评价PCT、PLT、CRP、ESR和WBC对川崎病的诊断价值  

Diagnostic values of procalcitonin, platelet, C-reactive protein, erythrocyte sedimentation rate and white blood cell count for Kawasaki disease

作　　者：吴立强[1] 陈建平 何念海[1] 

机构地区：[1]第三军医大学西南医院儿科,重庆400038 [2]西安雁塔天佑儿童医院,西安710065

出　　处：《第三军医大学学报》2016年第23期2527-2531,共5页Journal of Third Military Medical University

基　　金：国家自然科学基金面上项目(30600686)~~

摘　　要：目的评价5种实验诊断指标——降钙素原(procalcitonin,PCT)、血小板计数(blood platelet,PLT)、C反应蛋白(C-reactive protein,CRP)、红细胞沉降率(erythrocyte sedimentation rate,ESR)和白细胞计数(white blood cell count,WBC)及其联合试验在川崎病临床诊断中的价值。方法从2014年3月至2016年2月在西南医院儿科住院部及门诊就诊怀疑川崎病的所有儿童中,选取均检测PCT、PLT、CRP、ESR和WBC的儿童161例,以临床标准(临床症状及B超结果)作为金标准最终确诊92例为川崎病组(包括不完全川崎病和不典型川崎病),69例为疑似川崎病但最终排除川崎病诊断的其他疾病。绘制受试者工作特征曲线(ROC曲线),确定诊断截断点。结果诊断截断点分别是PCT:0.25 ng/m L,CRP:8.04 mg/L,ESR:35 mm/h,PLT:330×109/L,WBC:15.0×109/L。5种检验方法 ROC曲线下面积分别是PCT:0.766,CRP:0.727,ESR:0.699,PLT:0.702,WBC:0.660。检验的灵敏度、特异度、正确率、阳性预测值、阴性预测值、阳性似然比、阴性似然比,PCT+ESR+PLT平行试验分别是96.7%、30.4%、68.3%、65.0%、87.5%、1.33、0.19,PCT+ESR+PLT系列试验分别是19.6%、95.7%、52.2%、85.7%、50.8%、4.01、0.86。结论 PCT和CRP的特异度、灵敏度、正确率、阴性预测值、阳性预测值接近,且优于ESR、PLT和WBC,PCT+ESR+PLT联合试验对川崎病的诊断意义较大。Objective To evaluate the diagnostic values of procalcitonin （PCT）, C-reactive protein （CRP）, erythrocyte sedimentation rate （ESR）, blood platelet （PLT） and white blood cell count （WBC） for Kawasaki disease. Methods A total of 161 children suspected to Kawasaki disease admitted in our hospital from March 2014 to February 2016 were enrolled in this study. They were examined for the levels of PCT, CRP, ESR, PLT and WBC. With the clinical symptoms and B ultrasound examination as the golden standard, 92 cases of the 161 children （incomplete and atypical Kawasaki disease） were confirmed having Kawasaki disease, and the other 69 cases were excluded. Receiver operating characteristic curve （ROC） analysis was used to determine the diagnostic cut-off values. Results The cut-off point was 0.25 ng/mL for PCT, 8.04 mg/L for CRP, 35 mm/h for ESR, 330×109/L for PLT, and 15.0×109/L for WBC. The areas under ROC curves of PCT, PLT, CRP, ESR and WBC were 0.766, 0.727, 0.699, 0.702, 0.702 and 0.660 respectively in the Kawasaki disease diagnostic tests. The sensitivity, specificity, accuracy, positive and negative predictive values, positive likelihood ratio, negative likelihood ratio of parallel tests of PCT＋ESR＋PLT were 96.7%, 30.4%, 68.3%, 65.0%, 87.5%, 1.33 and 0.19, respectively, and those of serial tests of PCT＋ESR＋PLT were 19.6%, 95.7%, 52.2%, 85.7%, 50.8%, 4.01 and 0.86, respectively in the diagnosis of Kawasaki disease. Conclusion The sensitivity, specificity, accuracy, positive and negative predictive values of PCT are closely related to those of CRP, and are better to those of ESR, PLT and WBC. The combined detection of PCT＋ESR＋PLT is of important value in the diagnosis of Kawasaki disease.

关 键 词：川崎病 诊断 降钙素原 C反应蛋白 红细胞沉降率 血小板计数 白细胞计数 

分 类 号：R446.11[医药卫生—诊断学] R725.512[医药卫生—临床医学]