麻疹、手足口病和猩红热患儿的CRP和PCT水平分析及临床价值

The Analysis of the Clinical Value of CRP and PCT in Measles,HFMD and Scarlet Fever of Children

目的分析麻疹、手足口病和猩红热患儿的C-反应蛋白(CRP)和降钙素原(PCT)水平及临床价值。方法随机筛选2013年6月至2015年6月检测在我院就诊的60例麻疹患儿(麻疹组)、50例手足口病患儿(手足口病组)、40例猩红热患儿(猩红热组)和30例正常体检儿童(对照组),检测血清C-反应蛋白(CRP)、降钙素原(PCT),比较麻疹、手足口病和猩红热的PCT和CRP的检测结果。采用Logistic回归分析获得新的统计量,计算各曲线下面积(AUC),探讨二者在麻疹、手足口病和猩红热的临床价值。结果 (1)PCT和CRP在麻疹、手足口病和猩红热组均高于对照组(P<0.05)。猩红热组中PCT水平最高,依次为手足口病组、麻疹组,差异明显有统计学意义(P <0.05)。CRP在手足口病组中最高,依次为猩红热组和麻疹组,差异明显有统计学意义(P<0. 05)。(2)根据ROC曲线以及"灵敏度+特异性"取最大值的原则,确立麻疹、手足口病和猩红热患儿的PCT和CRP的最佳截断点分别为0. 35ng/mL、0. 45ng/mL和0. 525ng/mL;11. 1mg/L、8.55mg/L和7.35mg/L。(3)CRP+PCT的ROC曲线的AUC明显大于PCT和CRP任一指标的AUC。结论 PCT和CRP分别在麻疹、手足口病和猩红热的诊断中具有高的临床价值。但不能用唯一的PCT和CRP的参考值去衡量麻疹、手足口病和猩红热的感染及炎症程度。

Objective To analyze clinical value of CRP and PCT in children with measles,HFMD and scarlet fever. Methods We randomly screened 60 cases of children with measles (measles group),50 cases of HFMD(HFMD group),40 cases of scarlet fever (scarlet fever group) and 30 cases of normal physical examination (control group)in our hospital from June 2013 to June 2015 for the study.We then detected the serum C - reactive protein (CRP)and calcitonin (PCT),and compared the detection results among the measles group ,HFMD group and scarlet fever group.The logistic regression was used to obtain new statistics and calculate the area under each curve (AUC)to explore the clinical value of both markers in measles ,HFMD and carlet fever. Results (1)PCT and CRP levels in measles,HFMD and scarlet fever group were significantly higher than that of the control group ( P <0.05),The PCT level was the highest in scarlet fever group,and the difference was significant ( P <0.05).The CRP level was the highest in HFMD group,followed by the scarlet fever group and the measles group( P <0.05).(2)According to the ROC curve and "sensitivity +special" taking the maximum principle,the best cut- off point of PCT were 0.35ng/mL , 0.45ng/mL and 0.525ng/mL in measles,HFMD and scarlet fever,respectively . The best cut- off point of CRP were 11.1mg/L, 8.55mg/L and 7.35mg/L,respectively,in three groups.(3)The area under the ROC curve (AUC)of CRP+PCT was significantly greater than that of either PCT or CRP alone. Conclusion Levels of PCT and CRP have high clinical value in the diagnosis of measles,HFMD and scarlet fever .However,it is not sufficient to measure the infection and inflammation of measles,HFMD and scarlet fever with the only reference value of PCT and CRP.