、金黄色葡萄球菌、B族链球菌。结论采用CRP和PCT对宫内早期感染进行诊断具有较高价值,CRP相较于PCT更优。

Objective To explore the clinical application of calcium element（PCT） and C reactive protein（CRP） detection in the clinical value and the accuracy of diagnosis of intrauterine infection early, for the clinical diagnosis of intrauterineinfection and timely treatment to win time. Method Selected from May 2013 to May 2014 in our hospital maternity clinic of intrauterine infection patients 100 cases as patients group, according to the laboratory examination and clinical symptoms cases group patients were divided into bacterial infection group（38 cases） and viral infection group（62 cases）. Selected the same period for antenatal examination of pregnant women, 100 cases of normal pregnancy as control group, compared three groups of CRP and PCT, white blood cell（WBC）, interleukin（IL）-6 level and prognosis differences. Observed the CRP and PCT in the diagnosis of intrauterine infection degree of sensitivity, specific, diagnosis index, Youden index, positive likelihood ratio and negative likelihood ratio, the area under the ROC curve. Observed intrauterine infection major pathogens. Result Three groups of subjects with WBC, CRP, PCT and IL-6 levels between the two two groups was significant difference（P〈0.05）. Bacterial infection patients were significantly higher than vird infection group and control group, vird infection group indexes were higher than control group, the difference was significant（P〈0.05）. Used CRP diagnostic sensitivity was 85%, specificity was 93.33%, the diagnostic index for the 1.783〉1.7, Youden index was 0.783, the positive likelihood ratio was 6.67%, negative likelihood ratio of 15%, area under the ROC curve of Az 0.917〉0.7. Used the PCT diagnostic sensitivity was 82%, specificity was 89.17%, the diagnostic index for 1.712 than 1.7, the positive likelihood ratio was 10.83%, negative likelihood ratio was 18%, Youden index was 0.712, area under the ROC curve of Az 0.873 0.7. Indicated that the CRP and PTC detection of intrauterine infection also had high value, CRP curve area slightly larger than the area under the PCT curve, indicated that CRP diagnosis value was higher than PCT. 48 cases of premature rupture of the case group, significantly more than control group（34 cases）, the difference was significant（P〈0.05）. Test results showed that the main fungi for fecal coliform, Staphylococcus aureus, group B streptococcal infection. Conclusion The diagnosis is of great value in diagnosing early intrauterine infection of CRP and PCT, more valuable than PCT in diagnosis of ROC.