C反应蛋白、血清淀粉样蛋白A水平检测对感染性疾病类型及病情的诊断价值  

Diagnostic value of C-reactive protein and serum amyloid A levels in the type and degree of infectious diseases

作　　者：张琳 许序云 李永琦 余彦廷 章小凡 钟磊 ZHANG Lin;XU Xuyun;LI Yongqi;YU Yanting;ZHANG Xiaofan;ZHONG Lei(Department of Emergency,The Third People's Hospital of Kunming,Kunming,Yunnan 650041,China)

机构地区：[1]昆明市第三人民医院急诊科,云南昆明650041

出　　处：《安徽医药》2025年第4期783-788,共6页Anhui Medical and Pharmaceutical Journal

基　　金：昆明市卫生科研项目(2021-03-08-0010)。

摘　　要：目的探究感染性疾病病人C反应蛋白(CRP)、血清淀粉样蛋白A(SAA)水平检测对感染类型的诊断价值及与感染程度的相关性。方法选取2019年1月至2022年12月昆明市第三人民医院门诊收治102例急诊感染性疾病病人,依据感染类型分为细菌感染组(n=62)与病毒感染组(n=40),另选取同期健康体检者60例作为健康对照组,均进行血清CRP、SAA水平及血常规指标[白细胞计数、中性粒细胞百分比(NEU%)]检测。比较各组血清CRP、SAA水平及血常规指标,分析血清CRP、SAA水平与血常规指标的相关性,评价血清CRP、SAA水平与血常规指标联合诊断感染性疾病感染类型的诊断效能,比较不同病情程度病人血清CRP、SAA水平,分析血清CRP、SAA水平对感染性疾病病情加重的危险度及血清CRP、SAA水平交互作用。结果细菌感染组白细胞计数、CRP、NEU%、SAA均较病毒感染组、健康对照组高(P<0.05)。病毒感染组SAA(65.12±9.84)mg/L、白细胞计数(10.13±2.44)×10^(9)/L均较健康对照组(7.14±3.02)mg/L、(8.25±1.43)×10^(9)/L高(P<0.05)。细菌感染组、病毒感染组病人血清CRP、SAA水平均与白细胞计数、NEU%呈正相关(P<0.05)。血清CRP、SAA水平与血常规指标诊断感染性疾病感染类型的曲线下面积(AUC)及其95%CI分别为0.76(0.66,0.84)、0.75(0.65,0.83)、0.81(0.72,0.88)、0.78(0.69,0.86),四者联合诊断AUC为0.94(0.88,0.98),进一步对各诊断方案诊断价值比较显示,血清CRP、SAA水平与血常规指标联合诊断AUC最大,为最优方案(P<0.05)。细菌感染病人血清CRP、SAA水平与病情程度呈正相关关系(P<0.05);病毒感染病人血清SAA水平与病情程度呈正相关关系(P<0.05),血清CRP与病情程度无关(P>0.05)。细菌感染/病毒感染病人血清CRP、SAA高水平时,病情加重风险是低水平的7.31倍/1.66倍、5.76倍/2.41倍。细菌感染病人高CRP、高SAA之间存在交互作用,CRP、SAA同时暴露的交互效应的相对超危险度�Objective To investigate the diagnostic value of C-reactive protein(CRP)and serum amyloid A(SAA)level tests in patients with infectious diseases for the type of infection and the correlation with the degree of infection.Methods A total of 102 acute infectious disease patients admitted to the Outpatient Department of the Third People's Hospital in Kunming from January 2019 to December 2022 were selected and divided into bacterial infection group(n=62)and viral infection group(n=40)according to the type of infection,and another 60 cases of healthy physical examination patients were selected as healthy control group during the same period,all patients were tested for serum CRP,SAA levels,and routine blood indicators[white blood cell count,neutrophil percentage(NEU%)].The levels of serum CRP and SAA,as well as blood routine indicators,were compared among the groups.The correlation between serum CRP,SAA levels and blood routine indicators was analyzed.The diagnostic efficacy of combining serum CRP,SAA levels,and blood routine indicators to diagnose the type of infectious disease infection was evaluated.The levels of serum CRP and SAA were compared in patients with different degrees of illness.The risk of aggravation of infectious diseases and the interaction between serum CRP and SAA levels were analyzed.Results The white blood cell count,CRP,NEU%,and SAA levels in the bacterial infection group were higher than those in the viral infection group and the healthy control group(P<0.05).The SAA(65.12±9.84)mg/L and white blood cell count(10.13±2.44)×10^(9)/L in the viral infection group were higher than those in the healthy control group(7.14±3.02)mg/L and(8.25±1.43)×10^(9)/L(P<0.05).The levels of serum CRP and SAA in patients with bacterial infection and viral infection were positively correlated with white blood cell count and NEU%(P<0.05).The AUCs of serum CRP,SAA levels,and blood routine indicators for diagnosing the type of infectious diseases were 0.76(0.66,0.84),0.75(0.65,0.83),0.81(0.72,0.88),and 0.78(0.69,0.

关 键 词：感染性疾病 细菌感染 病毒感染 C反应蛋白 血清淀粉样蛋白A 

分 类 号：R51[医药卫生—内科学] R446.1[医药卫生—临床医学]