细胞因子及炎症指标在发热伴血小板减少综合征与脓毒症合并血小板减少症鉴别诊断中的意义

The significance of cytokines and inflammatory markers in differential diagnosis of severe fever with thrombocytopenia syndrome and sepsis with thrombocytopenia

目的:对比分析发热伴血小板减少综合征(SFTS)与脓毒症合并血小板减少症患者入院时细胞因子、血常规、C-反应蛋白(CRP)、降钙素原(PCT)等指标水平的差异,为两者早期鉴别诊断提供实验室依据。方法:收集SFTS患者34例(A组)、脓毒症合并血小板减少症患者39例(B组)的临床资料,回顾性分析2组患者入院时炎症指标水平的差异,并绘制受试者工作特性曲线(ROC曲线)。结果:①A组白细胞计数(WBC)和中性粒细胞计数(NEUT)明显低于B组(P<0.05);A组血小板计数(PLT)明显低于B组(P<0.05),且2组PLT均低于正常范围;B组纤维蛋白原(FIB)明显高于A组(P<0.05)。②B组PCT、CRP均明显高于A组(P<0.05),且A组PCT仅个别病例升高;B组中性粒细胞与淋巴细胞比值(NLR)、红细胞分布宽度(RDW)均明显高于A组(P<0.05);2组患者白细胞介素-6(IL-6)、肿瘤坏死因子α(TNF-α)、D二聚体(D-D)均升高,2组之间差异无统计学意义(P>0.05);2组患者淋巴细胞计数(LYMPH)差异无统计学意义(P>0.05)。③ROC曲线分析显示,SFTS患者WBC、NEUT、PCT、CRP、NLR的ROC曲线下面积(AUC)>0.9。结论:在SFTS与脓毒症合并血小板减少症发病初期,患者血液中PCT、CRP、WBC、NEUT、PLT、NLR、RDW、FIB水平存在差异,且WBC、NEUT、PCT、CRP、NLR对两者具有较高的诊断价值。

Objective:The differences in cytokines,blood routine,CRP,PCT and other indexes of patients withsevere fever with thrombocytopenia syndrome(SFTS)and patients with sepsis with thrombocytopenia at admission were compared and analyzed to provide laboratory basis for early differential diagnosis of the two.Method:Theclinical data of 34 patients with SFTS(group A)and 39 patients with sepsis with thrombocytopenia(group B)were collected.The differences of inflammatory indicators of the patients at admission between the two groups wereanalyzed retrospectively,and the receiver-operating characteristic curve(ROC curve)was plotted.Results:①WBC and NEUT of group A are significantly lower than those of group B(P<0.05);PLT of group A is significantly lower than that of group B(P<0.05),and PLT of both groups are lower than the normal range;FIB of group B is significantly higher than that of group A(P<0.05).②PCT and CRP of group B are significantly higher than those of group A(P<0.05),and PCT of group A increases only in individual cases;NLR and RDW of group B are significantly higher than those of group A(P<0.05);IL-6,TNF-α,and D-D are all increased in two groups,and there is no statistical significance for the difference between the two groups of patients(P>0.05).The difference in LYMPH between the two groups of patients was not statistically significant(P>0.05).③The ROC curve analysis shows that the area under the ROC curve(AUC)of WBC,NEUT,PCT,CRP,NLR of SFTS patients is>0.9.Conclusion:In the early stage of the onset of SFTS and sepsis with thrombocytopenia,the level of patients’PCT,CRP,WBC,NEUT,PLT,NLR,RDW,FIB are different,and WBC,NEUT,PCT,CRP and NLR have high diagnostic value for patients in both groups.