高浓度血清铁蛋白和肌红蛋白检测在军团菌肺炎患儿中的诊断价值及病情评估

摘要

目的 探讨高浓度血清铁蛋白和肌红蛋白检测在诊断儿童军团菌肺炎中的诊断价值及其浓度变化对病情的评估.方法 以本院2010年7月-2011年7月诊断为军团菌肺炎的35例患儿为试验组.选择同期诊断为链球菌肺炎患儿28例为对照组.比较2组患儿血清铁蛋白、肌红蛋白水平的差异及联合检查时对军团菌肺炎患儿诊断的敏感性、特异性以及病程中的血清浓度变化.结果 试验组患儿血清铁蛋白水平显著高于对照组(P＜0.01),试验组35例患儿中超过25％(9例)的患儿血清铁蛋白水平持续在600μg·L-1,超过正常值上限(正常值上限274 μg·L-1)2倍多,并且在病程中持续不降,患儿病情危重,病死率较高.血清肌红蛋白水平2组比较无统计学差异(P＞0.05).血清铁蛋白与肌红蛋白联合检查对儿童军团菌肺炎诊断的敏感性、特异性均显著高于该2项单独检测指标(P ＜0.05,0.01).结论 高水平血清铁蛋白可能是儿童军团菌肺炎中一项特异性升高的实验室指标,对病情评估有较高的临床指导价值,与肌红蛋白联合检测可提高对军团菌肺炎诊断的阳性率.%Objective To determine the diagnostic value and prognosis assessment of hight serum ferritin and myoglobin for children with legionella pneumonia. Methods Thirty - five cases of legionella pneumonia in the First Affiliated Hospital of Xinxiang Medical University from Jul. 2010 to Jul. 2011 were taken as the study group,28 cases of streptococcus pneumonia in the same period were taken as the control group. The concentrations of serum ferritin and myoglobin were comparatively analyzed,both the sensitivity and specificity for diagnosis legionella pneumonia by individual or joint test of serum ferritin and myoglobin were also determined in study group. The concentration change of serum ferritin in the course of disease to assess the state of an illness was observed. Results The level of serum ferritin in the study group was significantly higher than that in the control group (P<0.01). Clinical practice showed;more than 25% (9 cases) patients sustained serum ferritin concentration up to 600 μg · L-1, more than 2 times maximum normal level of human boby in the course of disease in study group,and they were critical condition,the mortality rate was higher. There was no significant difference in level of myoglobin between the 2 groups( P > 0.05). The sensitivity and specificity for diagnosis of legionella pneumonia by joint test were significantly higher than those by individual test( P < 0. 05,0. 01). Conclusions Highly concentration of serum ferritin level as a specificity diagnostic marker for legionella pneumonia has high clinical guiding value for the state of illness and prognosis. Simultaneous determination of myoglobin can improve the rate of positive diagnosis for legionella pneumonia.