Diagnostic value of combined measurement of multiple items in bacterial infection disease
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摘要: 目的:探讨降钙素原(PCT)、C-反应蛋白(CRP)、血清淀粉样蛋白A(SAA)、中性粒细胞与淋巴细胞比值(NLR)在细菌感染性疾病中的诊断价值。方法:收集2017-11—2018-11确诊的住院感染患者119例,将其分为4组,分别为细菌感染组56例、病毒感染组40例、真菌感染组15例和混合感染组8例,并选取同期健康体检者30例作为正常对照组。分别收集患者同一天的空腹静脉全血标本和血清标本同步进行PCT、CRP、SAA、NLR测定,并对结果进行统计分析比较。结果:细菌感染组PCT、CRP、SAA、NLR各指标显著高于病毒感染组,差异有统计学意义(P＜0.05);细菌感染组与真菌感染组比较,其PCT、CRP显著高于真菌感染组,差异有统计学意义(P＜0.05),而SAA、NLR差异无统计学意义(P＞0.05);细菌感染组与混合感染组比较,上述各指标差异无统计学意义(P＞0.05)。4种检测指标单独使用时,特异度以PCT最高,为88.5%,其次为NLR 60.5%,其他2种均较低;敏感性以SAA最高,为95.6%,其次为CRP 95.2%;以PCT为主的两两联合检测,以PCT和SAA联合模式最佳,特异度93.2%,灵敏度77.5%;以PCT为主的三者联合检测,以PCT联合CRP和SAA模式最佳,特异度95.5%,灵敏度76.4%。此外,受试者工作特征曲线(ROC)分析发现,上述4种检测指标的曲线下面积以PCT最高,为0.903,其cut-off值为0.55 ng/m时,敏感度和特异度分别为78.8%,85.6%。在革兰阳性菌(G+)与革兰阴性菌(G-)感染检测结果的鉴别中,PCT差异有统计学意义(P＜0.05),其他指标比较差异无统计学意义(P＞0.05)。结论:对细菌感染性疾病诊断,PCT联合CRP、SAA检测具有较高的诊断价值;PCT对于鉴别G+和G-感染有较高的应用价值,可为临床早期抗生素治疗提供参考依据。Abstract: Objective:To explore the diagnostic value of PCT,CRP,SAA and NLR in the bacterial infection diseases.Method:19 patients with confirmed infection diseases from Wuhan Union Hospital as disease group,and 30 cases of healthy subjects as control group were collected from November 2017 to November 2018.119 patients were divided into bacterial infection group,viral infection group,fungal infection group and mixed infection group.The concentrations of PCT,CRP,SAA and NLR were detected respectively and their results were analyzed.Result:The levels of PCT,CRP,SAA and NLR in the bacterial infection group were significantly higher than those in the virus infection group(P＜0.05).The levels of PCT and CRP in the bacterial infection group were significantly higher than those in the fungal infection group(P＜0.05),however,there were no differences in the levels of SAA and NLR(P＞0.05).There were no statistically significant differences with each index between bacterial infection group and mixed infection group(P＞0.05).When the four test indexes were used alone,the specificity was highest in PCT,88.5%,followed by NLR,60.5%,the other two indexes were lower;the sensitivity was highest in SAA,95.6%,followed by CRP,95.2%.PCT combined SAA was the best model in the combined analysis of two indicators that one was based of PCT,which the specificity was 93.2% and the sensitivity was 77.5%.PCT combined SAA and CRP was the model in the combined analysis of three indicators that one was based of PCT,which the specificity was 95.5% and the sensitivity was 76.4%.In addition,we used the ROC analysis and found that the PCT had the highest area under the ROC curve in the four indicators,which was 0.903.When its cut-off value was 0.55ng/ml,the sensitivity and specificity was 78.8% and 85.6% respectively.PCT had significant differences in identifying gram positive bacteria and gram negative bacteria,however,there were no differences in the other three indicators.Conclusion:PCT combined CRP and SAA could improve the sensitivity and specificity for the diagnosis of bacterial infection disease.PCT had important value in the diagnosis of gram positive bacteria and gram negative bacteria and could provide reference for the clinical early antibiotic treatment.
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Key words:
- procalcitonin /
- C-reactive protein /
- serum amyloid protein /
- bacterial infection
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