降钙素原对成人斯蒂尔病细菌感染和非感染性发热的鉴别诊断价值  

Diagnostic value of serum procalcitonin concentrations for differentiation between bacterial infection and non-infectious inflammation in febrile patients with active adult-onset Still's disease

作　　者：姚冬云[1] 霍河水[1] 赵文敏[1] 秦晨曼 魏秋瑾[1] 孙凯[1] 廉水清[2] 郭晓霞[2] 

机构地区：[1]河南省焦作市人民医院风湿免疫科,454002 [2]河南省焦作市人民医院检验科,454002

出　　处：《山西医药杂志》2015年第15期1743-1746,共4页Shanxi Medical Journal

摘　　要：目的评价血清降钙素原(PCT)检测对成人斯蒂尔病(AOSD)细菌感染和非感染性发热的鉴别作用。方法采用前瞻性、临床病例观察方法,筛选符合全身性炎症反应综合征(SIRS)的患者,入院24h内测定血清PCT、白细胞介素-6(IL-6)、C反应蛋白(CRP)、血清铁蛋白(SF)水平和白细胞(WBC)计数,将最后确诊AOSD活动或AOSD细菌感染的患者纳入研究,通过受试者工作特征(ROC)曲线及曲线下面积(AUC)评估PCT对鉴别AOSD细菌感染的准确性、敏感性和特异性。结果 2010年4月至2014年4月符合入选条件的AOSD细菌感染患者(感染组)共9例,AOSD活动非感染患者(非感染组)共22例。感染组血清PCT水平[6.20(4.23,14.16)ng/mL]明显高于非感染组[0.59(0.46,0.68)ng/mL,P=0.001)],而IL-6[(979±451)ng/L]、CRP[(110±28)mg/L]略高于非感染组[(729±240)ng/L,P=0.740;(86±28)mg/L];感染组的SF[(2 381±1 774)ng/mL]、WBC[(19.0±2.8)×109/L]与非感染组[(2 312±1 817)ng/mL,(17.6±3.4)×109/L]相近。所有炎症指标中,PCT的截断点界值为1.11ng/mL时,对AOSD感染的敏感性(100%)和特异性(95.5%)最高。与IL-6、CRP等相比较,PCT对AOSD感染的辨别力最佳(AUC为1.000),PCT对AOSD患者细菌感染的预测能力最强;CRP的AUC为0.730,IL-6的AUC为0.702,预测能力次之;WBC为0.609,预测能力较差;SF为0.566,预测能力最差。结论与IL-6、CRP和WBC、SF相比较,PCT水平升高对AOSD细菌感染和非感染性发热有更好的鉴别作用。Objective To examine whether serum procalcitonin （PCT） concentrations are useful for distinguishing bacterial infections from disease flares in patients with active adult-onset Still＇s disease （AOSD）. Methods Prospective, observational cohort study was conducted including patients with systemic inflammatory response syndrome（SIRS） who were admitted to our hospital. Serum PCT levels were measured with interleukin 6 （IL-6）, C-reactive protein （CRP）, white blood cell count （WBC） and serum ferritin （SF） in 31 inpatients with a diagnosis of AOSD. After careful microbio- logic screening, an infectious bacterial complication was diagnosed in 9 cases （Group A） while no obvious infection was demonstrated in 22 patients （Group B）. The diagnostic accuracy, sensitivity, and specificity for identifying a bacterial in- fection were estimated using the receiver operating characteristic（ROC）curve. Results Serum PCT levels were higher in the bacterial infection group than those in the disease flare group [ 6.20 （4.23,14. 16）ng/mL] vs [0.59 （0.46, 0.68） ng/mL, P=0. 001] ;whereas the differences for IL-6, CRP, WBC and SF did not reach statistical signifi- cance. In differentiating patients with bacterial infection from those with disease flare, the AUC of the ROC curve for PCT, IL-6, CRP, WBC and SF was 1. 000, 0. 702,0. 730,0. 609,0. 566, respectively. The best PCT cut-off value was estimated to be 1. 11 ng/mL. The sensitivity and specificity of the best cut-off value were 100% and 95.5 %, respectively. PCT ≥1.11 ng/mL was significant for identifying bacterial infection. Conclusion In com- parison with IL-6, CRP, WBC and SF, the elevated serum PCT levels have a good specificity for diagnosing bacte- rial infection from disease flares in febrile patients with AOSD.

关 键 词：Still病 成年型 白细胞介素-6 C反应蛋白质 发热 感染 降钙素原 

分 类 号：R593.2[医药卫生—内科学]