PCT、hs-CRP、WBC、N和NLR在儿童肺炎临床诊断中应用研究

Application of PCT,hs-CRP,WBC,N and NLR in the clinical diagnosis of pneumonia in children

目的降钙素原(PCT)、超敏C反应蛋白(hs-CRP)、白细胞计数(WBC)、中性粒细胞计数(N)和中性粒细胞/淋巴细胞比值(NLR)在不同病原体类型肺炎患儿中的水平变化及诊断价值分析。方法选取2020年1月至2020年12月在该院治疗的肺炎患儿241例,其中细菌性肺炎10^(9)例、病毒性肺炎55例,支原体肺炎77例,同时选取152例健康儿童作为对照组,检测各受试者细胞PCT、hs-CRP、WBC、N和NLR水平。结果细菌感染组、支原体感染组PCT、hs-CRP、WBC、N和病毒感染组PCT、hs-CRP、WBC明显高于对照组,差异有统计学意义(P<0.05),病毒感染组N、NLR和支原体感染组NLR与对照组比较差异无统计学意义(P>0.05);细菌感染组PCT、hs-CRP、WBC、N和NLR分别为(1.27±1.19)ng/mL、(8.71±5.44)mg/L、(11.14±4.50)×10^(9)/L、(8.87±3.83)×10^(9)/L、4.46±2.06,明显高于病毒感染组和支原体感染组,差异有统计学意义(P<0.05);支原体感染组PCT、hs-CRP、WBC、N分别为(0.54±0.39)ng/mL、(6.35±3.17)mg/L、(8.22±3.55)×10^(9)/L、(4.20±3.14)×10^(9)/L明显高于病毒感染组,差异有统计学意义(P<0.05);PCT、hs-CRP、WBC、N和NLR判断细菌性感染的受试者工作特征(ROC)曲线下面积(AUC)分别为0.943、0.861、0.708、0.761、0.650;其中PCT最佳临界值为0.65 ng/mL,相应的灵敏度和特异度分别为86.6%和90.0%,hs-CRP最佳临界值为4.90 mg/L,灵敏度和特异度分别为68.4%、98.5%。结论联合检查PCT、hs-CRP、WBC、N和NLR的水平在细菌性儿童肺炎的早期诊断及鉴别诊断中具有较大的临床应用价值。

Objective To analyze the level changes and diagnostic value of PCT,hs-CRP,WBC,N and NLR in children with different pathogen types of pneumonia.Methods A total of 241 children with pneumonia who were treated in Fourth Hospital of Changsha from January 2020 to December 2020 were selected,including 10^(9)cases of bacterial pneumonia,55 cases of viral pneumonia,and 77 cases of mycoplasma pneumonia.At the same time,152 healthy children were selected as the control group.The levels of PCT,hs-CRP,WBC,N and NLR in each subject's cells were detected.Results The PCT,hs-CRP,WBC,N of bacterial infection group,mycoplasma infection group and virus infection group were significantly higher than those of control group,the difference was statistically significant(P<0.05).N,NLR of virus infection group and NLR of mycoplasma infection group Compared with the control group,there was no significant difference(P>0.05);the bacterial infection group PCT,hs-CRP,WBC,N and NLR were(1.27±1.19)ng/mL,(8.71±5.44)mg/L,(11.14±4.50)×10^(9)/L,(8.87±3.83)×10^(9)/L,4.46±2.06,significantly higher than the virus infection group and mycoplasma infection group,the difference was statistically significant(P<0.05);the mycoplasma infection group PCT,hs-CRP,WBC,N were(0.54±0.39)ng/mL,(6.35±3.17)mg/L,(8.22±3.55)×10^(9)/L,(4.20±3.14)×10^(9)/L were significantly higher than those in the virus infection group,the difference was statistically significant(P<0.05);PCT,hs-CRP,WBC,N and NLR judged bacterial The areas under the ROC curve of infection were 0.943,0.861,0.708,0.761,0.650,respectively,the differences were statistically significant(P<0.05);the best critical value of PCT was 0.65 ng/mL,and the corresponding sensitivity and specificity were 86.6%and 90.0%,respectively,hs The optimal critical value of-CRP was 4.90 mg/L,and the sensitivity and specificity were 68.4%and 98.5%,respectively.Conclusion The combined examination of PCT,hs-CRP,WBC,N and NLR levels has great clinical application value in the early diagnosis and differential diagnosis of bacterial pneumonia in children.