摘要
目的探讨血清C反应蛋白(CRP)与降钙素原(PCT)联合评分系统在儿童侵袭性细菌性腹泻中的诊断价值。方法选择2016年8月至2017年8月于安徽省儿童医院消化内科诊治的腹泻患儿141例,其中侵袭性细菌性腹泻72例(观察组),非细菌性腹泻69例(对照组)。检测两组患儿的PCT、CRP水平,比较单一指标的诊断价值;同时构建二分类Logistic回归分析,分析两项指标与侵袭性细菌性腹泻的相关性,并依据其参数和回归系数构建两项指标的联合评分系统。联合评分构建后,通过对3项指标的ROC曲线下面积(AUC)、灵敏度、特异度等数据进行比较,验证联合评分系统的诊断价值。结果两组患儿的年龄、性别等基线资料比较,差异均无统计学意义(P>0.05)。观察组患儿中志贺菌感染7例(9.72%),沙门菌感染59例(81.94%),铜绿假单胞菌感染2例(2.78%),大肠埃希菌感染4例(5.56%);CRP和PCT水平均明显高于对照组(P<0.05)。二分类Logistic回归分析证实,CRP、PCT水平与侵袭性细菌性腹泻存在明显相关性(P<0.05)。构建后的联合评分系统与CRP和PCT的ROC曲线进行比较,联合评分、CRP及PCT的AUC分别为0.89、0.80及0.81,联合评分明显大于CRP和PCT(P<0.05)。以约登指数最大为原则截取3项指标的诊断界值,其中CRP的最佳诊断界值为14.40mg/L,PCT为1.24ng/mL,联合评分为0.52;以此计算3项指标的灵敏度和特异度,联合评分的灵敏度、特异度均明显高于CRP和PCT指标(P<0.05)。结论在儿童侵袭性细菌性腹泻中,血清CRP与PCT均有较好的诊断参考价值;基于两项指标为参数构建的联合评分系统可进一步提高诊断准确性。
Objective To investigate the diagnostic value of serum C-reactive protein(CRP)and procalcitonin(PCT)joint score system in children with invasive bacterial diarrhea.Methods 141 cases of diarrhea children diagnosed and treated in the department of gastroenterology of Anhui Children′s Hospital from August 2016 to August 2017 were selected,including 72 cases of invasive bacterial diarrhea(the observation group)and 69 cases of non-bacterial diarrhea(the control group).PCT and CRP levels in the two groups were detected,and the diagnostic value of a single index was compared.At the same time,binary Logistic regression analysis was constructed to analyze the correlation between the two indexes and invasive bacterial diarrhea,and a joint score system of the two indexes was constructed according to their parameters and regression coefficient.After the establishment of the joint score system,the diagnostic value was verified by comparing the three indexes:the area under the ROC curve,sensitivity,specificity and others.Results There was no significant difference in age,sex and other baseline data between the two groups(P>0.05).Among the 72 cases of invasive bacterial diarrhea,7 cases of Shigella infection(9.72%),59 cases of Salmonella infection(81.94%),2 cases of Pseudomonas aeruginosa(2.78%),and 4 cases of Escherichia coli(5.56%).The levels of CRP and PCT in the children with invasive bacterial diarrhea were significantly higher than those in the control group(P<0.05).Binary Logistic regression analysis confirmed that there was a significant correlation between CRP,PCT levels and invasive bacterial diarrhea(P<0.05).The joint score was compared with the ROC curves of CRP and PCT,the joint score of AUC area respectively were 0.89,0.80,0.81.And the joint score was significantly greater than CRP and PCT,the difference was statistically significant(P<0.05).The diagnostic boundary value of the three indexes was cut off with the maximum of the three indexs,of which the best diagnostic value:CRP was 14.4 mg/L,PCT was 1.24 ng/mL,and the joint score was 0.52,so as to calculate the sensitivity and specificity of the three indexes.Among them,the sensitivity and specificity of the joint score were significantly higher than those of CRP and PCT(P<0.05).Conclusion In children with invasive bacterial diarrhea,serum CRP and PCT have good reference value for the diagnosis,the joint score system based on the two indexes can further improve the accuracy of diagnosis.
作者
陈苗苗
吴成
王琍琍
CHEN Miaomiao;WU Cheng;WANG Lili(Department of Pediatrics,the First Affiliated Hospital of Anhui MedicalUniversity,Hefei,Anhui 230022,China;Department of Gastroenterology,AnhuiChildren's Hospital,Hefei,Anhui,230051,China)
出处
《重庆医学》
CAS
2019年第9期1523-1526,共4页
Chongqing medicine
基金
安徽省自然科学基金资助项目(1508085MH174)
