血清淀粉样蛋白A、降钙素原、超敏C反应蛋白检测对肺结核合并肺炎的诊断价值

Diagnostic value of serum amyloid A,procalcitonin and hypersensitive C-reactive protein for pulmonary tuberculosis complicated by pneumonia

目的探讨血清淀粉样蛋白A(SAA)、降钙素原(PCT)、超敏C反应蛋白(hs-CRP)水平在肺结核合并肺炎患者中的表达及诊断预测价值。方法收集2019年4月~2020年4月入住广州市胸科医院重症结核科的肺炎、肺结核、肺结核合并肺炎、肺结核合并脓毒症的患者血清,检测血清中SAA、PCT、hs-CRP水平,应用受试者工作特征(ROC)曲线评估SAA、PCT、hs-CRP预测肺结核合并肺炎的效能;评估以SAA、PCT、hs-CRP鉴别肺结核合并肺炎与脓毒症的可能性。收集2020年5月~7月的肺结核、肺结核合并肺炎患者的血清,检测SAA、PCT、hs-CRP水平,验证其联合预测肺结核并发肺炎的准确性。结果与肺结核组患者相比,肺炎组患者血SAA、hs-CRP水平明显升高;肺结核合并肺炎组患者血SAA、PCT、hs-CRP水平均较肺结核组患者明显升高,差异均有统计学意义(P均<0.05)。血SAA与hs-CRP、白细胞、中性粒细胞比率、D二聚体、纤维蛋白原、APTT水平存在正相关(P均<0.05)。ROC分析显示,血SAA、PCT、hs-CRP诊断肺结核合并肺炎的曲线下面积(AUC)分别为0.762、0.781、0.800;三者联合后AUC值为0.849(P均<0.001)。验证结果显示,以SAA联合PCT预测肺结核患者发生肺炎的敏感度为53.85%,特异度为90.48%;与SAA、PCT、hs-CRP三者联合相同。肺结核合并肺炎与结核合并脓毒症患者的血SAA、PCT水平差别无统计学意义。结论联合检测血SAA、PCT水平对诊断肺结核患者合并肺炎具有一定的临床价值。但不能以血SAA或PCT水平来鉴别患者合并肺炎与脓毒症,可能与血SAA、PCT水平受凝血功能的影响有关。

Objective To assess the value of serum amyloid A(SAA),procalcitonin(PCT)and high-sensitivity C-reactive protein(hs-CRP)in the diagnosis of pulmonary tuberculosis(PTB)complicated by pneumonia.Methods We collected serum samples from patients with pneumonia,patients with PTB,patients with PTB complicated by pneumonia and patients with PTB complicated by sepsis hospitalized in our hospital between April,2019 and April,2020.Serum levels of SAA,PCT and hs-CRP were tested,and receiver-operating characteristic(ROC)curves were used to evaluate their efficacy for predicting PTB with concurrent pneumonia and the possibility of differentiating PTB cases with pneumonia from those with sepsis using these 3 parameters.We also tested serum levels of SAA,PCT and hs-CRP in patients with PTB and those with PTB complicated by pneumonia admitted from May to July in 2020 to verify the accuracy of these 3 parameters combined for predicting the complication of PTB by pneumonia.Results Compared with the patients with PTB,the patients with pneumonia had significantly higher SAA and hs-CRP levels;serum SAA,PCT and hs-CRP levels were all significantly elevated in patients with PTB complicated by pneumonia(all P<0.05).The levels of hs-CRP,white blood cell,D-dimer,FIB,APTT and neutrophil ratio were positively correlated with serum SAA level(all P<0.05).The areas under the ROC curve(AUC)for serum SAA,PCT,and hs-CRP were 0.762,0.781,and 0.800,respectively,and their combined AUC was 0.849(all P<0.001).For predicting PTB complicated by pneumonia,SAA combined with PCT had the same sensitivity(53.85%)and specificity(90.48%)as SAA,PCT and hs-CRP all combined.Serum SAA and PCT levels were similar between PTB patients with pneumonia and those with sepsis.Conclusion Combined detection of serum SAA and PCT levels can be helpful in the diagnosis of PTB complicated by pneumonia,but neither of them is capable of differentiating the complication of pneumonia from sepsis possibly due to influence by abnormal blood coagulation.