儿童外周末梢全血与静脉血清降钙素原检测的多中心平行对照研究  

Consistency of peripheral whole blood and venous serum procalcitonin in children: a multicenter parallel controlled study

作　　者：陆权[1] 张泓[2] 董晓艳 刘瀚旻[3] 江咏梅[4] 邹映雪[5] 沈永明[6] 赵德育[7] 陈红兵[8] 艾涛 刘成桂 沈照波 杨俊梅[12] 郑跃杰[13] 陈运生[14] 陈炜刚 朱叶飞[15] 张冲林 田礼军 吴国荣[18] 李羚[19] 郑爱斌 顾猛[21] 魏永越 魏良敏 Lu Quart;Zhang Hong;Dong Xiaoyan;Liu Hanmin;Jiang Yongmei;Zou Yingxue;Shen Yongming;Zhao Deyu;Chen Hongbing;Ai Tao;Liu Chenggui;Shen Zhaobo;Yang Junmei;Zheng Yuejie;Chen Yunsheng;Chen Weigang;Zhu Yefei;Zhang Chonglin;Tian Lijun;Wu Guorong;Li Ling;Zheng Aibin;Gu Meng;Wei Yongyue;Wei Liangmin(Department of Pulmonology,Shanghai Children^Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200062,China;Clinical Laboratory,Shanghai Children’s Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200062,China;Department of Pediatric Pulmonology,West China Second University Hospital,Sichuan University,Chengdu 610041,China;Clinical Laboratory,West China Second University Hospital,Sichuan University,Chengdu 610041,China;Department of the Second Respiratory,Tianjin Children’s Hospital,Tianjin 300134,China;Clinical Laboratory,Tianjin Children^Hospital,Tianjin 300074,China;Department of Pulmonology,Nanjing Children^Hospital Affiliated to Nanjing Medical University,Nanjing 210008,China;Clinical Laboratory,Nanjing Children^Hospital Affiliated to Nanjing Medical University,Nanjing 210008,China;Department of Pulmonology,Chengdu Women’s and Children’s Central Hospital,School of Medicine,University of Electronic Science and Technology of China,Chengdu 611731,China;Clinical Laboratory,Chengdu Womens and Children^Central Hospital,School of Medicine,University of Electronic Science and Technology of China,Chengdu 611731,China;Department of Pulmonology,Children,Hospital Affiliated to Zhengzhou University,Zhengzhou 450053,China;Clinical Laboratory,Children^Hospital Affiliated to Zhengzhou University,Zhengzhou 450053,China;Department of Pulmonology,Shenzhen Children^Hospital,Shenzhen 518038,China;Clinical Laboratory,Shenzhen Children^Hospital,Shenzhen 518038,China;Department of Clinical Laboratory,the Second Affiliated Hospital of Nanjing Medical University,Nanjing 210011,China;Department of Pulmonology,Xuzhou Children^Hospital,Xuzhou Medical University,Xuzhou 221006,China;Clinical Laboratory,Xuzhou Ch

机构地区：[1]上海交通大学附属儿童医院呼吸科,200062 [2]上海交通大学附属儿童医院检验科,200062 [3]四川大学华西第二医院呼吸科,成都610041 [4]四川大学华西第二医院检验科,成都610041 [5]天津市儿童医院呼吸二科,300134 [6]天津市儿童医院检验科,300074 [7]南京医科大学附属儿童医院呼吸科,210008 [8]南京医科大学附属儿童医院检验科,210008 [9]电子科技大学医学院附属成都妇女儿童中心医院呼吸内科,成都611731 [10]电子科技大学医学院附属成都妇女儿童中心医院检验科,成都611731 [11]郑州大学附属儿童医院呼吸科,450053 [12]郑州大学附属儿童医院检验科,450053 [13]深圳市儿童医院呼吸科,518038 [14]深圳市儿童医院检验科,518038 [15]南京医科大学第二附属医院检验科,210011 [16]徐州医科大学附属徐州儿童医院呼吸科,221006 [17]徐州医科大学附属徐州儿童医院检验科,221006 [18]无锡市儿童医院检验科,214023 [19]无锡市儿童医院呼吸科,214023 [20]南通大学附属常州儿童医院科教科,213003 [21]南通大学附属常州儿童医院呼吸科,213003 [22]南京医科大学公共卫生学院生物统计学系,211166

出　　处：《中华儿科杂志》2021年第6期471-477,共7页Chinese Journal of Pediatrics

摘　　要：目的了解外周末梢全血与血清降钙素原(PCT)水平的相关性和一致性,探讨末梢全血PCT检测在儿科感染领域中的应用价值。方法横断面研究,对2018年3月至2019年2月在11所儿童专科医院出生28 d以上的1898例患儿同时采集的末梢全血和静脉血清,分别检测PCT水平,根据文献资料和临床对静脉血清PCT正常参考值及其临床意义分组。采用χ2检验和方差分析进行组间比较,定量数值Pearson相关分析法进行相关性分析,转换成等级资料在不同的临床界限区间采用Spearman检验作分层相关性分析,转换成二分类资料进行一致性评价并初步探索末梢血PCT水平的最佳切点。结果共纳入有效样本1898例(男1098例、女800例),年龄27.4(12.2,56.7)个月。末梢全血和静脉血清PCT之间有良好相关性(r=0.97,P<0.01),直线回归方程式为PCT_(静脉血清)=0.135+0.929×PCT_(末梢全血)。检测绝对值两者间的一致性欠佳,差异有统计学意义(r=0.51~0.92,P<0.01),但等级资料分层分析提示两者实测值在各界限区的符合率为84.9%~97.1%。二分类资料显示两种检测法一致性佳(符合率96.8%~99.3%,Youden指数0.82~0.89)。从病情轻重设定的4个PCT区间(<0.5、0.5~<2.0、2.0~<10.0、≥10.0μg/L)内,末梢全血PCT预判临床的效果良好(曲线下面积为0.9912~0.9979)。不同静脉血清PCT切点值0.5、1.0、2.0、10.0μg/L对应的末梢全血PCT的最佳切点值分别为0.395、0.595、1.175、3.545μg/L。结论末梢全血PCT与静脉血清PCT之间相关性良好,利用末梢全血PCT检测可以辅助判断临床病情的性质和轻重,而采血简便、快速报告并易重复检测的特点为其提供了临床应用的前景。Objective To explore the consistency of peripheral whole blood and venous serum procalcitonin(PCT)levels,and the value of peripheral whole blood PCT in evaluating pediatric bacterial infection.Methods This multicenter cross-sectional parallel control study was conducted in 11 children′s hospital.All the 1898 patients older than 28 days admitted to these hospitals from March 2018 to February 2019 had their peripheral whole blood and venous serum PCT detected simultaneously with unified equipment,reagent and method.According to the venous serum PCT level,the patients were stratified to subgroups.Analysis of variance and chi-square test were used to compare the demographic characteristics among groups.And the correlation between the peripheral blood and venous serum PCT level was investigated by quantitative Pearson correlation analysis.The PCT resultes were also converted into ranked data to further test the consistency between the two sampling methods by Spearman′s rank correlation test.Furthermore,the ranked data were converted into binary data to evaluate the consistency and investigate the best cut-off of peripheral blood PCT level in predicting bacterial infection.Results A total of 1898 valid samples were included(1098 males,800 females),age 27.4(12.2,56.7)months.There was a good correlation between PCT values of peripheral whole blood and venous serum(r=0.97,P<0.01).The linear regression equation was PCT_(venous serum)=0.135+0.929×PCT_(peripheral) whole blood.However,when stratified to 5 levels,PCT results showed diverse and unsatisfied consistency between the two sampling methods(r=0.51-0.92,all P<0.01).But after PCT was converted to ordinal categorical variables,the stratified analysis showed that the coincidence rate of the measured values by the two sampling methods in each boundary area was 84.9%-97.1%.The dichotomous variables also showed a good consistency(coincidence rate 96.8%-99.3%,Youden index 0.82-0.89).According to the severity of disease,the serum PCT value was classified into 4 intervals(

关 键 词：儿童 血清 降钙素原 诊断试验 

分 类 号：R725.1[医药卫生—儿科]