血清淀粉样蛋白A和C反应蛋白检测在儿童感染性疾病诊断中的应用  

Determinations of serum amyloid A and C-reactive protein for the diagnosis of infectious diseases in children

作　　者：田月如[1] 李巍[2] 叶志成[2] 杨丹[2] 徐锦[2] 

机构地区：[1]复旦大学附属华山医院检验科,上海200040 [2]复旦大学附属儿科医院临床检验中心,上海201102

出　　处：《检验医学》2017年第5期382-385,共4页Laboratory Medicine

摘　　要：目的探讨血清淀粉样蛋白A(SAA)和C反应蛋白(CRP)联合检测在儿童感染性疾病诊断中的应用。方法检测65例病毒感染患儿(病毒感染组)、72例细菌感染患儿(细菌感染组)和60名健康儿童(正常对照组)SAA、CRP水平,同时进行白细胞(WBC)计数和分类,计算中性粒细胞/淋巴细胞比值(NLR)。采用受试者工作特征(ROC)曲线分析SAA、CRP、SAA/CRP比值、WBC计数、NLR诊断细菌感染和病毒感染的效能。结果细菌感染组SAA、CRP、WBC计数及NLR明显高于正常对照组(P<0.05),而SAA/CRP比值明显低于正常对照组(P<0.05)。病毒感染组SAA、SAA/CRP比值水平明显高于正常对照组(P<0.05),而CRP、WBC计数及NLR与正常对照组比较差异均无统计学意义(P>0.05)。ROC曲线分析显示CRP诊断细菌感染的效能最好[ROC曲线下面积(AUC)、敏感性、特异性分别为0.977、99.0%、83.2%],SAA/CRP比值诊断病毒感染的效能最好(AUC、敏感性、特异性分别为0.916、87.7%、89.4%)。结论 SAA和CRP可作为细菌感染的诊断指标。在病毒感染中,SAA升高比CRP更为明显,且SAA/CRP比值更为敏感。联合检测SAA和CRP能更快速、准确地确定感染类型,为疾病的早期诊断和后续治疗提供有效的实验依据。Objective To investigate the combined determination of serum amyloid A （SAA） and C-reactive protein （CRP） for the diagnosis of infectious diseases in children. Methodse SAA and CRP levels were determined in 65 patients with viral infection,72 patients with bacterial infection and 60 healthy children （healthy control group）,and white blood cell （WBC） count and differentiation were determined,and the neutrophil/lymphocyte ratio （NLR） was calculated. Receiver operating characteristic （ROC）curve was used to analyze the efficacy of SAA,CRP,SAA/CRP ratio,WBC count and NLR in the diagnosis of bacterial and viral infections. Results The levels of SAA,CRP,WBC count and NLR in bacterial infection group were higher than those in healthy control group （P〈0.05）,and SAA/CRP ratio was lower（P〈0.05）. The levels of SAA and SAA/CRP ratio were higher in viral infection group than those in healthy control group （P〈0.05）,and there was no statistical significance for CRP,WBC count and NLR compared with healthy control group（P〉0.05）. ROC curve showed that CRP had the best performance for the diagnosis of bacterial infection,and the area under ROC curve （AUC）,sensitivity and specificity were 0.977,99.0% and 83.2%,respectively. SAA/CRP ratio had the best performance for the diagnosis of viral infection,and AUC,sensitivity and specificity were 0.916,87.7% and 89.4%. Conclusions SAA and CRP can be used as diagnostic parameters for bacterial infection. In viral infection,SAA increases more obviously than CRP,and SAA/CRP ratio is sensitive. The combined determination of SAA and CRP can determine the types of infections quickly and accurately,and can provide a reference for the early diagnosis and follow-up treatment.

关 键 词：血清淀粉样蛋白A C反应蛋白 儿童感染性疾病 

分 类 号：R446.1[医药卫生—诊断学]