C反应蛋白及降钙素原对儿童细菌感染性肺炎的早期诊断价值研究

Early diagnosis values of C-reactive protein and procalcitonin for children with bacterial infectious pneumonia

目的探讨降钙素原(PCT)和C反应蛋白(CRP)联合使用对早期诊断儿童细菌感染性肺炎的临床应用价值。方法细菌感染性肺炎患儿101例纳入细菌感染性肺炎组、非细菌感染性肺炎患儿64例纳入非细菌感染性肺炎组,非感染性疾病患儿73例纳入非感染性组。分别于治疗前检测3组患儿血清PCT和CRP水平。以痰液培养结果作为诊断败血症金标准,分别计算PCT与CRP单独检测及PCT/CRP序列试验、PCT/CRP平行试验诊断细菌感染性肺炎的灵敏度、特异度、阳性预测值、阴性预测值、约登指数和诊断准确度。结果细菌感染性肺炎组患儿PCT和CRP均明显高于非细菌感染性肺炎组和非感染组,比较差异有统计学意义(P<0.05)。以PCT≥0.5ng/mL和CRP≥8mg/mL作为最佳截断值,PCT诊断儿童细菌感染性肺炎的灵敏度、特异度、阳性预测值、阴性预测值、约登指数和诊断准确度分别是0.743、0.719、0.806、0.639、0.461和0.733;PCT/CRP序列试验的上述指标值分别是0.604、0.875、0.884、0.583、0.479和0.709,除灵敏度外,均高于CRP和PCT/CRP平行试验的上述各指标值。结论 PCT和PCT/CRP序列试验的联合运用是较理想的儿童细菌感染性肺炎早期诊断检测手段。

Objective To explore the early diagnosis value of C‐reactive protein （CRP） and procalcitonin （PCT ） for bacterial in‐fectious pneumonia of children .Methods A total of 101 children with bacterial infectious pneumonia ,64 children with non‐bacterial infectious pneumonia and 73 children with non‐infectious disease were selected in bacterial infectious pneumonia group ,non‐bacterial infectious pneumonia group and non‐infectious disease group respectively .Serum PCT and CRP levels were measured before treat‐ment in the three groups .With sputum culture results as gold standard for the diagnosis of bacterial infectious pneumonia ,the sensi‐tivity ,specificity ,positive predictive value ,negative predictive value ,Youden index and diagnostic accuracy of PCT ,CRP ,PCT /CRP series test and parallel test were calculated for bacterial infectious pneumonia diagnosis .Results The levels of PCT and CRP of children in bacterial infectious pneumonia group were significant higher than those of children in non‐bacterial infectious pneumonia group and non‐infectious disease group（P 〈 0 .05） .The sensitivity ,specificity ,positive predictive value ,negative predictive value , Youden index and diagnostic accuracy of PCT （ ≥ 0 .5 ng/mL as the best intercept point） for bacterial infectious pneumonia diagno‐sis were 0 .743 ,0 .719 ,0 .806 ,0 .639 ,0 .461 and 0 .733 .And the same values for PCT /CRP series test were 0 .604 ,0 .875 ,0 .884 , 0 .583 ,0 .479 and 0 .709 respectively .All the values were higher than those of children in non‐bacterial infectious pneumonia group and non‐infectious disease group except sensitivity .Conclusion The combination of PCT and PCT /CRP series test is ideal method for early diagnosis of bacterial infectious pneumonia with high sensitivity and specificity .