彭伟波

[摘要]目的 探讨C-反应蛋白（CRP）联合降钙素原（PCT）在儿科感染性疾病中的诊断价值。方法 选取2014年9月～2016年12月我院儿科收治的200例感染性疾病患儿，其中细菌感染100例（细菌感染组），病毒感染100例（病毒感染组），同时选取100例健康人员（健康组）。分析比较各组CRP和PCT的阳性率，采用绘制受试者工作曲线评估CRP和PCT对儿科感染性疾病的诊断价值。结果 细菌感染组的CRP、PCT水平高于病毒感染组和健康组，差异有统计学意义（P<0.05），病毒感染组和健康组受试者的CRP、PCT水平比较相近，差异无统计学意义（P>0.05）；细菌感染组的CRP阳性率高于健康组，PCT阳性率均高于病毒感染组和健康组，差异均有统计学意义（P<0.05）；病毒感染组和健康组受试者的CRP阳性率、PCT阳性率水平比较相近，差异无统计学意义（P>0.05）。ROC曲线分析显示，PCT临界值为0.83 μg/L时，诊断细菌感染的敏感度为100.00%，特异度为94.66%；诊断病毒感染的敏感度为98.93%，特異度为93.14%；CRP临界值为46.4 μg/L时，诊断细菌感染的敏感度为94.97%，特异度为87.43%；诊断病毒感染的敏感度为84.98%，特异度为79.62%；CRP诊断细菌感染的ROC AUC是0.842（95% CI=0.754～0.929），诊断病毒感染的ROC AUC是0.800（95% CI=0.701～0.899）；PCT诊断细菌感染的ROC AUC是0.668（95% CI=0.548～0.789），诊断病毒感染的ROC AUC是0.729（95% CI=0.614～0.845）。结论CRP和PCT可用于临床诊断儿科细菌性感染疾病的常规指标，但对儿科病毒性感染疾病的应用价值不高，需结合其他指标进行诊断。

[关键词]C-反应蛋白；降钙素原；儿科；感染性疾病；诊断

[中图分类号] R725.6 [文献标识码] A [文章编号] 1674-4721（2018）7（b）-0082-03

[Abstract] Objective To investigate the diagnostic value of C-reactive protein （CRP） and procalcitonin （PCT） in pediatric infectious diseases. Methods From September 2014 to December 2016， 200 cases of infectious diseases admitted to our hospital were selected， including 100 cases of bacterial infection （bacterial infection group）， 100 cases of virus infection （virus infection group） and 100 cases Health staff （health group）. Serum levels of CRP and PCT were measured by immunoturbidimetry. The positive rates of CRP and PCT in each group were analyzed and compared， and the diagnostic value of CRP and PCT in pediatric infectious diseases was evaluated by drawing the working curve of the subjects. Results The CRP and PCT levels in bacterial infection group were higher than those in virus infection group and healthy group （P<0.05）. CRP and PCT levels in virus infection group and healthy group were similar， with no difference （P>0.05）. The positive rate of CRP in bacterial infection group was higher than that in healthy group， and the positive rate of PCT was higher than that in virus infection group and healthy group （P<0.05）. The CRP positive rate and PCT positive rate of healthy subjects were similar， with no significant difference （P>0.05）. ROC curve analysis showed that the sensitivity of bacterial infection was 100.00% and the specificity was 94.66% when the critical value of PCT was 0.83 μg/L. The sensitivity and specificity of diagnosing virus infection were 98.93% and 93.14%. The sensitivity of diagnosis of bacterial infection was 94.97% and specificity was 87.43% when the critical value of CRP was 46.4 μg/L. The sensitivity and specificity of diagnosis of viral infection was 84.98% and 79.62% respectively； The diagnosis of bacterial infection by CRP ROC AUC was 0.842 （95% CI=0.754-0.929）， ROC AUC was 0.800 （95% CI=0.701-0.899） for diagnosis of viral infection， and ROC AUC for PCT diagnosis of bacterial infection was 0.668 （95% CI=0.548-0.889）， ROC AUC for diagnosing viral infection was 0.729 （95% CI=0.614-0.845）. Conclusion CRP and PCT can be used for clinical diagnosis of routine indicators of pediatric bacterial infections， but the value of the application of pediatric viral infections is not high， and it needs to be combined with other indicators for diagnosis.

[Key words] C-reactive protein； PCT； Pediatrics； Infectious diseases； Diagnosis

感染是儿科常见的临床疾病，多分为细菌性感染和病毒性感染[1]。C-反应蛋白（C-reactive protein，CRP）是临床诊断炎性疾病的典型指标，主要用于提示各种感染性疾病[2]。降钙素原（procalcitonin，PCT）则是一种无激素活性的降钙素前肽物质，近年来被大量研究证实在感染性疾病中会大量增加，可指导抗生素的临床使用[3-5]。……