婴幼儿血清降钙素原、血清淀粉样蛋白A对膀胱输尿管反流的诊断价值

Diagnostic value of serum procalcitonin and serum amyloid A protein in infants with urinary tract infection to bladder and ureteral reflux

目的探讨泌尿系感染(UTI)婴幼儿的血清降钙素原(PCT)和血清淀粉样蛋白A(SAA)水平,并分析二者对膀胱输尿管反流(VUR)的诊断价值。方法选取2016年2月至2018年12月延安大学附属医院收治的118例UTI患儿为研究对象,根据是否合并VUR将患儿分为UTI组(70例)和UTI合并VUR组(48例),根据国际儿童反流协会分级系统将VUR患儿分为低级别反流组(20例)和高级别反流组(28例)。分别采用全自动化学发光仪检测血清PCT水平,采用PA600 lifotronic蛋白分析仪检测SAA水平,采用全自动生化分析仪检测血清尿素氮(BUN)、肌酐(Scr)、尿白蛋白(Alb)水平。采用受试者工作特征(ROC)曲线分析血清PCT、SAA及二者联合检测对UTI合并VUR的预测价值,对影响VUR发生的相关因素进行logistic回归分析。结果UTI合并VUR组的血清的PCT、SAA水平较UTI组升高(均P<0.05)。高级别反流组患儿的血清PCT、SAA水平较低级别反流组升高(均P<0.05)。血清PCT水平预测VUR的界值是0.89 ng/mL,灵敏度为70.80%,特异度为90.00%,曲线下面积(AUC)为0.872(95%CI:0.810~0.935,P<0.05),血清SAA预测VUR的界值是235.58 mg/L,灵敏度为72.90%,特异度为54.20%,AUC为0.732(95%CI:0.639~0.825,P<0.05),血清PCT联合SAA预测VUR的灵敏度85.40%,特异度87.10%,AUC为0.906(95%CI:0.851~0.961,P<0.05)。血清PCT高水平、SAA高水平是影响UTI患儿VUR发生的危险因素(均P<0.05)。结论UTI合并VUR患儿的血清PCT、SAA水平较UTI患儿显著升高,PCT、SAA水平对UTI合并VUR具有一定的诊断价值,可作为UTI合并VUR诊断的辅助检查指标。

ObjectiveTo detect serum procalcitonin(PCT),serum amyloid A protein(SAA)level in infants with urinary tract infection(UTI)and to analyze both and the diagnostic value of vesicoureteral reflux(VUR).MethodsA total of 118 children with UTI admitted to the Affiliated Hospital of Yan′an University from February 2016 to December 2018 were selected as the study objects,and were divided into UTI group(70 cases)and UTI combined VUR group(48 cases)according to whether they had VUR.According to the International Children′s Reflux Association classification system,the children with VUR were divided into low-grade reflux group(20 cases)and high-grade reflux group(28 cases).The level of serum PCT was detected by automatic chemiluminescence instrument,the level of SAA was detected by PA600 lifotronic protein analyzer,and the levels of serum urea nitrogen(BUN),creatinine(Scr)and urinary albumin(Alb)were detected by automatic biochemical analyzer.The receiver operating characteristic(ROC)curve was used to analyze the predictive value of serum PCT level for UTI combined with VUR,and logistic regression analysis was performed on the related factors affecting the occurrence of VUR.ResultsThe levels of serum PCT and SAA in UTI combined VUR group were higher than those in UTI group(all P<0.05).The levels of serum PCT and SAA in high-grade reflux group were higher than those in low-grade reflux group(all P<0.05).Serum PCT level predicted VUR with a cut-off of 0.89 ng/mL,sensitivity of 70.80%,specificity of 90.00%,and area under the curve(AUC)of 0.872(95%CI:0.810-0.935,P<0.05),the threshold value of serum SAA for predicting VUR was 235.58 mg/L,the sensitivity was 72.90%,the specificity was 54.20%,and the AUC was 0.732(95%CI:0.639-0.825,P<0.05),the sensitivity and specificity of serum PCT combined with SAA to predict VUR were 85.40%,87.10%,and AUC were 0.906(95%CI:0.851-0.961,P<0.05).High levels of serum PCT and SAA were risk factors for VUR in children with UTI(all P<0.05).ConclusionsThe serum PCT level in UTI combined VUR group is significantly higher than that in UTI group,PCT and SAA levels have certain diagnostic value for UTI combined with VUR and could be used as auxiliary examination indexes in the diagnosis of UTI combined with VUR.