常规实验室检查对儿童社区获得性肺炎程度评估的价值

Values of blood routine indexes, C-reactive protein, procalcitonin and lactate dehydrogenase in evaluating severity of community-acquired pneumonia

目的 探讨常规实验室检查血常规、血清炎症因子C-反应蛋白(CRP)、血清降钙素原(PCT)、血沉(ESR)及乳酸脱氢酶(LDH)与肺炎患儿病情严重程度的关系及在评估儿童社区获得性肺炎(CAP)病情的价值。方法 选取2018年10月1日至2019年3月31日于西安交通大学第一附属医院儿科住院治疗的590例CAP患儿,将所有患儿分为轻症肺炎组(399例)和重症肺炎组(191例)。对两组的血常规常用指标、CRP、PCT、ESR及LDH水平进行比较分析。结果 轻症肺炎组患儿的WBC、PLT、CRP、PCT、ESR及LDH均显著低于重症肺炎组,差异均有统计学意义(t值分别为-2.423、-2.637、-2.594、-2.413、-2.817、-3.476,P<0.05)。受试者工作特征(ROC)曲线分析显示:CRP的曲线下面积(AUC)为0.738,取最佳截断值时预测CAP严重程度的特异度为68.20%、灵敏度为93.70%、约登指数为0.619;PCT的AUC为0.744,取最佳截断值时预测CAP严重程度的特异度为46.10%、灵敏度为90.10%、约登指数为0.362。CRP和PCT对CAP严重程度的预测价值优于WBC、PLT、LDH及ESR。结论 常规实验室检查中WBC、PLT、CRP、PCT、ESR及LDH与CAP患儿病情严重程度有关,且CRP和PCT的预测价值优于WBC、PLT、ESR及LDH,通过观察以上常规实验室指标变化可预测疾病的严重程度及预后,为CAP患儿的临床诊治提供参考。

Objective To explore relationships of common routine laboratory examinations including routine blood indexes, serum inflammatory factor C-reactive protein(CRP) level, serum procalcitonin(PCT) level, erythrocyte sedimentation rate(ESR) and serum lactate dehydrogenase(LDH) level with severity of pneumonia in children, and their evaluating values in predicting condition of community-acquired pneumonia(CAP) in children.Methods 590 children with community-acquired pneumonia who admitted to Department of Pediatrics, The First Affiliated Hospital of Xi′an Jiaotong University from October 1,2018 to March 31,2019 were selected as research subjects and divided into mild CAP group(399 cases) and severe CAP group(191 cases).The levels of common routine blood indexes, serum levels of CRP,PCT,LDH and ESR of the children were detected and compared between the two groups.Results White blood cell count(WBC),platelet count(PLT),CRP,PCT,ESR and LDH of the children in the severe CAP group were significantly higher than those in the mild CAP group(t=-2.423,-2.637,-2.594,-2.413,-2.817 and-3.476 respectively, all P<0.05).Receiver operating characteristic(ROC) curve analysis showed that area under the curve(AUC) of CRP was 0.738,and the specificity, sensitivity and Youden index for predicting the severity of CAP in children were 68.20%,93.70% and 0.619 respectively;the AUC of PCT was 0.744,and the specificity, sensitivity and Youden index were 46.10%,90.10% and 0.362 respectively.CRP and PCT were better than WBC,PLT,LDH and ESR in predicting the severity of CAP in children(both P<0.05).Conclusion WBC,PLT,serum levels of inflammatory factors C-RP,PCT,ESR and LDH are associated with the severity of CAP in children, and the predictive values of PCT and CRP are better than WBC,PLT,ESR and LDH.The detection of the above routine laboratory indexes can predict the severity and the prognosis of the disease, and provide reference for clinical diagnosis and treatment of CAP in children.