血清降钙素原、C反应蛋白、淀粉样蛋白在鉴别诊断小儿肠炎中的价值

The value of serum PCT,CRP and SAA in differential diagnosis of infantile enteritis

目的探讨检测血清降钙素原(PCT)、C反应蛋白(CRP)、淀粉样蛋白(SAA)鉴别诊断小儿肠炎的临床价值。方法回顾性选取2016年3月至2017年9月长沙市中心医院细菌感染性腹泻病儿100例(细菌组)、病毒感染致腹泻病儿100例(病毒组),检测两组病儿血清PCT、CRP、SAA水平,并分析这三种指标单独及联合应用于临床鉴别诊断细菌、病毒感染腹泻病儿的价值。结果细菌组的血清PCT、CRP、SAA、外周血白细胞(WBC)、中性粒细胞(N%)水平显著的高于病毒组,差异有统计学意义(P<0.05);血清PCT鉴别诊断细菌性和病毒性肠炎的临界值为1.02μg/L,诊断的灵敏度为88.12%、特异度为93.17%、受试者工作特征曲线(ROC曲线)下面积(AUC)值为0.908;血清CRP鉴别诊断细菌性和病毒性肠炎的临界值为15.8 mg/L,诊断的灵敏度为78.63%、特异度为85.04%、AUC值为0.829;血清SAA鉴别诊断细菌性和病毒性肠炎的临界值为155.2 mg/L,诊断的灵敏度为81.38%、特异度为87.29%、AUC值为0.843;PCT+CRP+SAA鉴别诊断细菌性和病毒性肠炎的灵敏度为91.44%、特异度为96.91%、漏诊率为8.56%、误诊率为3.09%、AUC值为0.946。结论PCT对细菌性和病毒性肠炎的诊断价值高于CRP、SAA,三者联合应用具有更高的诊断价值。

Objective To explore the clinical value of detecting serum procalcitonin(PCT),C?reactive protein(CRP)and serum amyloid protein(SAA)in differential diagnosis of infantile enteritis.Methods A total of 100 cases of bacterial infectious diarrhea(bacterial group)and 100 cases of diarrhea caused by viral infection(viral group)treated in The Central Hospital of Changsha from March 2016 to September 2017 were collected retrospectively.The serum levels of PCT,CRP and SAA in two groups were de?tected,and the value of these three indicators separately and combinedly in the clinical differential diagnosis of children with bacte?rial and viral diarrhea was analyzed.Results The levels of serum PCT,CRP,SAA,peripheral white blood cells(WBC)and neutro?phil(N%)in the bacterial group were significantly higher than those in the virus group,and the difference was statistically signifi?cant(P<0.05).The critical value of serum PCT in the differential diagnosis of bacterial and viral enteritis was 1.02μg/L,the sen?sitivity of diagnosis was 88.12%,the specificity was 93.17%,and the area under receiver operating curve(AUC)was 0.908.The critical value of serum CRP in the differential diagnosis of bacterial and viral enteritis was 15.8 mg/L,the sensitivity of diagnosis was 78.63%,the specificity was 85.04%,and the AUC was 0.829.The critical value of serum SAA in the differential diagnosis of bacterial and viral enteritis was 155.2 mg/L,the sensitivity of diagnosis was 81.38%,the specificity was 87.29%,and the AUC was 0.843.The sensitivity,specificity,omission diagnostic rate and misdiagnosis rate of PCT+CRP+SAA in the differential diagnosis of bacterial and viral enteritis were 91.44%,96.91%,8.56%,and 3.09%,respectively.The AUC was 0.946.Conclusion The value of PCT in the diagnosis of bacterial and viral enteritis was higher than the values of CRP and SAA,and the combination of the three has a higher diagnostic value.