PCT、hs-CRP及SAA检测在感染性疾病诊断中的临床应用价值

【摘要】目的探讨降钙素原（procalcitionin，PCT）、超敏C-反应蛋白（highsensitive-Creactiveprotein,hs—CRP）及血清淀粉样蛋白A（serumamyloid A，SAA）检测在局部和全身细菌感染中的早期诊断价值。方法选择2013年6月至2014年6月于我院就诊的局部细菌感染者150例、全身细菌感染者120例及非感染者82例，检测受检者的血清PCT、hs—CRP、SAA、WBC、Neu％（中性粒细胞百分比）、血沉（erythrocyte sedimentationrate，ESR）水平，分析各指标在各组间的差异，并应用受试者工作特征（reeeiver operating characteristic，ROC）曲线评价各指标对感染性疾病的诊断价值。结果三组间PCT、hs—CRP、SAA、WBC、Neu％水平差异均有统计学意义（P均〈0．05），而ESR、体温差异均无统计学意义（P均〉0．05）。局部细菌感染组与全身细菌感染组的PCT、hs—CRP、SAA、WBC、Neu％水平均高于非感染组，且差异均有统计学意义（P均〈0．05），全身细菌感染组的PCT、hs—CRP、WBC、Neu％水平均高于局部细菌感染组，且差异均有统计学意义（P均〈0．05）。hs—CRP、PCT、SAA、WBC和Neu％用于诊断局部细菌感染的ROC曲线下面积依次为0．668、0．679、0．658、0．796、0．734。hs—CRP、PCT、SAA、WBC和Neu％用于诊断全身细菌感染的ROC曲线下面积分别为0．855、0．939、0．788、0．745和0．856。hs—CRP、PCT、SAA、WBC和Neu％用于鉴别局部感染与全身细菌感染的ROC曲线下面积依次为0．722、0．884、0．611、0．595、0．621，当cutoff值设为2．72ng／mL时，PCT用于鉴别诊断局部细菌感染与全身细菌感染的灵敏度为71．7％，特异性为85．9％。结论对于细菌感染PCT是一个较好的诊断指标，且能有效地鉴别局部和全身细菌感染。

Clinical application of serum PCT,hs-CRP and SAA detecting in infectious diseases diagnosis

Objective To explore the value of serum high sensitive-C reactive protein （hs-CRP）, procalcitonin （PCT） and serum amyloid-A （SAA） detecting in local and systemic bacterial infection early di- agnosis. Methods 150 cases patients with local bacterial infection, 120 cases patients with systemic bacterial infection and 82 cases un-infection patients from June 2013 to June 2014 in our hospital were collected. The levels of PCT, hs-CRP, SAA, WBC, Neu% and erythrocyte sedimentation rate （ESR） were detected and the results were analyzed statistically. The diagnosis value to infectious diseases of each index were evaluated by receiver operating characteristic（ROC） curve. Results There were statistical significance in the differences of PCT, hs-CRP, SAA, WBC and Neu% levels except ESR and body temperature among three groups （Pall〈 0.05）. The levels of PCT, hs-CRP, SAA, WBC, Neu% in local bacterial infection group and systemic bacte- rial infection group were all higher than that of un-infection group, and the differences all had statistical signif- icance （Pall〈 0.05）. The levels of PCT, hs-CRP, SAA, WBC, Neu% in systemic bacterial infection group were all higher than that of local bacterial infection group, and the differences all had statistical significance （Pall〈 0.05 ）. The area under ROC curve of hs-CRP, PCT, SAA, WBC and Neu% in diagnosis local bacterial infection were 0.668, 0.679, 0.658, 0.796, 0.734, respectively. The area under ROC curve ofhs-CRP, PCT, SAA, WBC and Neu% in diagnosis systemic bacterial infection were 0.855, 0.939, 0.788, 0.745 and 0.856, respectively. The area under ROC curve of hs-CRP, PCT, SAA, WBC and Neu% in distinguishing systemic bacterial infection and local bacterial infection were 0.722, 0.884, 0.611, 0.595, 0.621, respectively. When the cutoff value was 2.72 ng/mL, the sensitivity and specificity of PCT in distinguishing systemic bacterial in-fection and local bacterial infection were 71.7% and 85.9%, respectively. Conclusion PCT is a good marker fo