血清降钙素原在儿童细菌性上呼吸道感染中的诊断价值

Diagnosis value of serum procalcitonin in children with upper respiratory tract infection

目的探讨血清降钙素原(PCT)在儿童细菌性上呼吸道感染中的诊断价值。方法回顾性分析2015年1月-2017年6月271例上呼吸道感染患儿相关信息,以细菌培养结果为金标准,比较PCT、C-反应蛋白(CRP)及白细胞(WBC)计数在革兰阳性或阴性菌感染区分及儿童细菌性上呼吸道感染诊断中的价值。结果细菌培养阳性148例(54.6%),共分离到致病菌191株,单一感染革兰阳性菌和阴性菌分别有73例和55例。以2.0μg/L为界限PCT检测革兰阳性和阴性菌阳性率差异有统计学意义(P<0.01),当PCT≥10.0μg/L时,革兰阴性菌感染可能性更大。以细菌培养结果为金标准,PCT检测的灵敏度、特异度、准确度均高于CRP与WBC检测,漏诊率、误诊率均低于CRP与WBC检测。结论血清PCT作为区分革兰阳性和阴性菌感染指标有一定价值,采用PCT诊断儿童细菌性上呼吸道感染较传统的CRP和WBC更快速和准确,PCT检测为区分上呼吸道感染性质提供了一种新途径。

Objective To analyze the diagnostic value of serum procalcitonin（PCT） in children with bacterial upper respiratory tract infection. Methods A total of 271 children with bacterial upper respiratory tract infection were selected from Jan 2015 to Jun 2017. With the result of bacterial culture as gold standard, the values of C-reactive protein（CRP） and WBC in differentiating gram positive bacteria and gram negative bacteria and diagnosing children with bacterial upper respiratory tract infection were compared. Results 148 cases（54.6% ） were positive for bacterial culture, and 191 pathogenic bacteria were isolated. There were 73 cases of single infection gram-positive bacteria and 55 cases of gram-negative bacteria, respectively. There was statistical significance on the positive rate difference of gram-positive and gram-negative bacteria by PCT detection with the detection limit of 2.0 μg/L （P〈0.01）. When PCT was ≥110.0 μg/L, gram-negative bacteria infection was more likely to happen. With the results of bacterial culture as the gold standard, the sensitivity, specificity and accuracy of PCT detection were higher than those of CRP and WBC. The rates of missed diagnosis and misdiagnosis were lower than that of CRP and WBC. Conclusion Serum PCT has certain value as an indicator of gram-positive and gram-negative infection. PCT can diagnose children＇s bacterial upper respiratory tract infection faster and more accurately than traditional CRP and WBC. PCT detection provides a new way to diagnose the upper respiratory tract infection.