血清炎症标志物在社区获得性肺炎中的诊断价值

The Diagnostic Value of Serum Inflammatory Markers in Community Acquired Pneumonia

目的社区获得性肺炎(community acquired pneumonia,CAP)是呼吸系统最常见的疾病之一,不同的患者表现出不同的炎症指标升高,本研究将观察炎症指标对CAP的诊断价值。方法收集2018年10月至2020年1月,实验组216例,来自中国中医科学院西苑医院肺病科,健康对照组100例,来自体检中心。采用非参数检验分析两组降钙素原(procalcitonin,PCT)、C反应蛋白(C-reactive protein,CRP)、白介素-6(interleukin-6,IL-6)、白细胞计数(white blood cell,WBC)、中性粒细胞计数(neutrophils,Neu#)和淋巴细胞计数(lymphocyte,Lym#)的相关性;采用卡方检验比较阳性率;Spearman方法分析各炎症指标的相关性;受试者工作特征曲线(ROC)评价炎症指标对CAP的诊断价值。结果实验组PCT、CRP、IL-6、WBC和Neut#水平均高于对照组,Lym#水平低于对照组,两组比较差异有统计学意义(P<0.05);实验组PCT、CRP、IL-6、WBC、Neut#和Lym#阳性率比较,PCT阳性率最高为67.59%,其次为CRP阳性率57.87%,均显著高于其他指标,差异有统计学意义(P<0.05);CAP患者PCT、CRP、IL-6、WBC、Neut#和Lym#相关性结果显示,WBC与Neut#和IL-6与CRP具有较强相关性(r=0.914、0.564),弱相关指标为PCT与CRP、WBC与Lym#、IL-6与Neut#、PCT与IL-6、IL-6与WBC、CRP与Neut#、PCT与Neut#(r=0.391、0.466、0.371、0.354、0.372、0.290、0.290),差异有统计学意义(P<0.05);ROC曲线结果显示,CRP曲线下面积为0.926,灵敏度和特异性为88%,临界值为1.880 mg/L;其次是PCT,曲线下面积0.896,灵敏度为79.6%,特异性为86.0%,临界值为0.035pg/mL,差异有统计学意义(P<0.05)。结论CAP组PCT、CRP、IL-6、WBC、Neut#均高于正常对照组,Lym#水平低于对照组。PCT、CRP阳性率较高,诊断效果最佳,是评估CAP价值的重要辅助指标。

Objective Community acquired pneumonia is one of the most common diseases of the respiratory system and different patients show increase patterns with different inflammatory indicators.This study investigated the diagnostic value of various inflammatory indicators for community acquired pneumonias.Methods The data of 216 cases in the experimental group were collected from October,2018 to January,2020,from the Department of Pulmonary Diseases,Xiyuan Hospital,China Academy of Chinese Medical Sciences,while 100 cases in the control group were from the Physical Examination Center.A non-parametric test was used to analyze the correlation between two groups of PCT,CRP,IL-6,WBC,Neut#and Lym#;chi-square test was used to compare the positive rate;spearman was used to analyze the correlation of each inflammation index;Operating characteristic curve(ROC)was drawn to evaluate the diagnostic performance of inflammation indicators in community acquired pneumonia.Results Levels of PCT,CRP,IL-6,WBC and Neut#in the experimental group were higher than those in the control group,while Lym#level was lower than the control group,and the difference between the two groups was statistically significant(P<0.05).Comparing the positive rates of PCT,CRP,IL-6,WBC,Neut#and Lym#in the experimental group,the highest positive rate of PCT was 67.59%,followed by CRP of 57.87%,both significantly higher than other indicators(P<0.05).The correlation results of PCT,CRP,IL-6,WBC,Neut#and Lym#in patients with community acquired pneumonia showed that the strong correlation indicators were WBC&Neut#and IL-6&CRP(r=0.914,0.564),while the weak correlation indicators were PCT&CRP,WBC&Lym#,IL-6&Neut#,PCT&IL-6,IL-6&WBC,CRP&Neut#,and PCT&Neut#(r=0.391,0.466,0.371,0.354,0.372,0.290,0.290)(P<0.05).The results of the ROC curve showed that the area under the CRP curve was 0.926,with both sensitivity and specificity of 88%,and the critical value was 1.880.Followed by the PCT,the area under the curve was 0.896,with the sensitivity of 79.6%,the specificity of 86.0%,the critical value of 0.035(P<0.05).Conclusion PCT,CRP,IL-6,WBC and Neut#of the community acquired pneumonia group are higher than those of the normal control group,while Lym#level is lower than control group.The positive rates of PCT and CRP are higher with the best diagnostic performance,and it is an important auxiliary diagnosis for evaluating community acquired pneumonia value.