多项炎性标志物在儿童急性呼吸道细菌感染诊断中的应用价值

Significance of Multiple Inflammatory Markers in Diagnosis of Acute Respiratory Bacterial Infection in Children

目的:探讨降钙素原(PCT)、C反应蛋白(CRP)、白细胞计数(WBC)及中性粒细胞比例(NC)等炎性标志物单项及联合应用在儿童急性呼吸道细菌感染早期诊断中的应用价值。方法:采用病例对照方法分析某医院儿科急性呼吸道感染病例354例及50例同期门诊体检正常儿童的PCT、CRP、WBC及NC水平及其ROC曲线下AUC诊断效能,以及不同组合模式对细菌感染性ARIs诊断的ROC曲线。结果:PCT、CRP、WBC及NC等指标单独应用时的ROC曲线下AUC分别为0.80(95%CI 0.76~0.85)、0.80(95%CI 0.76~0.85)、0.77(95%CI 0.72~0.82)及0.75(95%CI 0.70~0.80),只具有中等诊断效能。联合应用时,模式1(PCT+CRP)、模式2(PCT+WBC+NC)、模式4(PCT+CRP+WBC+NC)的ROC曲线下AUC分别为0.90(95%CI 0.87~0.93)、0.94(95%CI 0.91~0.96)、0.95(95%CI 0.93~0.97),均具有较高的诊断准确性。结论:PCT、CRP、WBC及NC等炎性标志物单独应用诊断急性呼吸道早期细菌感染时只有中等诊断效能,(PCT+CRP)模式、(PCT+WBC+NC)模式、(PCT+CRP+WBC+NC)模式可大幅提高其诊断效能,其中(PCT+WBC+NC)模式为最优经济适用组合模式。

Objective To explore the clinical value of single and combined inflammatory markers such as procalcitonin（ PCT）,C-reactive protein（ CRP）,White blood cell count（ WBC） and Neutrophil classification（ NC） in the early diagnosis of acute respiratory bacterial infection in children. Methods A case-control method was used to analyze the level of PCT,CRP,WBC and NC in 354 pediatric patients with acute respiratory infections（ ARIs） and 50 healthy pediatric volunteers in the same hospital. The diagnostic efficacy of AUC under ROC curve and the diagnosis of bacterial infectious ARIs ROC curve was also determined. Results The area under the ROC curves（ AUC）（ 95%CI） was 0.80（ 0.76 - 0.85）,0.80（ 90.76-0.85）,0.77（ 0.72-0.82） and 0.72（ 0.70-0.80） for PCT,CRP,WBC and NC respectively when used alone,with only moderate diagnostic efficiency. When used as combination,the AUC（ 95% CI） was 0. 90（ 0. 87 - 0. 93）,0. 94（ 0. 91-0.96）,and 0.95（ 0.93-0.97） for Model 1（ PCT ＋CRP）,Model 2（ PCT＋WBC ＋NC） and Mode 4（ PCT＋CRP＋WBC＋NC） respectively and they all had higher diagnostic accuracy. Conclusion The application of PCT,CRP,WBC and NC and other inflammatory markers alone for early diagnosis of acute respiratory bacterial infection showed only moderate diagnostic efficiency. However,the combination models,1,2 and 4,can greatly improve the diagnostic efficiency,among them model 2（ PCT ＋ WBC ＋ NC） was the economic application of optimal combination model.