降钙素原、C 反应蛋白在诊断社区获得性肺炎中的价值评价

The value assessment of procalcitonin and C-reactive protein in diagnosis of community-acquired pneumonia

目的探讨降钙素原（PCT）、白细胞介素（IL）-6、C 反应蛋白（CRP）、外周血白细胞（WBC）在诊断社区获得性肺炎（CAP）中的诊断价值。方法共纳入因急性发热入院患者共107例，CAP 组59例、急性上呼吸道感染（简称上感）组48例。比较 PCT、IL-6、CRP、WBC 在两组间的差异。根据受试者工作特征曲线（ROC）下面积（AUC），评价4个参数对诊断 CAP 的价值，并得出最佳的诊断截点值。结果PCT、CRP、WBC 在 CAP 组较上感组明显增高，差异均有统计学意义（P＜0．05）。PCT、IL-6、CRP、WBC 预测 CAP 的 AUC 分别为0．89、0．79、0．91、0．77。PCT、CRP 曲线下面积均高于 IL-6、WBC，差异有统计学意义（P ＜0．05），表明 PCT 和 CRP 对诊断 CAP 可能具有较高的准确性。PCT ＝0．3 ng／ml 时预测 CAP 的敏感度为77．8％，特异度为85．4％，推荐为最佳截点值。CRP ＝120 mg／L 时，其预测 CAP 的敏感度为84．4％，特异度为93．3％，推荐为最佳截点值。结论PCT、CRP 可能是诊断 CAP 有效的生物标志物，可作为传统诊断模式的有效补充。

Objective To evaluate the ability of procalcitonin（PCT）,C-reactive protein（CRP）, interleukin（IL）-6 and peripheral white blood cell（WBC）to differentiate community acquired pneumonia （CAP）.Methods We analyzed a total of 107 patients with acute fever.CAP group and upper respiratory tract infection group included 58 patients,47 patients,respectively.PCT,IL-6,CRP and WBC levels were measured.The area under the receiver operating characteristic curves（ROC-AUC）was used to estimate the power of variables to predict CAP.Recommended the best diagnostic cut-off value.Results The ser-um concentrations of PCT,IL-6,CRP,and WBC in CAP group were significantly higher than upper respir-atory tract infection group（P 〈0.05）.The ROC-AUC of PCT,IL-6,CRP and WBC were 0.89,0.79, 0.91,and 0.77,respectively.The AUC of PCT and CRP were higer than IL-6 and WBC,the difference was statistically significant（P 〈0.05）.This date indicated that PCT and CRP may have a higher accuracy in the diagnosis of CAP.The best cut-off value for PCT to diagnose CAP was 0.3 ng/ml,with a sensitivity of 77.8% and a specificity of 85.4%.The best cut-off value for CRP to diagnose CAP was 120 mg/L,the sensitivity and specificity were 84.4% and 93.3%,respectively.Conclusion The PCT and CRP are useful biomarker to enhance the diagnostic accuracy of CAP as an effective supplement to the traditional diagnosis mode.