血清淀粉样蛋白A、降钙素原及C-反应蛋白联合检测在儿童早期感染类疾病中的应用价值探讨

Combined determination of serum amyloid A,procalcitonin and C-reactive protein in the early diagnosis of infectious diseases in children

目的探讨血清淀粉样蛋白A(SAA)、降钙素原(PCT)以及C-反应蛋白(CRP)在儿童感染类疾病中的诊断意义。方法选取93例诊断细菌感染的儿童(细菌感染组),77例病毒感染(病毒感染组)和50例健康儿童(正常对照组)分别测定SAA、PCT及CRP,进行SAA/CRP比值的计算。比较各组间各指标差异,采用受试者工作特征(ROC)曲线分析SAA、PCT、CRP、SAA/CRP比值及三者联合诊断细菌感染和病毒感染的效能。结果细菌感染组SAA、PCT及CRP明显高于正常对照组(P<0.01),而SAA/CRP比值与其比较差异无统计学意义(P>0.05)。病毒感染组SAA、SAA/CRP比值、PCT明显高于正常对照组(P<0.05),而CRP与其比较差异无统计学意义(P>0.05)。病毒感染组SAA/CRP比值明显高于细菌感染组(P<0.01)。ROC曲线分析显示CRP诊断细菌感染的曲线下面积(AUC)为0.971,SAA/CRP比值诊断病毒感染的AUC为0.927,效能较好。结论SAA、PCT及CRP的检测对儿童细菌感染有较好的诊断价值,SAA/CRP比值的应用可以更快速、准确地诊断病毒感染,三指标的联合检测效能并没有优于单个项目。

Objective To investigate the combined determination of serum amyloid A(SAA),procalcitonin(PCT)and C-reactive protein(CRP)in the diagnosis of infectious diseases in children.Methods SAA,PCT and CRP levels were determined in 93 patients with bacterial infection,77 patients with viral infection and 50 healthy children(control group);meanwhile,SAA/CRP ratio was calculated.The basic data and the serum SAA,PCT and CRP levels were compared among different groups.Receiver operating characteristic(ROC)curve was used to analyze the efficacies of SAA,PCT,CRP and SAA/CRP ratio in the diagnosis of bacterial and viral infections.Results The levels of SAA,PCT,and CRP in bacterial infection group were higher than those in the control group(P<0.01),and there was no statistical significance on the difference of that,compared with SAA/CRP ratio(P>0.05).The levels of SAA,SAA/CRP ratio and PCT were higher in viral infection group than those in the control group(P<0.05),and there was no statistical significance for CRP(P>0.05).SAA/CRP ratio in the viral infection group was significantly higher than that in the bacterial infection group(P<0.01).ROC curve showed that the AUC of CRP in the diagnosis of bacterial infection was 0.971,and the AUC of SAA/CRP ratio in the diagnosis of viral infection was 0.927,and both have good diagnostic efficacy.Conclusion SAA,PCT and CRP can be used as diagnostic parameters for bacterial infection.SAA/CRP ratio can be used to diagnose viral infection more quickly and accurately.The combined determination of SAA,PCT and CRP is not better than that of a single test item.