SAA、hs-CRP在小儿感染性疾病早期鉴别诊断中的价值

SAA and hs-CRP for the early diagnosis of infectious diseases in children

目的探讨血清淀粉样蛋白A(SAA)、高敏C反应蛋白(hs-CRP)在小儿感染性疾病早期鉴别诊断中的价值。方法选取住院的感染患儿共184例,其中确诊为病毒感染者80例(病毒感染组),确诊为细菌感染者104例(细菌感染组)。另选取同期体检健康的儿童120名作为对照组。检测SAA、hs-CRP与白细胞(WBC)水平,并计算和分析其在小儿感染性疾病鉴别诊断中的效能。结果血清hs-CRP水平细菌感染组[11.50(6.25,15.00)mg/L]显著高于病毒感染组[7.00(5.25,17.50)mg/L]和对照组[2.25(1.25,4.00)mg/L],SAA水平病毒感染组[39.50(22.50,58.00)mg/L]显著高于细菌感染组[24.50(14.25,26.50)mg/L]和对照组[4.00(1.50,6.50)mg/L],差异有统计学意义(P<0.05)。当血清hs-CRP截断值为10 mg/L时获得最大的诊断效能,此时敏感性76.25%、特异性为56.73%、约登指数为0.330、受试者工作特征(ROC)曲线的曲线下面积为0.52。当SAA截断值为22.5 mg/L时获得最大的诊断效能,此时敏感性为83.75%、特异性为66.35%、约登指数为0.501、ROC曲线的曲线下面积为0.64。结论 SAA水平在小儿感染性疾病早期鉴别诊断中的效能优于血清hs-CRP,值得临床推广与应用。

Objective To investigate the roles of serum amyloid-A（SAA） and high-sensitivity C-reactive protein（hs-CRP） for the early diagnosis of infectious diseases in children. Methods A total of 184 inpatient children were enrolled. Totally,80 cases were confirmed as viral infection（viral infection group）,and 104 cases were diagnosed as bacterial infection（bacterial infection group）. A total of 120 children were enrolled as control group. SAA and hs-CRP levels and white blood cell（WBC） count were determined,and the diagnostic efficiency for infectious diseases in children was analyzed. Results Serum hs-CRP level in bacterial infection group [11.50（6.25,15.00）mg/L] was higher than those in viral infection group [7.00（5.25,17.50）mg/L] and control group [2.25（1.25,4.00）mg/L]. The level of SAA in viral infection group [39.50（22.50,58.00）mg/L] was higher than those in bacterial infection group [24.50（14.25,26.50）mg/L] and control group [4.00（1.50,6.50）mg/L]（P0.05）. The maximum diagnostic efficiency was obtained,when serum hs-CRP cut-off value was 10 mg/L,with a sensitivity of 76.25%,a specificity of 56.73%,a Youden index of 0.330 and an area under receiver operating characteristic（ROC） curve of 0.52. The maximum diagnostic efficiency was obtained,when SAA cutoff value was 22.5 mg/L,with a sensitivity of 83.75%,a specificity of 66.35%,a Youden index of 0.501 and an area under ROC curve of 0.64. Conclusions SAA level has better diagnostic efficiency than serum hs-CRP level for the early diagnosis of infectious diseases in children,which deserves clinical application and promotion.