实验室炎症指标在COVID-19患者诊疗中的临床价值  

Clinical values of laboratory inflammation indicators for diagnosis and treatment of COVID-19 patients

作　　者：王大刚 李韦杰 金方方 王爽 孙继云[1] 周淳[1] 徐飞[1] 郭晶晶[1] 王雅杰 Wang Dagang;Li Weijie;Jin Fangfang;Wang Shuang;Sun Jiyun;Zhou Chun;Xu Fei;Guo Jingjing;Wang Yajie(Department of Clinical Laboratory,Beijing Ditan Hospital,Capital Medical University,Beijing 100015,China)

机构地区：[1]首都医科大学附属北京地坛医院检验科,北京100015

出　　处：《中华实验和临床病毒学杂志》2020年第4期347-351,共5页Chinese Journal of Experimental and Clinical Virology

基　　金：北京市医院管理中心新型冠状病毒肺炎科技攻关(COVID-19-BHA05);北京市科学技术委员会科技计划(Z201100005420012)。

摘　　要：目的探讨淋巴细胞计数、C反应蛋白(C reactive protein,CRP)、血清淀粉样蛋白A(serum amyloid A protein,SAA)、降钙素原(procalcitonin,PCT)等炎症指标在新型冠状病毒肺炎(COVID-19)患者诊疗中的临床价值。方法收集北京地坛医院2020年2~3月确诊的77例COVID-19患者临床资料,按诊疗方案分为普通型49例、重型28例。比较普通型、重型和出院患者的淋巴细胞计数、CRP、SAA、PCT等指标的差异,并通过Logistic回归和ROC曲线分析筛选出对疾病进展和预后具有较好预测价值的指标。结果重型患者与普通型相比,淋巴细胞计数显著降低(P=0.000),CRP和SAA显著升高(P=0.000,P=0.000),PCT阳性率明显升高(χ^2=11.003,P=0.001);出院患者的淋巴细胞计数较普通型(P=0.001)和重型患者(P=0.000)均有明显升高,而CRP(P=0.036,P=0.000)和SAA(P=0.002,P=0.000)均有显著降低;出院患者PCT阳性率较重型明显降低(χ^2=6.891,P=0.009),但与普通型比较差异无统计学意义(χ^2=0.169,P=0.681)。多因素Logistic回归分析表明SAA和CRP升高都是预测重型发生的危险因素,而SAA降低则可作为预测出院的独立指标;ROC曲线分析SAA诊断重型的敏感度为85.71%,特异度为87.76%,CRP的敏感度为82.14%,特异度为93.88%;SAA诊断出院的敏感度为100%,特异度为57.89%。结论淋巴细胞计数、CRP、SAA和PCT等炎症指标对于COVID-19患者的诊疗具有重要的临床意义,其中SAA是评价疾病进展和预后更为敏感的独立指标。Objective To investigate the clinical values of laboratory inflammation indicators including lymphocyte count,C reactive protein(CRP),serum amyloid A protein(SAA),and procalcitonin(PCT)in the diagnosis and treatment of 2019 novel corona virus disease(COVID-19)patients.Methods The data of clinical characteristics of 77 hospitalized COVID-19 patients were collected from February to March 2020.According to the guidelines for diagnosis and management of COVID-19,these patients were divided into moderate type(49 cases)and severe type(28 cases).Among them 19 cases were discharged.The differences of lymphocyte count,CRP,SAA and PCT among moderate,severe and discharged groups were compared.The indicators with better predictive value for disease development and prognosis were screened out by logistic regression and receiver operating characteristic curve(ROC)analysis.Results The severe patients had lower lymphocyte count compared to the moderate patients(P=0.000),while their CRP(P=0.000),SAA(P=0.000)and PCT positive rate(χ^2=11.003,P=0.001)were significantly higher;The lymphocyte count of discharged patients was much higher than that of moderate(P=0.001)and severe(P=0.000)patients,while CRP(P=0.036,P=0.000)and SAA(P=0.002,P=0.000)were dramatically lower;Although the discharged patients had much lower PCT positive rate than severe patients(χ^2=6.891,P=0.009),they were not significantly different from moderate patients(χ^2=0.169,P=0.681).Logistic regression analysis showed that the increased SAA and CRP were both risk factors for predicting severe illness,but the decreased SAA were demonstrated as an independent indicator for discharge.The ROC curve analysis showed that the sensitivity and specificity of SAA for diagnosis of severe patients were 85.71%and 87.76%,whereas CRP were 82.14%and 93.88%.Further,the sensitivity and specificity of SAA for predicting discharge were 100%and 57.89%.Conclusions The laboratory inflammation indicators such as lymphocyte count,CRP,SAA and PCT had important clinical significance for the d

关 键 词：淋巴细胞计数 C反应蛋白 血清淀粉样蛋白A 降钙素原 新型冠状病毒肺炎 

分 类 号：R563.1[医药卫生—呼吸系统]