肝素结合蛋白与降钙素原和C反应蛋白及白细胞计数对呼吸道局部细菌感染诊断的应用价值

The role of heparin.binding protein, procalcitonin, C-reactive protein and white blood cell in respiratory tract bacterial infection

目的探讨血液中肝素结合蛋白（HBP）、降钙素原（PCT）和C反应蛋白（CRP）水平以及白细胞（WBC）计数在呼吸道局部细菌感染中的诊断价值。方法采用前瞻性研究模型，选取2015年10月至2017年3月在中南大学湘雅三医院收治的呼吸道细菌感染患者66例，呼吸道非细菌感染患者37例，同时选取同一时期健康体检者39名作为健康对照组。分别采用双位点夹心酶联免疫吸附试验、荧光免疫法和免疫比浊法测定样品中HBP、PCT及CRP水平；采用血细胞分析仪和其配套试剂检测外周血WBC，统计分析各组4个指标的差异，正态分布计量资料比较采用t检验，方差齐性的非正态分布计量资料比较采用单因素方差分析，方差不齐的非正态分布计量资料比较采用秩和检验。建立受试者工作特征曲线并计算曲线下面积以分析HBP、PCT、CRP及WBC计数对呼吸道局部细菌感染诊断的价值。结果呼吸道细菌局部感染组患者、非细菌感染组患者和健康对照组中HBP值分别为36.30 （7.78～89.36） ng/ml、5.57 （4.37～8.23） ng/ml、2.84 （1.53～6.51） ng/ml，PCT值分别为0.08 （0.04～0.83） ng/ml、0.09 （0.04～0.30） ng/ml、0.04 （0.03～0.08） ng/ml，CRP值分别为56.20 （19.33～76.23） mg/L、34.40 （2.15～83.95） mg/L、（2.20±0.99）mg/L，WBC计数值分别为（10.59±4.58）×109个/L、8.40 （5.80～11.88） ×109个/L、（6.14±1.31）×109个/L。呼吸道细菌感染组患者血液HBP水平与非细菌感染组、健康对照组比较，差异均有统计学意义（Z＝－4.828, P〈0.001; Z＝－5.685, P〈0.001）。细菌感染组患者血液PCT、CRP及WBC计数水平与非细菌感染组比较，差异无统计学意义（F＝0.045, P〉0.05; F＝0.100, P〉0.05; F＝2.417, P〉0.05）；和对照组比较，差异有统计学意义（Z＝－2.881, P〈0.05; Z＝－6.595, P〈0.001; t＝6.499, P〈0.001）。HBP、PCT、CRP及WBC计数诊断呼吸道局部细菌感染曲线下面积分别为0.89、0.69、0.95及0.85，HBP鉴别诊断细菌感染和非细菌感染曲线下面积为0.80。结论HBP能够快速有效地辅助诊断呼吸道局部细菌感染，其鉴别诊断价值优于PCT、CRP、WBC计数等常用手段。

ObjectiveTo evaluate the diagnostic value of the heparin-binding protein （HBP）, procalcitonin （PCT）, C-reactive protein （CRP）, white blood cell （WBC） in respiratory tract bacterial infection.Methods66 respiratory tract bacterial infection patients, 37 respiratory tract non-bacterial infection patients and 39 control group in the Third Xiangya Hospital from October 2015 to March 2017 was selected as objects in this prospective study. The levels of HBP, PCT and CRP in blood of the objects were tested with ELESA, immunofluorescence assay, immunoturbidimetry respectively; WBC counts were taken by Sysmex XE-5000 blood analyzer. The difference among the three groups was analyzed by Student′s t test, one-way ANOVA or Wilcoxon test. Receiver operating characteristic curve was utilized to analyze the diagnostic value of HBP, PCT, CRP and WBC in respiratory tract bacterial infection.ResultsThe plasma level of HBP were 36.30 （7.78-89.36） ng/ml, 5.57 （4.37-8.23） ng/ml, 2.84 （1.53-6.51） ng/ml in respiratory tract bacterial infection group, respiratory tract non-bacterial infection group and control group respectively. The socre of PCT were 0.08 （0.04-0.83） ng/ml, 0.09 （0.04-0.30） ng/ml, 0.04 （0.03-0.08） ng/ml. The socre of CRP were 56.20 （19.33-76.23） mg/L, 34.40 （2.15-83.95） mg/L, （2.20±0.99） mg/L. The socre of WBC count were （10.59±4.58） ×109/L, 8.40 （5.80-11.88） ×109/L, （6.14±1.31） ×109/L. There were statistically significant differences in HBP scores between respiratory tract bacterial infection group and respiratory tract non-bacterial infection group or control group （Z=-4.828, P〈0.001; Z=-5.685, P〈0.001）. There were no statistically significant differences in PCT, CRP and WBC scores between respiratory tract bacterial infection group and non-bacterial infection group （F=0.045, P〉0.05; F=0.100, P〉0.05; F=2.417, P〉0.05）, but significant differences between respiratory tract bacterial infection group and control group （Z=-2.881, P〈0.05; Z=-6.595, P〈0.001; t=6.499, P〈0.001）. The area under curve （AUC） of HBP, PCT, CRP and WBC diagnosing respiratory tract bacterial infection was 0.89, 0.69, 0.95 and 0.85 respectively. The AUC of HBP differential diagnosising was 0.80.ConclusionHBP can be used as an efficient supplementary indicator for respiratory tract bacterial infection, the differential diagnostic value is superior to PCT, CRP and WBC.