儿童无明显感染灶急性发热常用检验指标应用的诊断分析

发布时间：2018-04-20 12:06

本文选题：C-反应蛋白 + 降钙素原　；参考：《中华医院感染学杂志》2016年20期

【摘要】：目的研究儿童急性发热无明显感染灶运用常用检验指标进行诊断的临床价值,为临床诊断提供理论依据。方法选择2013年5月-2015年5月医院诊治456例未见明显感染灶以及病态的急性发热住院患儿临床资料,根据最终诊断研究C-反应蛋白(CRP)、血白细胞计数(WBC)、降钙素原(PCT)及中性粒细胞百分比的诊断价值。结果 456例患儿中84例患有严重疾病,其PCT和CRP水平均比非严重疾病患儿高,差异有统计学意义(P0.01);CRP诊断截点为67.1mg/L时,对严重疾病诊断的灵敏度为0.810,特异度为0.715;PCT诊断截点为0.505μg/L,灵敏度为0.762,特异度为0.672;联合两者的特异度达到了0.918,灵敏度为0.617;64例患儿为病毒感染,80例患儿为细菌感染,30例患儿为支原体属感染,根据感染类型不同,患儿之间CRP、PCT、WBC及中性粒细胞百分比的差异有统计学意义(P0.01);当对细菌和病毒感染进行鉴别时,对于CRP诊断截点为38mg/L,灵敏度为0.900,特异度为0.813;PCT诊断截点为0.450μg/L,灵敏度为0.700,特异度为0.812;假如两者结合,特异度为0.965,敏感度为0.630,当对支原体与细菌感染进行鉴别时,CRP的诊断截点为80.75mg/L,灵敏度为0.700,特异度为0.933。结论对于无明显感染灶及病态的急性发热患儿,运用CRP及PCT鉴别5岁患儿病情的严重度及病原学具有一定的帮助,而且两者联合应用的特异性更佳。
[Abstract]:Objective to study the clinical value of using common test indexes in the diagnosis of children with acute fever without obvious infection, and to provide theoretical basis for clinical diagnosis. Methods from May 2013 to May 2015, 456 hospitalized children with acute fever without obvious infection and pathological conditions were selected. According to the final diagnosis, the diagnostic value of C-reactive protein (CRP), white blood cell count (WBC), procalcitonin (PCT) and percentage of neutrophils were studied. Results the levels of PCT and CRP in 84 of 456 children with severe disease were higher than those with non-severe disease. The difference was statistically significant when the diagnostic cut-off point of 67.1mg/L was 67.1mg/L. The sensitivity for the diagnosis of severe diseases was 0.810, the specificity was 0.715 渭 g / L, the sensitivity was 0.762and the specificity was 0.672.The specificity of the combination was 0.918, and the sensitivity was 0.6171.64 cases of viral infection and 80 cases of bacterial infection were 30 cases. The children were infected with Mycoplasma. According to the type of infection, there were significant differences in the percentage of WBC and neutrophils between the children with CRP, PCT, WBC and neutrophils, and when the bacterial and viral infections were differentiated, there was a significant difference in the percentage of WBC and neutrophils. For CRP, the diagnostic cut-off point is 38 mg / L, the sensitivity is 0.900, the specificity is 0.813, the diagnostic cut-off point is 0.450 渭 g / L, the sensitivity is 0.700, and the specificity is 0.812. The specificity was 0.965 and the sensitivity was 0.630.The diagnostic cut-off point of CRP was 80.75 mg / L, the sensitivity was 0.700 and the specificity was 0.933 when the mycoplasma and bacterial infections were differentiated. Conclusion CRP and PCT can be used to identify the severity and etiology of 5-year-old children with acute fever without obvious infective foci and morbid conditions, and the specificity of the combined use of the two methods is better.
【作者单位】：济南市第四人民医院检验科;
【基金】：山东省卫生厅科研基金资助项目(SW2010B-028)
【分类号】：R446

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