C-反应蛋白、血沉、乳酸脱氢酶及血清铁蛋白联合检测对儿童发热待查病因诊断价值的探讨

Value of combined measurement of C-reactive protein, erythrocyte sedimentation rate, lactate dehydrogenase and serum ferritin in etiological diagnosis of fever of unknown origin in children

目的探讨C-反应蛋白(CRP)、红细胞沉降率(ESR)、乳酸脱氢酶(LDH)及血清铁蛋白(SF)联合检测对发热待查患儿病因诊断的临床应用价值。方法回顾性分析热程2周以上的发热待查住院患儿154例的临床资料,并根据出院诊断分为感染组(n=54)、风湿组(n=67)、恶性肿瘤组(简称为肿瘤组,n=33),对3组患儿血清CRP、ESR、LDH及SF 4项指标的均值进行比较,并通过ROC曲线分析其单独及联合检测对发热待查患儿病因的诊断价值。结果感染组、风湿组、肿瘤组3组患儿血清CRP和ESR均升高,其中风湿组升高最明显;血清LDH在肿瘤组升高最明显;SF在风湿组和肿瘤组均明显升高。LDH对风湿性疾病、CRP和ESR对恶性肿瘤诊断的ROC曲线下面积(AUC)<0.7(P>0.05)。CRP诊断感染和风湿性疾病的AUC分别为0.861、0.782;ESR诊断感染和风湿性疾病的AUC分别为0.770、0.743;LDH诊断感染和恶性肿瘤的AUC、灵敏度、特异度及约登指数均较低;SF诊断感染的AUC、灵敏度、约登指数均为最高,但特异度最低;SF诊断风湿性疾病的AUC、灵敏度、特异度、约登指数都较高;SF诊断恶性肿瘤的AUC较低。4项指标联合检测对诊断风湿性疾病和恶性肿瘤的AUC、灵敏度、特异度比单独检测时高。结论在发热待查患儿的病因诊断中,CRP、ESR、LDH及SF对初步诊断风湿性疾病有一定临床意义,对感染性疾病和恶性肿瘤的诊断和鉴别价值有限;4项指标联合检测对发热待查患儿的病因诊断价值优于单独检测。

Objective To study the clinical value of combined measurement of C-reactive protein （CRP）, erythrocyte sedimentation rate （ESR）, lactate dehydrogenase （LDH）, and serum ferritin （SF） in the etiological diagnosis of fever of unknown origin （FUO） in children. Methods The clinical data of 154 hospitalized children who had FUO for at least two weeks were retrospectively analyzed, and they were classiifed into infection （n=54）, rheumatism （n=67）, and tumor （n=33） groups according to the diagnosis at discharge. The levels of CRP, ESR, LDH, and SF were compared between the three groups, and the diagnostic values of the four indices alone or together were analyzed using the receiver operating characteristic （ROC） curve. Results Serum CRP and ESR levels were elevated in all the three groups, and increased most signiifcantly in the rheumatism group. Serum LDH level was increased most signiifcantly in the tumor group. SF level was signiifcantly increased in the rheumatism and tumor groups. The area under the ROC curve （AUC） of LDH for diagnosing rheumatism and the AUC of ESR and CRP for diagnosing tumors were lower than 0.7 （P〉0.05）. The AUC of CRP for diagnosing infection and rheumatism was 0.861 and 0.782, respectively. The AUC of ESR for diagnosing infection and rheumatism was 0.770 and 0.743, respectively. LDH had relatively low AUC, sensitivity, speciifcity, and Youden＇s index in diagnosing infection and tumors. SF had the highest AUC, sensitivity, and Youden＇s index in diagnosing infection, but had the lowest speciifcity. SF had relatively high AUC, sensitivity, speciifcity, and Youden＇s index in diagnosing rheumatism, but had relatively low AUC in diagnosing tumor. The four indices had higher AUC, sensitivity, and speciifcity in diagnosing rheumatism and tumors when measured together than when measured alone. Conclusions In the etiological diagnosis of FUO in children, CRP, ESR, LDH, and SF have certain clinical signiifcance in the preliminary diagnosis of rheumatic diseases, but have limited value in the diagnosis and differentiation of infectious diseases and malignant tumors. Combined measurement of the four indices is superior to the determination of each one for the etiological diagnosis of FUO in children.