血清PCT和CRP对老年感染性疾病诊断价值的比较

摘要

目的 探讨血清降钙素原(PCT) 与C-反应蛋白(CRP)在老年住院患者感染性疾病中的诊断意义.方法使用VIDAS PCT Assay仪器 (法国梅里埃)定量测定125例老年住院患者和26例对照者的血清PCT水平,并采用激光散射速率法检测CRP水平,同时对患者进行病原学或血清免疫学检查明确感染类型.根据临床表现、实验室检查、病原学检测最终结果,将患者分为细菌感染组和病毒感染组,比较两组间血清PCT和CRP的检测结果.使用ROC曲线下面积评价PCT和CRP对于感染的诊断价值.结果 细菌感染组患者86例,以呼吸系统和泌尿系统感染为主,病毒感染组患者39例.细菌感染组患者的PCT水平(11.401±23.011 ng/ml)明显高于病毒感染组患者的PCT水平(2.544±8.804 ng/ml),差异有统计学意义(t=2.324,P<0.05);细菌感染组患者的CRP水平(51.812±45.858 mg/L)明显高于病毒感染组患者的CRP水平(21.843±26.165 mg/L),差异具有统计学意义(t=3.805,P<0.01).诊断价值方面,PCT和CRP的ROC曲线下面积分别为0.902和0.718(P<0.05).PCT>0.365 ng/ml的诊断灵敏度为98.8%,特异度为73.8%;CRP>10.20 mg/L的诊断灵敏度为82.6%,特异度为66.7%,说明PCT比CRP具有更高的诊断准确性.结论血清PCT在判断老年患者细菌感染方面,诊断价值优于CRP.%Objective To investigate the clinical significance of serum Procalcitonin (PCT) and CRP in the diagnosis of infectious diseases in old patients. Methods A total of 125 patients were enrolled in this study. PCT was measured by Enzyme-linked fluorescence immunoassay, CRP and pathogenic examination were tested. These patients were divided into bacterial group and vital group. And 36 hypertension old patients without infectious disease were divided as control group. Compared the PCT and CRP level between these groups,and used ROC curve to indicate value of the tests. Results The major infections in bacterial group were respiratory tract infection and urinary tract infection. The PCT levels of bacterial group (11. 401 ± 23. O11 ng/ml) was higher than the PCT levels of vital group (2. 544 ± 8. 804 ng/ml),differences were statistical significance (t=2. 324, P<0. 05). The CRP levels of bacterial group (51. 812 ± 45. 858 mg/L) was higher than the CRP levels of vital group (21. 843 ± 26. 165 mg/L),differences were statistical significance (t=3. 805, P<0. 01). The ROC Curve showed the area under PCT curve was 0. 902 and the area under CRP curve was 0. 718(P<0. 05). The study showed that PCT>0. 365ng/ml had 98. 8% sensitivity and 73. 8% specificity whereas CRP>10. 20 mg/L had 82. 6% sensitivity and 66. 7% specificity, which indicated PCT had more diagnostic value than CRP. Conclusion Elevated PCT levels in old patients can be used to differentiate between bacterial or vital infections.