官晓玲 官逸婧 许慧

【摘要】 目的：研究感染相关因子单项及联合诊断对小儿肠炎感染类型的鉴别价值。方法：选取2021年1月—2023年4月于上饶市立医院就诊的小儿肠炎感染患儿90例，根据轮状病毒试验结果及微生物实验室结果，将细菌性感染患儿45例纳入细菌组，将病毒性感染患儿45例纳入病毒组，比较两组患儿的感染相关因子[白细胞（WBC）、中性粒细胞（NEUT）、淋巴细胞（LYM）、C反应蛋白（CRP）、超敏C反应蛋白（hs-CRP）、降钙素原（PCT）、淀粉样蛋白A（SAA）]水平变化，以受试者操作曲线（ROC）曲线评估感染相关因子单项及联合诊断小儿肠炎感染类型的价值。结果：细菌组患儿的WBC、NEUT、CRP、hs-CRP、PCT均显著高于病毒组，差异均有统计学意义（P<0.05），细菌组患儿的LYM和SAA均显著低于病毒组，差异均有统计学意义（P<0.05）。感染相关因子WBC、NEUT、LYM、CRP、hs-CRP、PCT、SAA单项诊断小儿肠炎感染类型的曲线下面积（AUC）分别为0.681、0.754、0.828、0.711、0.741、0.669、0.796，敏感度分别为57.78%、93.33%、77.78%、51.11%、60.00%、40.00%、93.33%，特异度分别为77.78%、62.22%、75.56%、88.89%、97.78%、93.33%、57.78%；感染相关因子联合诊断小儿肠炎感染类型的AUC为0.970，敏感度为93.33%，特异度为91.11%。结论：WBC、NEUT、CRP、hs-CRP、PCT在小儿肠炎细菌感染患儿体内高水平表达，且较病毒感染患儿更高，而细菌组患儿的LYM和SAA的表达水平显著低于病毒感染患儿，其联合诊断对于小儿肠炎具有重要的临床参考价值。

【关键词】 小儿肠炎 病毒性感染 细菌性感染 C反应蛋白 降钙素原

Value of Single and Combined Diagnosis of Infection-related Factors in the Identification of Enteritis Infection Types in Children/GUAN Xiaoling， GUAN Yijing， XU Hui. //Medical Innovation of China， 2024， 21（15）： -126

[Abstract] Objective： To study the identification value of single blood routine indicator and combined diagnosis on types of enteritis infection in children. Method： A total of 90 children with enteritis infection in Shangrao Municipal Hospital from January 2021 to April 2023 were selected. According to the results of rotavirus test and microbiology laboratory， 45 pediatric patients with bacterial infection were included in bacterial group， and 45 pediatric patients with viral infection were enrolled as viral group. The two groups were compared in terms of infection-related factors [white blood cell （WBC）， neutrophil （NEUT）， lymphocyte （LYM）， C reactive protein （CRP）， hypersensitive C reactive protein （hs-CRP）， procalcitonin （PCT）， serum amyloid A （SAA）]. Receiver operating characteristic （ROC） curve was used to evaluate the diagnostic value of single and combined infection-related factors in the diagnosis of enteritis infection type in children. Result： WBC， NEUT， CRP， hs-CRP and PCT in bacterial group were significantly higher than those in viral group （P<0.05）， while LYM and SAA were significantly lower than those in viral group （P<0.05）. The areas under the curves （AUC） of WBC， NEUT， LYM， CRP， hs-CRP， PCT and SAA in the diagnosis of enteritis infection type in children were 0.681， 0.754， 0.828， 0.711， 0.741， 0.669 and 0.796， the sensitivities were 57.78%， 93.33%， 77.78%， 51.11%， 60.00%， 40.00% and 93.33%， and the specificities were 77.78%， 62.22%， 75.56%， 88.89%， 97.78%， 93.33% and 57.78% respectively. The AUC， sensitivity and specificity of the combination of infection-related factors in the diagnosis of enteritis infection type in children were 0.970， 93.33% and 91.11%. Conclusion： WBC， NEUT， CRP， hs-CRP and PCT are highly expressed in children with enteritis bacterial infection， and the above expression levels are higher than those in children with virus infection， while the expression levels of LYM and SAA of children with bacterial infection are significantly lower compared to children with virus infection. The combined diagnosis of the above indicators has important clinical reference value on children with enteritis.

[Key words] Children enteritis Viral infection Bacterial infection C reactive protein Procalcitonin

First-author's address： Department of Laboratory Medicine， Shangrao Municipal Hospital， Shangrao 334000， China

doi：10.3969/j.issn.1674-4985.2024.15.029

小儿肠炎一般是指由于微生物感染而导致小肠及结肠的炎症，其致病微生物种类繁多，如细菌、病毒等，主要临床症状表现为呕吐、腹泻等。目前临床多以病菌培养结果为诊断标准，但其存在耗时长、阳性率低等不足，无法及时获得检验结果，临床应用存在一定的局限性[1]。因此，临床上迫切需要简单、快速的方法对小儿肠炎的感染类型做出诊断，在提高临床诊断效率的同时，更利于对患儿进行对症治疗。感染相关因子中，白细胞（WBC）是常见的炎症细胞，而中性粒细胞（NEUT）和淋巴细胞（LYM）可共同评估是否是细菌或者是病毒感染。而C反应蛋白（CRP）和超敏C反应蛋白（hs-CRP）是急性时相反应蛋白，降钙素原（PCT）是一种可反映炎症的蛋白质指标，淀粉样蛋白A（SAA）也是一种急性时相反应蛋白，在发生细菌感染时其升高幅度显著大于病毒感染[2-3]。……