血清铁蛋白在鉴别发热住院患者感染性与非感染性疾病中的应用  

Application of serum ferritin in differential diagnosis of infectious and non-infectious diseases in hospitalization fever patients

作　　者：吴卫华 严晓敏[1] 黄睿[1] 贾蓓 吴超[1] WU Wei-hua;YAN Xiao-min;HUANG Rui;JIA Bei;WU Chao(Department of Infectious Diseases,The Affiliated Nanjing Drum Tower Hospital of Nanjing Medical University,Nanjing,Jiangsu 210008,China)

机构地区：[1]南京医科大学鼓楼临床医学院感染科,江苏南京210008

出　　处：《中国临床研究》2018年第11期1560-1563,1570,共5页Chinese Journal of Clinical Research

摘　　要：目的分析血清铁蛋白(FER)在鉴别发热住院患者感染性与非感染性疾病中的临床价值。方法回顾性分析2016年8月至2018年1月在南京鼓楼医院感染科住院时诊断不明确的发热患者共390例。其中病因不明者53例,出院诊断明确的患者共337例,分为感染组(n=270)与非感染组(n=67)。比较两组临床特征、实验室检查结果,并对患者实验室指标进行单因素及多因素分析。结果两组年龄、性别、热峰比较无统计学差异(P>0. 05)。感染组入院前发热热程较非感染组短,差异有统计学意义(P <0. 01)。感染组发热合并寒颤的比例、合并2型糖尿病的比例高于非感染组(P <0. 05)。感染组患者白细胞计数(WBC)、中性粒细胞计数(N)、单核细胞计数(M)均高于非感染组,而FER、碱性磷酸酶(AKP)均低于非感染组,差异有统计学意义(P <0. 05,P <0. 01)。多因素Logistic回归分析结果示FER(OR=1. 0001,95%CI:1. 0001～1. 0002,P=0. 002)为鉴别感染性与非感染性疾病的独立指标。FER鉴别感染性疾病的AUC曲线下的面积为0. 643,截断值为1 129. 60 ng/ml,敏感性为80. 74%,特异性为46. 27%,阳性预测值为85. 8%,阴性预测值为37. 3%。结论 FER水平可作为早期鉴别感染性与非感染性疾病的独立指标。Objective To investigate the clinical value of serum ferritin（FER） in the differential diagnosis of infectious and non-infectious diseases in hospitalization fever patients. Methods A total of 390 in-patients who were diagnosed at Nanjing Drum Tower Hospital from August 2016 to January 2018 were retrospectively analyzed. There were 53 patients with unknown etiology and 337 patients with definite diagnosis,and they were divided into infection group（n = 270） and noninfection group（n = 67）. The clinical and laboratory findings of the two groups were compared. Univariate and multivariate analysis were carried out in laboratory indicators of patients. Results There were no significant differences between age,gender and peak temperature in two groups（P〉0. 05）. The pre-hospitalization fever course in infection group was significant shorter than that in non-infection group（P〈0. 05）. The proportion of fever and chill and type 2 diabetes in the infection group were higher than those in the non-infection group（P〈0. 05）. In infection group,the white cell count,neutrophil count and monocyte count were higher,and the FER and alkaline phosphatase（AKP） were lower than those in non-infection group（P〈0. 05,P〈0. 01）. Multivariate Logistic regression showed that FER was the independent indicator for infectious and non-infectious diseases identification（OR = 1. 0001,95% CI：1. 0001-1. 0002,P = 0. 002）. The area under the curve（AUC） of FER for identifying infectious and non-infectious diseases was 0. 643,the cut-off value was1 129. 60 ng/ml,the sensitivity was 80. 74%,the specificity was 46. 27%,the positive predictive value was 85. 8%,and the negative predictive value was 37. 3%. Conclusion FER level could be the independent indicator for the early identification of infectious and non-infectious diseases.

关 键 词：发热 感染性疾病 非感染性疾病 诊断 血清铁蛋白 

分 类 号：R446.11[医药卫生—诊断学]