降钙素原和C反应蛋白联合检测在重症肺炎患儿病情和预后评估中的价值

Clinical value of combined detection of procalcitonin and C reactive protein in evaluation of pathogenetic condition and prognosis of pediatric severe pneumonia

目的探讨降钙素原(PCT)和C反应蛋白(CRP)联合检测在重症肺炎患儿病情和预后评估中的价值。方法选择2011年7月至2014年7月就诊于广州市南沙中心医院儿科的重症肺炎患儿96例,根据小儿危重病例评分系统将其分为非危重组(36例)、危重组(32例)及极危重组(28例),根据患儿预后情况将其分为存活组(83例)和死亡组(13例)。检测所有患儿外周血PCT、CRP水平、白细胞(WBC)计数及中性粒细胞(NEU)百分比。应用敏感度、特异度和受试者工作特性曲线(ROC)评估上述指标对重症肺炎患儿病情和预后的评估价值。结果非危重组、危重组及极危重组患儿组间比较血清PCT和CRP水平差异有统计学意义(P<0.05),且其水平极危重组>危重组>非危重组;而WBC计数和NEU百分比比较差异无统计学意义(P>0.05);死亡组患儿血清PCT和CRP水平较存活组患儿显著升高(P<0.05),而WBC计数和NEU百分比与存活组比较差异无统计学意义(P>0.05)。血清PCT在重症肺炎患儿预后评估中的的灵敏度高于CRP(P<0.05),PCT和CRP联合检测ROC下面积高于PCT与CRP单独测定时ROC下面积。结论 PCT和CRP联合检测有助于重症肺炎患儿病情诊断和预后评估。

Objective To investigate the clinical value of combined detection of procalcitonin （PCT） and C reactive protein （CRP） in evaluation of pathogenetic condition and prognosis of pediatric severe pneumonia. Methods A total of 96 children with severe pneumonia recruited in Department of Pediatrics of Guangzhou Nansha Central Hospital were divided into non-critical group（ n = 32）, critical group （n = 32） and serious critical group（ n = 28 ） according to the pediatric critical illness score system. Then based on the patient＇s prognosis, they were divided into survival group（ n = 83 ） and death group（ n = 13 ）. The levels of PCT, CRP, white blood cell（WBC） count and neutrophil （NEU）percentage were detected in all of the patients. Sensitivity, specificity and receiver operating characteristic （ROC） curve analysis were used to evaluate the pathogenetic condi- tion and prognosis of severe pneumonia. Results There were significant differences of PCT and CRP levels among the non- critical group, critical group and serious critical group （ P 〈 0.05 ）, and serious critical group 〉 critical group 〉 non-critical group. The WBC count and NEU percentage among the three groups had no significant difference（P 〉0.05）. The serum PCT and CRP levels in death group were significantly higher than those in survival group （ P 〈 0.05 ）, while the WBC count and NEU percentage in death group had no significant difference compared with those in survival group （ P 〉 0.05 ）. Serum PCT sensitivity for the prognosis evaluation in children with severe pneumonia was significantly higher than that of CRP （P 〈 0. 05 ）. The area under curve（AUC） of PCT and CRP combined detection was higher than that of the AUC measured by PCT and CRP alone. Conclusion PCT and CRP combined detection can be helpful to evaluating pathogenetic condition and prog- nosis of pediatric severe pneumonia.