新型冠状病毒肺炎患者血浆CRP,PCT和IL-6水平检测的临床诊断价值  

Diagnostic Value of Determination of Plasma CRP,PCT and IL-6 Levels in Patients with COVID-19

作　　者：马俊娥 崔湘铧 刘芮 韩欢 邬开朗[2] 刘芳[2] 祝成亮[1] MA Jun-e;CUI Xiang-hua;LIU Rui;HAN Huan;WU Kai-lang;LIU Fang;ZHU Cheng-liang(Department of Clinical Laboratory,Renmin Hospital of Wuhan University,Wuhan 430060,China;State Key Laboratory of Virology of Wuhan University,Wuhan 430072,China)

机构地区：[1]武汉大学人民医院检验科,武汉430060 [2]武汉大学病毒学国家重点实验室,武汉430072

出　　处：《现代检验医学杂志》2021年第5期105-109,共5页Journal of Modern Laboratory Medicine

基　　金：国家科技重大专项课题(2017ZX10103005),国家自然科学基金(81672079)。

摘　　要：目的评估单独及联合检测新型冠状病毒肺炎(coronavirus disease-2019,COVID-19)患者血浆C反应蛋白(C reactive protein,CRP)、降钙素原(procalcitonin,PCT)和白介素-6(interleukin-6,IL-6)水平的临床诊断价值。方法选取2020年1月1日~2月2日期间武汉大学人民医院COVID-19确诊患者96例,其中普通型41例,重型45例和危重型10例,另选40例健康者作为对照组,收集96例患者的CRP,PCT和IL-6以及40例健康者的CRP和PCT检测结果并绘制ROC曲线。结果与对照组相比,COVID-19组患者的CRP[0.40(0.40~0.57)mg/L vs 60.35(21.00~108.48mg/L)]和PCT[0.05(0.04~0.07)ng/ml vs 0.09(0.05~0.20)ng/ml]水平显著增高,差异有统计学意义(Z=-4.662和-9.202,均P<0.001)。在COVID-19患者中,普通型患者的CRP[36.80(10.20~67.40)mg/L vs 84.90(49.25~134.65)mg/L,94.10(122.18~198.05)mg/L],PCT[0.06(0.04~0.09)ng/ml vs 0.12(0.07~0.27)ng/ml,0.22(0.05~0.47)ng/ml]水平明显低于重型、危重型患者,差异有统计学意义(Z=-4.576~-2.48,均P<0.05)。普通型患者的IL-6[8.42(1.73~20.59)pg/ml vs 73.65(18.03~311.39)pg/ml]水平低于危重型,差异均有统计学意义(Z=3.118,P<0.05);ROC曲线显示PCT和CRP诊断COVID-19价值较高,诊断重型和危重型COVID-19患者,CRP的价值最高,且三个指标联合检测可以提高诊断效能;诊断危重型COVID-19患者,IL-6有较高的预测价值。结论血浆CRP,PCT和IL-6水平可能是诊断COVID-19的潜在生物标志物,并且其血浆水平可以评估COVID-19的严重程度,三指标联合检测可以提高评估效能,对COVID-19的临床诊断和治疗具有重要的参考价值。Objective To evaluate the clinical diagnostic value of plasma CRP,PCT and IL-6 levels in patients with COVID-19 alone and in combination.Methods A total of 96 confirmed COVID-19 patients were selected from the Renmin Hospital of Wuhan University during January 1,2020 and February 2,2020,including 41 cases of moderate type,45 cases of severe type and 10 cases of critical type,another 40 healthy subjects were selected as the control group.The detection results of CRP,PCT and IL-6 in 96 patients and CRP,PCT in 40 healthy subjects were collected and ROC curves were drawn.Results Compared with the control group,the levels of CRP[0.40(0.40~0.57)mg/L vs 60.35(21.00~108.48mg/L)]and PCT[0.05(0.04~0.07)ng/ml vs 0.09(0.05~0.20)ng/ml]in COVID-19 group were significantly increased,the differences were statistically significant(Z=-9.202,-4.662,all P<0.01).Among COVID-19 patients,the CRP[36.80(10.20~67.40)mg/L vs 84.90(49.25~134.65)mg/L,94.10(122.175~198.05)mg/L]and PCT[0.06(0.04~0.09)ng/ml vs 0.12(0.07~0.27)ng/ml,0.22(0.05~0.47)ng/ml]levels of moderate patients were significantly lower than those of severe and critical patients the differences were statistically significant(Z=-4.576~-2.480,all P<0.05).The level of IL-6 in the moderate type was lower than that in the critical type[(8.42(1.73~20.59)pg/ml vs 73.65(18.03~311.39)pg/ml)],all differences were statistically significant(Z=3.118,P<0.05).The ROC curve showed that PCT and CRP had high value in the diagnosis of COVID-19,and CRP had the highest value in the evaluation of patients with severe and critical COVID-19,and the combined detection of the three indexes could improve the evaluation efficiency.IL-6 had a high predictive value in the evaluation of critical COVID-19 patients.Conclusion CRP,PCT and IL-6 levels may be potential biomarkers for the diagnosis of COVID-19 and can be used to assess the severity of COVID-19,the combined diagnosis of three indicators may improve the diagnostic efficiency,providing important reference value for the clinical diagnosis and treatmen

关 键 词：新型冠状病毒肺炎 C反应蛋白 降钙素原 白介素-6 

分 类 号：R373.1[医药卫生—病原生物学] R446.11[医药卫生—基础医学]