降钙素原、C反应蛋白、血清淀粉样蛋白A在儿童细菌性与非细菌性医院获得性肺炎中的鉴别诊断价值

Value of Procalcitonin,C-reactive Protein,and Serum Amyloid A Protein in Differential Diagnosis of Bacterial and Non-bacterial Hospital-acquired Pneumonia in Children

目的探讨降钙素原(PCT)、C反应蛋白(CRP)、血清淀粉样蛋白A(SAA)在儿童细菌性与非细菌性医院获得性肺炎(HAP)中的鉴别诊断价值。方法收集2016年1月至2019年6月在沧州市中心医院(儿科、新生儿科、小儿外科)住院且出现HAP症状的150例患儿的病历资料,患儿均在出现HAP症状后行痰培养和咽拭子病毒、肺炎支原体检测以及血PCT、CRP、SAA水平检测。结果150例HAP患儿中细菌感染95例、非细菌感染55例(其中病毒性肺炎29例、支原体肺炎26例),细菌感染组和非细菌感染组一般资料比较差异无统计学意义(P>0.05)。细菌感染组HAP患儿PCT、CRP、SAA水平均高于非细菌性组[(7.92±0.38)μg/L比(1.42±0.18)μg/L、(59.7±8.6)mg/L比(20.4±4.6)mg/L、(77.2±15.3)mg/L比(24.9±9.3)mg/L](t=12.214,P=0.001;t=15.138,P=0.012;t=18.195,P=0.007)。PCT诊断儿童细菌性HAP的灵敏度、特异度、阳性预测值和阴性预测值均高于CRP和SAA(P<0.05)。PCT+CRP、PCT+SAA、PCT+CRP+SAA联合检测诊断HAP的灵敏度均高于PCT单独检测(P<0.05),但三者联合检测诊断HAP的特异度低于PCT以及CRP单独检测(P<0.05),三者联合检测诊断HAP的阳性预测值低于PCT单独检测(P<0.05),三者联合检测诊断HAP的阴性预测值高于PCT、CRP、SAA单独检测(P<0.05)。结论PCT对于儿童细菌性HAP患者鉴别诊断价值最大。PCT、CRP、SAA联合检测可提高儿童细菌性HAP肺炎的鉴别诊断敏感性,从而有效指导临床用药。

Objective To investigate the value of procalcitonin(PCT),C-reactive protein(CRP)and serum amyloid A protein(SAA)in the differential diagnosis of bacterial and non-bacterial hospital-acquired pneumonia(HAP)in children.Methods The medical records of 150 children with HAP who were hospitalized in Cangzhou Central Hospital(pediatrics,neonatology,pediatric surgery)from Jan.2016 to Jun.2019 were collected.All the children underwent sputum culture and throat swab for virus and mycoplasma pneumoniae detection and blood PCT,CRP,and SAA level detection after HAP.Results There were 95 cases of bacterial infection and 55 cases of non-bacterial infection(including 29 cases of viral pneumonia and 26 cases of mycoplasma pneumonia)among the 150 HAP children.There was no significant difference in general data between the bacterial infection group and the non-bacterial infection group(P>0.05).The serum levels of PCT,CRP and SAA in HAP children were higher in the bacterial infection group than those in the non-bacterial group[(7.92±0.38)μg/L vs(1.42±0.18)μg/L,(59.7±8.6)mg/L vs(20.4±4.6)mg/L,(77.2±15.3)mg/L vs(24.9±9.3)mg/L](t=12.214,P=0.001;t=15.138,P=0.012;t=18.195,P=0.007).The sensitivity,specificity,positive predictive value and negative predictive value of PCT in diagnosing bacterial HAP in children were higher than CRP and SAA(P<0.05).The sensitivity of PCT+CRP,PCT+SAA,and PCT+CRP+SAA in the diagnosis of HAP was all higher than that of PCT alone(P<0.05),but the specificity of the three combined test for HAP diagnosis was lower than that of PCT and CRP alone(P<0.05).The positive predictive value of the three combined tests for HAP diagnosis was lower than that of PCT alone(P<0.05).The negative predictive value of the three combined tests for HAP diagnosis was higher than that of PCT,CRP and SAA alone(P<0.05).Conclusion PCT has the greatest value in the differential diagnosis of bacterial HAP in children.The combined detection of PCT,CRP,and SAA can improve the sensitivity of the differential diagnosis,thus effectively guide the clinical medication.