血清淀粉样蛋白A和急性时相蛋白C反应蛋白在不同病毒所致手足口病患儿中的诊断效能

Diagnostic Efficacy of Serum Amyloid A and Acute Phase Protein C Reactive Protein in Children with Hand,Foot and Mouth Disease Caused by Different Viruses

目的分析血清淀粉样蛋白A(SAA)和急性时相蛋白C反应蛋白(CRP)在不同病毒所致手足口病患儿中的诊断效能。方法选取2018年1月至2019年12月在安徽省儿童医院治疗的188例手足口病患儿作为观察组,选取同一时间段进行体检的100名健康儿童作为对照组,所有参与研究的儿童均进行SAA和CRP检查。建立受试者工作特征(ROC)曲线,比较CRP与SAA的诊断效能。结果观察组的SAA、CRP水平均明显高于对照组[(93.55±4.13) mg/L比(5.26±0.74) mg/L,(15.73±1.19) mg/L比(1.02±0.17) mg/L](P <0.05)。肠道病毒71(EV71)组患儿的SAA水平明显低于柯萨奇病毒A组16型(COXA16)组[(34.18±16.94) mg/L比(87.41±6.72) mg/L](P <0.05),而两组的CRP水平比较差异无统计学意义(P> 0.05)。手足口病通用引物聚合酶链反应产物阳性发热患儿的CRP水平高于不发热患儿[(20.6±2.8) mg/L比(13.3±1.7) mg/L](P <0.05),而两者的SAA水平比较差异无统计学意义(P> 0.05)。建立ROC曲线显示,SAA对通用引物PCR产物阳性的手足口病患儿的灵敏度、特异度均明显高于CRP(51.3%比38.9%,47.8%比45.7%)。结论在正常儿童与手足口病患儿中SAA、CRP均具有诊断价值,其中SAA对EV71和COXA16有鉴别判断价值,而CRP对发热的手足口病患儿更具价值,且SAA的诊断效能更高。

Objective To analyze the diagnostic efficacy of serum amyloid A( SAA) and acute phase protein C-reactive protein( CRP) in children with hand,foot and mouth disease( HFMD) caused by different viruses.Methods A total of188 children with HFMD treated in Anhui Provincial Children’s Hospital from Jan.2018 to Dec.2019 were included as an observation group,and 100 healthy children who had physical examination during the same time period were included as a control group.All the children who participated in the study were given SAA and CRP examinations.The receiver operating characteristic( ROC) curve was established and the diagnostic efficacy of CRP and SAA was compared.Results The levels of SAA and CRP in the observation group were significantly higher than those in the control group[( 93.55 ± 4.13) mg/L vs( 5.26 ± 0.74) mg/L,( 15.73 ± 1.19) mg/L vs( 1.02 ± 0.17) mg/L]( P < 0.05).The SAA level of enterovirus71( EV71) group was significantly lower than that of Coxsackievirus A16( COXA16) group[( 34.18 ± 16.94) mg/L vs( 87.41 ± 6.72) mg/L]( P < 0.05),but there was no significant difference in CRP level between the two groups( P >0.05).The level of CRP in febrile children was higher than that in unfebrile children[( 20.6 ± 2.8) mg/L vs( 13.3 ±1.7) mg/L]( P < 0.05),but there was no significant difference in SAA between them( P > 0.05).According to the ROC curve,the sensitivity and specificity of SAA were significantly higher than CRP in children with HFMD diagnosed with positive universal primers( 51.3% vs 38.9%,47.8% vs 45.7%).Conclusion Both SAA and CRP have diagnostic value in normal children and children with HFMD,and SAA has the value of distinguishing EV71 and COXA16,while CRP is more valuable in the children patients with fever;the diagnostic efficacy of SAA is higher.