非洲输入性疟疾患者乳酸、降钙素原与疾病严重程度的相关性分析

Correlation analysis between lactic,procalcitonin and disease severity in patients with imported malaria from Africa

目的探讨非洲输入性疟疾患者的临床特点,以及其乳酸、降钙素原水平与疾病严重程度的相关性。方法收集2018年1月1日至2021年4月30日广州医科大学附属市八医院收治的186例非洲输入性疟疾患者的临床资料,回顾性分析患者的一般情况、临床表现、实验室检查、治疗和预后。绘制受试者工作特征(ROC)曲线评价相关指标预测重症疟疾的价值。结果186例患者中,男169例(90.9%),女17例(9.1%),年龄(38.3±10.3)岁;重症48例,非重症138例;感染虫种以恶性疟原虫为主,共166例(89.2%);重症患者均为恶性疟。与非重症组相比,重症组患者的乳酸、降钙素原、白细胞计数、中性粒细胞计数均升高,差异均有统计学意义(均P<0.01);单核细胞百分比、红细胞计数、血红蛋白、血细胞比容、血小板计数均降低,差异均有统计学意义(均P<0.01)。乳酸、降钙素原、红细胞计数、血红蛋白、血细胞比容、血小板计数预测重症疟疾的ROC曲线下面积(AUC)均>0.700,AUC(95%CI)分别为0.753(0.663~0.844)、0.755(0.670~0.841)、0.782(0.700~0.864)、0.738(0.652~0.823)、0.760(0.676~0.844)、0.778(0.699~0.857)(均P<0.01)。当约登指数最大时,乳酸的最佳截断值为2.29 mmol/L,其对重症疟疾预测的灵敏度为56.3%,特异度为93.5%;降钙素原的最佳截断值为2.12μg/L,其对重症疟疾预测的灵敏度为77.1%,特异度为68.1%。重症患者病死率为4.2%(2/48)。结论贫血和血小板减少是预测疟疾严重程度的常见指标。乳酸、降钙素原对预测重症疟疾亦有较高价值,有助于尽早识别重症疟疾,提高治愈率,降低死亡风险。

Objective To explore the clinical characteristics,the correlation between lactate,procalcitonin and disease severity of imported malaria from Africa.Methods The clinical data of 186 patients with imported malaria were collected from January 1,2018 to April 30,2021 in the Guangzhou Eighth People′s Hospital,Guangzhou Medical University.The general conditions,clinical symptoms,laboratory tests,treatment,and prognosis of the patients were analyzed retrospectively.Receiver operating characteristic(ROC)curves were drawn to evaluate the value of relevant indicators in predicting severe malaria.Results A total of 186 patients were divided into severe cases(n=48)and non-severe cases(n=138)in this study,of which the mean age was(38.3±10.3)years,169(90.9%)cases were male,17(9.1%)cases were female.The main infection species was Plasmodium falciparum,in a total of 166 cases(89.2%).The severe cases were all falciparum malarias.Compared with the non-severe group,the lactic,procalcitonin,white blood cell count and neutrophil count of the severe group were all increased,the differences were all statistically significant(all P<0.01);the percentage of monocytes,red blood cell count,hemoglobin,hematocrit and platelet count were all decreased,the difference were all statistically significant(all P<0.01).The areas under the ROC curves(AUC)(95%CI)of lactate,procalcitonin,red blood cell count,hemoglobin,hematocrit and platelet count for predicting severe malaria was 0.753(0.663-0.844),0.755(0.670-0.841),0.782(0.700-0.864),0.738(0.652-0.823),0.760(0.676-0.844),0.778(0.699-0.857),respectively(all P<0.01).When the Youden indexes were at their maximum,the best cut-off value of lactic was 2.29 mmol/L,with sensitivity in predicting of severe malaria was 56.3%,and the specificity was 93.5%;the best cut-off value of procalcitonin was 2.12μg/L,with sensitivity in predicting of severe malaria was 77.1%,and the specificity was 68.1%.The fatality rate of severe malaria was 4.2%(2/48).Conclusions Anemia and thrombocytopenia are common indicators for predicting the severity of malaria.Lactic and procalcitonin also have higher predictive value for severe malaria,which could help to identify severe malaria as early as possible,improve the cure rate and reduce the risk of death.