摘要
目的分析小婴儿(0～90d)发热病因,探讨白细胞计数(white blood cell count,WBC)、中性粒细胞计数百分比(neutrophil count percentage,NEUT%)、C反应蛋白(C-reactive protein,CRP)及降钙素原(procalcitonin,PCT)诊断小婴儿严重细菌感染的价值。方法回顾性分析264例发热住院小婴儿的临床资料。结果 264例罹患单一疾病199例,合并≥2种疾病65例,肺炎发病率为68.93%;严重细菌感染72例,非严重细菌感染160例,可疑严重细菌感染32例;严重细菌感染患儿WBC [(14.49±4.81)×109个/L]、NEUT%[(58.44±15.66)%]、CRP[(45.15±30.01)mg/L]、PCT[(3.32±3.04)μg/L]水平均高于非严重细菌感染患儿[(11.32±7.52)×109个/L、(41.52±15.54)%、(8.12±7.78)mg/L、(0.28±0.24)μg/L](P<0.05);ROC曲线分析结果显示,WBC以12.60×109个/L为最佳截断值,诊断小婴儿发生严重细菌感染的AUC为0.718 7(95%CI:0.618 3～0.819 1,P<0.001),灵敏度为72.2%,特异度为69.8%;NEUT%以53%为最佳截断值,诊断小婴儿发生严重细菌感染的AUC为0.781 8(95%CI:0.690 7～0.873 0,P<0.001),灵敏度为75.0%,特异度为79.1%;CRP以15.65mg/L为最佳截断值,诊断小婴儿发生严重细菌感染的AUC为0.897 1(95%CI:0.829 6～0.964 7,P<0.001),灵敏度为91.7%,特异度为82.6%;PCT以0.88μg/L为最佳截断值,诊断小婴儿发生严重细菌感染的AUC为0.981 4(95%CI:0.928 2～0.996 5,P<0.001),灵敏度为91.7%,特异度为97.7%;WBC+NEUT%+CRP+PCT联合诊断小婴儿发生严重细菌感染的AUC为0.993 4(95%CI:0.968 3～0.999 1,P<0.001),灵敏度为99.4%,特异度为99.1%,均高于各指标单独检测(P<0.05)。结论小婴儿发热病因以肺炎多见,WBC+NEUT%+CRP+PCT对小婴儿严重细菌感有较高的诊断价值。
Objective To investigate the etiology of fever and to evaluate the values of white blood cell count(WBC),neutrophil count percentage(NEUT%),C-reactive protein(CRP)and procalcitonin(PCT)to the diagnosis of severe bacterial infection(SBI)in infants(aged 0-90 d).Methods The clinical data of 264 infants with fever were retrospectively analyzed.Results In 264 infants,199 suffered from single disease and 65 were complicated with 2 or more diseases.The incidence of pneumonia was 68.93%.Seventy-two infants were found SBI,160 were found non-SBI,and32 were found suspected SBI.The levels of WBC((14.49±4.81)×109/L),NEUT%((58.44±15.66)%),CRP((45.15±30.01)mg/L)and PCT((3.32±3.04)μg/L)in SBI infants were significantly higher than those in non-SBI infants((11.32±7.52)×109/L,(41.52±15.54)%,(8.12±7.78)mg/L),(0.28±0.24)μg/L)(P<0.05).ROC analysis showed that when the optimal cut-offvalue of WBC was 12.60×109/L,the AUCfor the diagnosis of SBI was0.718 7(95%CI:0.618 3-0.819 1,P<0.001),the sensitivity was 72.2% and the specificity was 69.8%;when the optimal cut-offvalue of NEUT% was 53%,the AUC was 0.781 8(95%CI:0.690 7-0.873 0,P<0.001),the sensitivity was 75.0%,and the specificity was 79.1%;when the optimal cut-off value of CRP was 15.65 mg/L,the AUCwas 0.897 1(95%CI:0.829 6-0.964 7,P<0.001),the sensitivity was 91.7%,and the specificity was 82.6%;when the optimal cut-offvalue of PCT was 0.88μg/L,the AUCwas 0.981 4(95%CI:0.928 2-0.996 5,P<0.001),the sensitivity was 91.7%,and the specificity was 97.7%;the AUC of joint detection of WBC+ NEUT% +CRP+PCT was 0.993 4(95% CI:0.968 3-0.999 1,P<0.001),the sensitivity was 99.4% and the specificity was99.1%,which were significantly higher than those of single detection of each index(P<0.05).Conclusion Pneumonia is the main cause of fever in infants(aged 0-90 d).The joint detection of WBC+NEUT%+CRP+PCT has a high value to the diagnosis of SBI.
作者
吕奎林
张雨平
温恩懿
杨张娅
杨望
金玲
张红
游静
常琴
LYU Kuilin;ZHANG Yuping;WEN Enyi;YANG Zhangya;YANG Wang;JIN Ling;ZHANG Hong;YOU Jing;CHANG Qin(Department of Pediatrics,the Second Affiliated Hospital of PLA Military Medical University,Chongqing 400037,China)
出处
《中华实用诊断与治疗杂志》
2018年第12期1197-1199,共3页
Journal of Chinese Practical Diagnosis and Therapy
基金
国家社会科学基金(16BGL029)
作者简介
通信作者:常琴,E-mail:19616427@qq.com。
