白细胞计数、C反应蛋白联合呼吸道病原体抗体检测在小儿肺炎的早期诊断价值

Value of white blood cell count, C-reactive protein combined with respiratorypathogen antibody in the early diagnosis of pneumonia in children

目的 探讨血清降钙素原（procalcitonin,PCT）、C反应蛋白（C-reactive protein,CRP）及白细胞计数（white blood cell count,WBC）的测定在儿童不同病原感染性疾病中的诊断价值。方法 选取2013年1月~2016年1月慈溪市妇幼保健院收治的1 300例住院肺炎患儿,对其CRP、WBC、PCT及病原体进行检测并比较。结果 CRP的阳性率为13.53%,1 300例患儿中,CRP阳性例数在〈1岁组中最多,MP-Ig M、CP-Ig M及RSV-Ig M的阳性患儿主要在1~3岁组中,ADV-Ig M阳性患儿主要在3~5岁组中,FLUAIg M阳性患儿主要在〈1岁以及〉5岁组中,各类病原体感染组间表达差异无统计学意义。细菌感染组的血清PCT、CRP及WBC水平相比于病毒感染组均显著升高,肺炎支原体感染组CRP水平相比于病毒感染组明显升高,差异均有统计学意义（P〈0.05）,血清CRP、WBC水平比较差异无统计学意义,细菌感染患者的PCT及WBC水平明显高于支原体感染组,差异有统计学意义（P〈0.05）,CRP水平比较差异无统计学意义。以PCT〉0.05 ng/m L,CR P〉6 mg/L及WBC〉10×109/L作为诊断阳性标准,结果发现,CRP诊断细菌感染的灵敏度为91.07%,特异性为90.78%,阳性预测值为87.95%,阴性预测值为90.78%,相比于CRP及WBC诊断的灵敏度、特异性等均明显升高。结论 当在临床上遇到可明确诊断为感染的患儿时,可先应用WBC进行检测,予以初步筛查,随后进行CRP及病原体检测对疾病进行综合评估和鉴别。

Objective To investigate the effects of procalcitonin （PCT） , C-reactive protein （CRP） and white blood cell count （WBC） in children with different pathogenic infectious diseases diagnostic value. Methods 1 300 cases of hospitalized pneumonia fromjanuary 2013 to January 2016in our hospital were selected, and the CRP, WBC, PCT and pathogens were examined and compared. Results The positive rate of CRP was 13. 53% , among the 1 300 cases, the number of CRP positive was the highest among the 〈 1 year old group, the positive cases of MP-IgM, CP-IgM and RSV-IgM were mainly in the one to three years group,the expression of FLUA-IgM in children aged 〈 1 and 〉 5 years old in the group, and there was no significant difference between the two groups. The levels of serum PCT, CRP and WBC in bacterial infection group were significantly higher than those in virus infection group, the level of CRP in mycoplasma pneumoniae infection group was significantly higher than that in virus infection group, the levels of PCT and WBC in patients with bacterial infection were significantly higher than those in Mycoplasma infection group, the difference was statistically significant （P 〈0. 05）. There was no significant difference in CRP level between the two groups. The sensitivity and specificity of CRP 〉 0. 05ng / mL, CRP 〉 6 mg/L and WBC 〉 10 x 109/L were 91. 07% and 90. 78% respectively. The positive predictive value was 87. 95% , negative predictive value of 90. 78% , compared to CRP and WBC diagnosis of sensitivity, specificity were significantly increased. Conclusion When the clinical diagnosis of infection in children can be diagnosed, the first application of WBC for testing, to be initially screening, followed by CRP and pathogen detection of the disease to conduct a comprehensive assessment and identification.