儿童无明显感染灶急性发热常用检验指标应用的诊断分析
Commonly used test indicators for children with acutefever without obvious focus of infections
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摘要: 目的 研究儿童急性发热无明显感染灶运用常用检验指标进行诊断的临床价值,为临床诊断提供理论依据。方法 选择2013年5月-2015年5月医院诊治456例未见明显感染灶以及病态的急性发热住院患儿临床资料,根据最终诊断研究C-反应蛋白(CRP)、血白细胞计数(WBC)、降钙素原(PCT)及中性粒细胞百分比的诊断价值。结果 456例患儿中84例患有严重疾病,其PCT和CRP水平均比非严重疾病患儿高,差异有统计学意义(P<0.01);CRP诊断截点为67.1 mg/L时,对严重疾病诊断的灵敏度为0.810,特异度为0.715;PCT诊断截点为0.505 μg/L,灵敏度为0.762,特异度为0.672;联合两者的特异度达到了0.918,灵敏度为0.617;64例患儿为病毒感染,80例患儿为细菌感染,30例患儿为支原体属感染,根据感染类型不同,患儿之间CRP、PCT、WBC及中性粒细胞百分比的差异有统计学意义(P<0.01);当对细菌和病毒感染进行鉴别时,对于CRP诊断截点为38 mg/L,灵敏度为0.900,特异度为0.813;PCT诊断截点为0.450 μg/L,灵敏度为0.700,特异度为0.812;假如两者结合,特异度为0.965,敏感度为0.630,当对支原体与细菌感染进行鉴别时,CRP的诊断截点为80.75 mg/L,灵敏度为0.700,特异度为0.933。结论 对于无明显感染灶及病态的急性发热患儿,运用CRP及PCT鉴别<5岁患儿病情的严重度及病原学具有一定的帮助,而且两者联合应用的特异性更佳。Abstract: OBJECTIVE To study the clinical diagnostic value of common indices for detection of children with acute fever without obvious focus of infections,so as to provide theoretical value for clinical diagnosis.METHODS A total of 456 cases of children’clinical data were selected,who had acute fever but without obvious focus of infections in our hospital from May 2013 to May 2015.Contribution rate of C-reactive protein(CRP),white blood cell count(WBC),procalcitonin(PCT)and the neutrophile granulocyte were used for analysis of diagnosis.RESULTS From the 456 children,84cases with serious illness,the PCT and CRP levels were significantly higher than children with non-severe disease(P<0.01).CRP diagnostic cut-off point of 67.1mg/L,the sensitivity for the diagnosis of serious disease was 0.810,specificity 0.715;PCT diagnostic cut-off point 0.505μg/L,sensitivity was0.762 and specificity was 0.672.Specificity reached 0.918 when both joint,sensitivity 0.617.A total of 64 patients got infected with the virus and 80 cases of children with bacterial infections,30 cases with mycoplasma infections.According to the different types of infections,CRP among children,PCT,WBC and the percentage of neutrophils were significant different(P<0.01).When bacterial and viral infections were identified,the diagnostic cut-off point for CRP was 38 mg/L,the sensitivity was 0.900,specificity 0.813;PCT diagnostic cut-off point0.450μg/L,the sensitivity 0.700,specificity 0.812.If combine the two,the specificity was 0.965,sensitivity0.630.When mycoplasma and bacterial infections were identified,CRP diagnostic cut-off point 80.75mg/L,the sensitivity 0.700,specificity 0.933.CONCLUSION About children with no obvious focus of infections and acute fever,CRP and PCT could help to detect disease severity and etiology for children no more than 5years old,and their combination is more specific.
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