降钙素原联合C-反应蛋白在儿童细菌性肺炎诊断中的价值

Value of procalcitonin and C-reactive protein in the diagnosis of bacterial pneumonia in children

目的探讨降钙素原联合C-反应蛋白(CRP)在儿童细菌性肺炎诊断中的价值。方法将张家口市第一医院2015年1—12月收治的细菌性肺炎患儿根据病原体的不同分为细菌组(43例),病毒组(29例)和支原体组(23例),选取同期来院体检的健康儿童35例作为对照组,均检测降钙素原(PCT)和CRP的水平,并比较四组PCT和CRP水平是否有差异;根据PCT、CRP、PCT/CRP串联试验和PCT/CRP并联试验阳性判定标准分别评价其在儿童细菌性肺炎诊断中的价值。结果细菌组PCT水平为(5.42±1.41)μg/L,CRP水平为(26.25±10.08)mg/L,均高于支原体组[(0.36±0.15)μg/L和(17.14±6.02)mg/L]、病毒组[(0.23±0.10)μg/L和(3.25±0.74)mg/L]和对照组[(0.18±0.06)μg/L和(2.78±0.88)mg/L],差异有统计学意义(P<0.001);PCT单独检测和PCT/CRP串联试验中细菌组阳性率分别为86.05%和69.77%,均高于支原体组(43.48%和21.74%)和病毒组(27.59%和13.79%),差异有统计学意义(P<0.001),但是在CRP单独检测和PCT/CRP并联试验中,病毒组与支原体组比较差异无统计学意义(P>0.017);四种评估策略中,PCT/CRP并联试验的灵敏度最高为90.70%,PCT/CRP串联试验的特异度最高为82.69%,且PCT/CRP串联试验具有最高的Youden指数为0.51。结论 PCT和PCT/CRP串联试验对儿童细菌性肺炎有较好的诊断特异度,可以作为儿童细菌性肺炎临床诊断的依据之一。

Objective To investigate the clinical value of procalcitonin(PCT)and C-reactive protein(CRP)in the diagnosis of bacterial pneumonia in children.Methods The children with bacterial pneumonia who were treated in the Number One Hospital of Zhangjiakou from January to December 2015 were selected and assigned into three groups according to the different pathogens:the bacterial group(43 cases),the virus group(29 cases)and the mycoplasma group(23 cases).And 35 healthy children having physical examination in the same period were selected as the control group.The levels of PCT and CRP in the four groups were measured and compared.The diagnosis value of PCT and CRP in children with bacterial pneumonia was evaluated respectively according to the positive criteria of the PCT,CRP,PCT/CRP series test and the PCT/CRP parallel test.Results In the bacterial group,the level of PCT was(5.42±1.41)μg/L and the level of CRP was(26.25±10.08)mg/L,which were significantly higher(P<0.001)than those in the mycoplasma group[(0.36±0.15)μg/L and(17.14±6.02)mg/L],the virus group[(0.23±0.10)μg/L and(3.25±0.74)mg/L]and the control group[(0.18±0.06)μg/L and(2.78±0.88)mg/L].In the PCT and PCT/CRP series test,the positive rates of the bacterial group were 86.05%and 69.77%,higher than those in the mycoplasma group(43.48%and 21.74%,P<0.001)and the virus group(27.59%and 13.79%,P<0.001).However,in the CRP and PCT/CRP parallel test,there was no statistically difference between the virus group and the mycoplasma group(P >0.017).Among the four assessment strategies,the sensitivity of PCT/CRP parallel test was 90.70%,which was the highest.The specificity of PCT/CRP series test was the highest,which was 82.69%.Also,the Youden index of PCT/CRP series test was 0.51,which was higher than the others.Conclusions The PCT and PCT/CRP series test have good diagnostic specificity for children's bacterial pneumonia,which can be used as a basis for clinical diagnosis of bacterial pneumonia in children.