临床常用炎症指标对不明原因发热诊断价值的研究  

A research of diagnostic value of clinical common inflammatory markers on fever of unknown origin

作　　者：王超[1] 付小萌[2] 石秋萍[1] 王红[1] 张淑文[1] 

机构地区：[1]首都医科大学附属北京友谊医院感染内科,北京100050 [2]首都医科大学

出　　处：《临床和实验医学杂志》2014年第14期1210-1213,共4页Journal of Clinical and Experimental Medicine

基　　金：首都医学发展科研基金项目(项目编号:2009-1034)

摘　　要：目的评价临床常用炎症指标对不明原因发热(FUO)的诊断价值。方法回顾性分析2003年1月至2013年8月期间符合FUO诊断标准的病人372例。入选病例根据病因分组,对感染性疾病、风湿免疫性疾病、肿瘤性疾病3组,对共303例病例的白细胞计数(WBC)、C反应蛋白(CRP)、降钙素原(PCT)和铁蛋白(SF)进行分析比较。结果303例FUO中,感染性疾病组224例(73.9%),风湿免疫性疾病组48例(15.8%),肿瘤性疾病组31例(10.2%)。不同疾病组间WBC水平不同,风湿免疫组的WBC水平较高,而感染性疾病组的WBC水平较低,差异有统计学意义;不同疾病组的CRP水平不同,肿瘤性疾病组的CRP明显升高,且高于感染性疾病组和风湿免疫组,差异有统计学意义;风湿免疫组的SF水平高于其他另两组,差异有统计学意义;ROC曲线分析提示WBC(入院第1天,入院第7天)、CRP、PCT和SF的曲线下面积(AUC)分别是0.581,0.550,0.728,0.769和0.648,其中,只有CRP的差异具有统计学意义。结论在FUO患者中,WBC、CRP、PCT、SF对其病因的经验性诊断有一定的价值。Objective To evaluate the diagnostic value of clinical common inflammatory markers on fever of unknown origin. Methods A total of 372 patients with fever of unknown origin in our hospital were collected from January 2003 to August 2013. The clinical data of these patients were analyzed retrospectively. 372 patients were divided into 3 groups according to the causes of FUO. WBC,CRP,PCT,ferritin of infectious,rheumatic autoimmune,tumor 3 groups of 303 patients were analyzed and compared. Results In the 303 cases of FUO,the infectious disease group included 224 cases（ 73. 9%）,48 cases were classified as rheumatic autoimmune disease group（ 15. 8%）,31 cases were classified as tumor disease group（ 10. 2%）. WBC were different among the three groups. The WBC of the rheumatic autoimmune group was higher than the other 2 groups,while that of infectious group was the lowest. The difference was statistically significant. CRP were different among the three groups. The CRP value of tumor group was significantly elevated and higher than that of infectious and rheumatic autoimmune groups. The difference was statistically significant. The ferritin value of rheumatic autoimmune was higher than the other 2 groups. The difference was statistically significant. The ROC curve analysis showed that AUC of WBC（ the first day and the seventh day admitted）,CRP,PCT,ferritin were 0. 581,0. 550,0. 728,0. 769 and 0. 648 respectively. And only the AUC of CRP was significant different. Conclusion The detection of WBC,CRP,PCT and ferritin has important clinical value in the empirical diagnosis of causes of patients with FUO.

关 键 词：不明原因发热 回顾性分析 WBC CRP PCT SF 诊断价值 

分 类 号：R441.3[医药卫生—诊断学]