C反应蛋白与血清心肌酶联合检测手足口病毒的临床价值分析

Clinical Value of C-reactive Protein and Serum Myocardial Enzyme to Detect Hand-Foot-Mouth Disease

目的通过检测手足口病患儿的C反应蛋白与血清心肌酶水平探究心肌酶指标和C反应蛋白单独及联合检测在手足口病诊断方面的临床价值。方法回顾性分析本地区近5年源自临床诊断病例送检的咽拭子样本,所有样本均通过荧光PCR方法检测EV71、CVA16和通用型手足口肠道病毒,分为EV71(+)、CVA16(+)、通用型和阴性对照组同时收集患者的基本信息及在患病期间的血清心肌酶和CRP检测结果对各组的血清指标结果进行差异性分析,并采用ROC曲线评价各指标单独检测及联合检测对EV71(+)和CVA16(+)的诊断价值。结果共收集病例2646例,男性多于女性,但性别之间并无明显差异(χ2=1.2881,P=0.732);年龄13~36个月有1413例,检出人数最多且各血清指标在各年龄组间差异有统计学意义(χ2=57.704,P=0.000);AST、LDH、HBDH、CK-MB和CRP的检测结果在四个组间的差异有统计学意义(P<0.05);EV71(+)患儿AST、LDH、HBDH和CRP水平与对照组和通用型组比较差异有统计学意义(P<0.05);EV71(+) ROC曲线AST、LDH和HBDH的AUC分别为0.617、0.603和0.658,取临床参考值时,AST灵敏度最高(94.52%),LDH和HBDH的特异性最高(91.20%)。CVA16(+)患儿HBDH、CK-MB和CRP水平与对照组和通用型组比较差异具有统计学意义(P<0.05);CVA16(+) ROC曲线HBDH、CK-MB和CRP的AUC分别为0.652、0.620和0.672,取临床参考值时,CK-MB灵敏度最高(80.51%),HBDH特异性最高(91.20%)。联合指标检测时,CVA16和EV71的6联指标AUC分别为0.784和0.729,诊断准确性最高,且与其他单独检测和联合检测指标比较有显著性差异(P<0.05)。结论CRP和血清心肌酶检测在鉴别CVA16和EV71感染时有一定的诊断指导价值,单指标检测的诊断效能一般,多指标联合检测时诊断效能高于单独检测,对疾病预测价值较高。

Objective To explore clinical value of myocardial enzymes indexes and C-reactive protein alone or in combination to diagnose hand-foot-mouth disease(HFMD)by detecting C-reactive protein and serum myocardial enzymes in HFMD children.Method Throat swab samples from clinically diagnosed cases in the past 5 years was conducted by retrospective analysis.EV71,CVA16 and universal virus of hand,foot,mouth and enterovirus were tested by fluorescent PCR method.All were divided into EV71(+),CVA16(+),general and negative control group.At the same time,basic information,serum myocardial enzymes and CRP were collected,differences of serum index were analyzed.And ROC curve was used to evaluate diagnostic value of each index individually and combined for EV71(+)and CVA16(+).Results 2646 cases were collected.Men were more than women without significant difference(=1.2881,P=0.732).There were 1413 cases aged 13-36 months that was the largest number detected,and differences in serum indexes among each age group were statistically significant(=57.704,P=0.000).AST,LDH,HBDH,CK-MB and CRP were significantly different among four groups(P<0.05).AST,LDH,HBDH and CRP in EV71(+)children were significantly different from those in control group and universal group(P<0.05).In EV71(+)ROC curve,AUC of AST,LDH and HBDH were 0.617,0.603 and 0.658,respectively.When taking clinical reference value,AST has the highest sensitivity(94.52%),and LDH and HBDH had the highest specificity(91.20%).The HBDH,CK-MB and CRP in CVA16(+)children were significantly different from those of control group and universal group(P<0.05).The AUC of CVA16(+)ROC curves of HBDH,CK-MB and CRP were 0.652,0.620 and 0.672,respectively.When clinical reference value was taken,CK-MB had the highest sensitivity(80.51%)and HBDH had the highest specificity(91.20%).Diagnostic accuracy of combined index detection was the highest that 6 indexes AUC of CVA16 and EV71 were 0.784 and 0.729,respectively.And there were significant differences compared with other independent detection and combined detection indexes(P<0.05).Conclusion The detection of CRP and serum myocardial enzymes has certain diagnostic guidance value in differentiating CVA16 and EV71 infections.The diagnostic efficiency of multiple indexes combined detection is higher than single index,which has higher predictive value for disease.