急性布鲁菌病患者血清PCT和CRP水平与临床转归的相关性分析

Correlation between serum PCT and CRP levels and clinical outcome in patients with acute brucellosis

目的探讨急性布鲁菌病(布病)患者血清降钙素原(PCT)和C反应蛋白(CRP)水平与临床转归的相关性。方法选择2014年6月至2020年6月湖州市安吉县人民医院确诊的急性布病患者73例作为急性布病组、慢性布病患者68例作为慢性布病组,另选择健康体检者60例作为对照组。采用化学发光分析法、免疫比浊法分别测定各组观察对象血清PCT、CRP水平。急性布病患者给予利福平、多西环素、利福喷汀胶囊治疗,疗程为9周。比较各组观察对象血清PCT和CRP水平;分析不同疗效急性布病患者血清PCT和CRP水平变化。采用单因素和多因素Cox回归分析影响急性布病患者疗效的相关因素,并利用PCT和CRP指标的受试者工作特征(ROC)曲线下面积(AUC)值和截断值进行急性布病诊断作用评价。结果急性布病组患者血清PCT和CRP水平[(3.25±0.49)ng/ml,(31.28±6.56)mg/L]均高于慢性布病组[(0.12±0.05)ng/ml,(5.21±0.89)mg/L]和对照组[(0.03±0.01)ng/ml,(2.63±0.37)mg/L],且慢性布病组均高于对照组(P均<0.05)。急性布病患者治疗有效56例,治疗无效17例;治疗无效的急性布病患者血清PCT和CRP水平均明显高于治疗有效患者(P均<0.05)。单因素Cox回归分析显示,不同疗效的急性布病患者白细胞计数,中性粒细胞计数,PCT、CRP水平比较,差异均有统计学意义(P均<0.05)。多因素Cox回归分析显示,白细胞计数,中性粒细胞计数,PCT、CRP水平均为影响疗效的危险因素(P均<0.05)。诊断作用评价显示,PCT对急性布病的诊断灵敏度和特异度分别为95.24%和80.00%,CRP对急性布病的诊断灵敏度和特异度分别为93.10%和80.00%。结论急性布病患者血清PCT、CRP水平明显升高,且为影响疗效的危险因素,可作为诊断和治疗急性布病的参考指标。

Objective To investigate the correlation between serum PCT and CRP levels and clinical outcome in patients with acute brucellosis.Methods From June 2014 to June 2020,73 patients with acute brucellosis diagnosed in Anji County People's Hospital,Huzhou City were selected as acute brucellosis group and 68 patients with chronic brucellosis as chronic brucellosis group;another 60 healthy people were selected as control group.The levels of serum PCT and CRP of each group were measured by chemiluminescence assay and immunoturbidimetric assay.Patients with acute brucellosis were treated with rifampicin,doxycycline and rifapentine capsules for 9 weeks.The levels of serum PCT and CRP in three groups and patients with acute brucellosis with different therapeutic effects were compared.Univariate and multivariate Cox regression analysis were used to analyze the related factors affecting the efficacy of patients with acute brucellosis.The area under curve(AUC)and cut-off value of receiver operating characteristic(ROC)curve of PCT and CRP were used to evaluate the diagnosis of acute brucellosis.Results The levels of serum PCT and CRP in acute brucellosis group[(3.25±0.49)ng/ml,(31.28±6.56)mg/L]were higher than those in chronic brucellosis group[(0.12±0.05)ng/ml,(5.21±0.89)mg/L]and control group[(0.03±0.01)ng/ml,(2.63±0.37)mg/L],and those in chronic brucellosis group were higher than those in control group(P<0.05).In acute brucellosis patients,56 cases were effective and 17 cases were ineffective.The levels of serum PCT and CRP in ineffective patients were higher than those in effective patients(P<0.05).Univariate Cox regression analysis showed that there were significant differences in leukocyte count,neutrophil count,PCT and CRP levels among acute brucellosis patients with different therapeutic effects(P<0.05).Multivariate Cox regression analysis showed that leukocyte count,neutrophil count,PCT and CRP levels were the risk factors for therapeutic effect(P<0.05).The diagnostic evaluation showed that the sensitivity and specificity of PCT in the diagnosis of acute brucellosis were 95.24%and 80.00%,respectively;and the sensitivity and specificity of CRP in the diagnosis of acute brucellosis were 93.10%and 80.00%,respectively.Conclusion The levels of serum PCT and CRP in patients with acute brucellosis are significantly increased,and they are risk factors for therapeutic effect,which should be used as reference indexes for diagnosis and treatment of acute brucellosis.