多种炎症指标在新型冠状病毒肺炎的表达水平及临床应用价值  

Expressions of multiple inflammation markers in the patients with COVID-19 and their clinical values

作　　者：石亚玲[1] 区静怡 陈星[1] 谭明凯 李芳[1] 刘艳霞 Shi Yaling;Ou Jingyi;Chen Xing;Tan Mingkai;Li Fang;Liu Yanxia(Department of Laboratory Medicine,Guangzhou Eighth People′s Hospital,Guangzhou 510060,China)

机构地区：[1]广州市第八人民医院,广州510060

出　　处：《中华检验医学杂志》2020年第4期346-351,共6页Chinese Journal of Laboratory Medicine

基　　金：2020年广东省防控新型冠状病毒科技攻关应急专项(2020B111108001)。

摘　　要：目的:探讨多种炎症指标在新型冠状病毒肺炎(COVID-19)中的表达水平以及临床应用价值,为临床诊疗提供理论依据。方法:选取2020年1至2月广州市第八人民医院收治的164例COVID-19确诊患者作为研究对象并将其按疾病程度分为普通型、重型、危重型3组,另选取同期66例已排除感染的患者作为阴性对照组,回顾性分析和比较各组患者白细胞(WBC)、淋巴细胞(LYM)、C反应蛋白(CRP)、血清淀粉样蛋白A(SAA)和前降钙素原(PCT)各指标的表达水平,并采用受试者工作曲线(ROC)评价WBC、CRP、SAA及三者联合在COVID-19中及在普通型和重型/危重型COVID-19间的诊断价值。结果:与对照组WBC计数[8.13(6.51,9.42)×109/L]和LYM计数[2.00(1.28,2.43)×109/L]相比,COVID-19患者的WBC计数[4.94(4.05,6.67)×109/L]和LYM计数[1.33(0.94,1.96)×109/L]均明显降低(Z=-7.435,P<0.01;Z=-4.906,P<0.01);确诊病例组的CRP[7.93(2.45~23.98)mg/ml]和SAA[34.13(4.83~198.40)mg/ml]水平均较对照组[CRP:1.36(0.57~5.67)mg/ml;SAA:4.98(4.80~15.75)mg/ml]的高(Z=-5.72,P<0.01;Z=-4.166,P<0.01),对照组与病例组的PCT水平分别是0.1000(0.0306~0.1000)ng/ml和0.0445(0.0316~0.0770)ng/ml,两组间差异没有统计学意义(Z=-1.451,P=0.147);WBC、CRP和SAA诊断COVID-19患者的ROC曲线下面积分别是0.814、0.742和0.673(P<0.01),三者联合诊断COVID-19患者的ROC曲线下面积是0.882,特异度和敏感度分别83.33%(55/66)和84.76%(139/164),P<0.01;WBC、CRP及SAA预测重型/危重型COVID-19的ROC曲线下面积分别是0.799、0.779和0.886(P<0.01),三者联合预测重型/危重型COVID-19的ROC曲线下面积是0.924,特异度和敏感度分别78.67%(118/150)和14/14(P<0.01)。结论:联合WBC、CRP和SAA三者可提高COVID-19诊断的特异度和敏感度,同样对重型和危重型COVID-19有较高的预测价值。Objective To explore the expressions of multiple inflammation markers in the patients with COVID-19 and their clinical values,and to provide theoretical basis for clinical diagnosis and treatment.Methods A total of 164 patients,diagnosed with COVID-19 and admitted to Guangzhou Eighth People′s Hospital from January to February 2020,were selected as the research group and divided into three groups(ordinary,severe,and critically severe pneumonia)according to the disease severity.Meanwhile 66 non-infected patients during the same period were selected as negative control group.The expressions of white blood cell(WBC),lymphocyte(LYM),C-reactive protein(CRP),serum amyloid A protein(SAA),and procalcitonin(PCT)were retrospective studied and compared between groups.The diagnostic values of WBC,CRP,SAA and the combination of these three markers in all patients with COVID-19 and in different severity groups were analyzed by receiver operator characteristic(ROC)curve.Results Compared with control group[WBC count:8.13(6.51,9.42)×109/L,LYM count:2.00(1.28,2.43)×109/L],WBC count[4.94(4.05,6.67)×109/L]and LYM count[1.33(0.94,1.96)×109/L]of COVID-19 patients were significantly reduced(Z=-7.435,P<0.01;Z=-4.906,P<0.01).Compared with the control group[CRP:1.36(0.57~5.67)mg/ml;SAA:4.98(4.80-15.75)mg/ml],CRP[7.93(2.45-23.98)mg/ml]and SAA[34.13(4.83-198.40)mg/ml]were increased in research group(Z=-5.72,P<0.01;Z=-4.166,P<0.01).PCT in the control group and the research group were 0.1000(0.0306-0.1000)ng/ml and 0.0445(0.0316-0.0770)ng/ml,respectively.There was no statistical difference between two groups(Z=-1.451,P=0.147).The areas under the receiver operator characteristic curve(AUC)of WBC,CRP and SAA in patients with COVID-19 were 0.814,0.742,0.673,respectively(P<0.01),while the AUC of the combination of three indexes for COVID-19 diagnosis was 0.882,with 83.33%(55/66)specificity and 84.76%(139/164)sensitivity,P<0.01.The AUCs of WBC,CRP,and SAA for predicting severe and critically severe COVID-19 were 0.799,0.779,and 0.886,respecti

关 键 词：炎症 冠状病毒属 肺炎 病毒性 白细胞计数 C反应蛋白质 血清淀粉样蛋白A 敏感性与特异性 

分 类 号：R563[医药卫生—呼吸系统]