WBC、CRP、SAA、PCT和ESR在肺结核与社区获得性肺炎鉴别诊断中的应用

The Application of WBC, CRP, SAA, PCT and ESR in the Differential Diagnosis of Pulmonary Tuberculosis and Community-acquired Pneumonia

目的 探讨WBC、CRP、SAA、PCT和ESR在肺结核(PTB)与社区获得性肺炎(CAP)鉴别诊断中的临床应用价值。方法 选取明确诊断的72例PTB患者(PTB组)及74例CAP患者(CAP组)纳为研究对象,分析两组患者WBC、CRP、SAA、PCT和ESR水平的差异,比较上述实验室指标对两种疾病的鉴别诊断价值。结果 (1)PTB组CRP、PCT及ESR水平显著高于CAP组(P<0.05),WBC、SAA水平在PTB组和CAP组间差异无统计学意义(P>0.05)。(2)CRP、PCT及ESR在PTB与CAP鉴别诊断中的AUC分别为:0.599(95%CI 0.507~0.691)、0.623(95%CI 0.532~0.714)和0.715(95%CI 0.631~0.798),且均具有统计学意义(P<0.05);SAA在两组疾病鉴别诊断中的AUC无统计学意义(P>0.05);当ESR取值27.00时(灵敏度为68.1%,特异性为64.9%),为鉴别两种疾病的最佳临界值。(3)CRP与SAA在PTB组和CAP组中都呈现极强正相关(r=0.817,P<0.001;r=0.838,P<0.001)。结论 WBC和SAA水平不能作为炎症标志物来鉴别PTB和CAP,ESR、CRP及PCT在上述两种疾病的鉴别诊断中有一定价值,其中ESR的价值较高,其可作为鉴别诊断的一个有效指标。

Objective To investigate the clinical application value of WBC,CRP,SAA,PCT and ESR in the differential diagnosis of pulmonary tuberculosis(PTB)and community-acquired pneumonia(CAP).Methods Seventy-two patients with PTB(PTB group)and 74 patients with CAP(CAP group)were selected as the study objects.The differences of WBC,CRP,SAA,PCT and ESR levels between the two groups were analyzed,and the differential diagnosis value of the above laboratory indicators for the two diseases was compared.Results(1)Levels of CRP,PCT and ESR in the PTB group were significantly higher than those in the CAP group(P<0.05),while levels of WBC and SAA were not significantly different between the PTB and CAP groups(P>0.05).(2)AUCs of CRP,PCT and ESR in the differential diagnosis of PTB and CAP were 0.599(95%CI 0.507-0.691),0.623(95%CI 0.532-0.714)and 0.715(95%CI 0.631-0.798),respectively,and all of them were statistically significant(P<0.05);AUC of SAA in the differential diagnosis of the two groups of diseases was not statistically significant(P>0.05);An ESR value of 27.00(sensitivity 68.1%,specificity 64.9%)was found to be the optimal threshold for distinguishing the two diseases.(3)CRP showed an extremely strong positive correlation with SAA in both the PTB and CAP groups(r=0.817,P<0.001;r=0.838,P<0.001).Conclusion WBC and SAA cannot be used as inflammatory markers to distinguish PTB from CAP.ESR,CRP and PCT have certain clinical value in the differential diagnosis of these two diseases,among which ESR has a higher value and can be used as a valid index for the differential diagnosis.