前白蛋白对中国儿童社区获得性肺炎诊断及严重度评估的价值研究

Value of prealbumin in diagnosis of children with community-acquired pneumonia in China and assessment of severity

目的探讨前白蛋白(PA)在儿童社区获得性肺炎(Community-acquired pneumonia,CAP)诊断及严重度评估的价值,以指导临床治疗。方法回顾性分析2014年5月-2016年5月儿科入院CAP患儿174例设为试验组,记录入院生命体征、炎症指标、PA及呼吸道病原体IgM抗体检测结果,选择同期33名健康儿童作为对照组,比较两组的实验室检查结果,并比较试验组轻度和重度患儿生命体征及实验室检查数据。结果 174例CAP患儿肺炎支原体(MP)感染率为27.4%,不同季节间差异无统计学意义;试验组PCT及CRP与对照组比较,差异无统计学意义;试验组患儿白细胞计数(WBC)、中性粒细胞百分比、中性粒细胞计数、红细胞沉降率(ESR)升高,PA降低(P<0.05);PA诊断CAP的敏感度达0.847,高于其他炎症指标;多因素分析提示PA是儿童CAP独立的保护因素(OR:0.974;95%CI:0.956~0.993;P<0.01);重度患儿PA低于轻度(P<0.01);在界值125mg/l时,PA鉴别CAP严重程度的敏感度为0.714,特异度为0.703。结论 PA与其他炎症指标联合,可提升儿童CAP的诊断效能,且还可鉴别肺炎严重程度,有助于CAP的治疗。

OBJECTIVE To explore the value of prealbumin（PA）in diagnosis of children with community-acquired pneumonia（CAP）and assessment of severity so as to provide guidance for clinical treatment.METHODS Totally174 children with CAP who were treated in pediatrics department from May 2014 to May 2016 were assigned as the experimental group.The vital sings,inflammatory indexes,PA and IgM of respiratory tract pathogens were recorded at the admission,meanwhile,33 healthy children were set as the control group.The result of laboratory test was compared between the two groups,and the vital signs and laboratory test data were compared between the children with mild CAP and the children with severe CAP.RESULTS Among the 174 children with CAP,the incidence rate of Mycoplasma pneumoniae infection was 27.4%,and there was no significant difference among the seasons.There was no significant difference in the PCT or CRP between the experimental group and the control group.The white blood cell（WBC）counts,neutrophilic granulocyte percentage,neutrophils counts and erythrocyte sedimentation rate（ESR）of the experimental group were increased,while the PA level was reduced（P〈0.05）.The sensitivity of PA was 0.847 in diagnosis of CAP,higher than that of other indexes.The multivariate analysis indicated that the PA was an independent protective factor for CAP（OR：0.974;95% CI：0.956-0.993;P〈0.01）.When the cutoff value was 125 mg/l,the sensitivity of the PA was 0.714 in identification of severity of CAP,the specificity 0.703.CONCLUSION The PA in combination with other inflammatory indexes may improve the efficacy of diagnosis of CAP,identify the severity of pneumonia and facilitate the treatment of CAP.