血清淀粉样蛋白A、降钙素原及C-反应蛋白作为新生儿感染性肺炎辅助诊断的有效性

李磊; 陈子松; 李玲莉; 杨爱娟; 刘涛

doi:10.19428/j.cnki.sjpm.2020.19954

血清淀粉样蛋白A、降钙素原及C-反应蛋白作为新生儿感染性肺炎辅助诊断的有效性

Diagnostic value of serum amyloid A, procalcitonin and C-reactive protein for neonatal infectious pneumonia

摘要

摘要:
目的探讨血清淀粉样蛋白A(SAA)、降钙素原(PCT)和C-反应蛋白(CRP)检测在新生儿感染性肺炎诊断中的应用价值。
方法2018年6月至2019年5月，选取永康市妇幼保健院因感染性肺炎收治的74例新生儿为研究组，另选取98例同期无感染性疾病的健康新生儿为对照组。采用电化学发光和免疫比浊的方法检测研究对象血清SAA、PCT和CRP水平，应用ROC曲线得到最佳截断值，并比较几个指标的诊断效率。
结果细菌感染组SAA、PCT、CRP和SAA/CRP比值4项指标质量浓度水平均高于对照组(P < 0.01)；病毒感染组与健康对照组相比，PCT分别为0.09 mg/L和0.12 mg/L，差异无统计学意义(Z=-0.604，P=0.546)，其余3项指标差异有统计学意义(P < 0.01)。受试者工作曲线(ROC曲线)结果显示，无论在新生儿细菌感染性肺炎还是病毒感染性肺炎诊断中，SAA均有最大的曲线下面积(AUC)，AUC分别为0.971和0.858，说明在以上4项指标中诊断效率最高。根据ROC曲线确定的最佳界值，4项指标用于新生儿细菌感染性肺炎诊断时，SAA/CRP比值有最好的敏感性(97.2%)，而PCT有最好的特异性(100%)。当用于新生儿病毒感染性肺炎诊断时，SAA/CRP比值有最好的敏感性(87.5%)，CRP有最好的特异性(96.9%)。
结论SAA作为较新的感染监测标志物，可以给新生儿感染性肺炎的辅助诊断提供有用的参考信息，SAA、PCT、CRP和SAA/CRP比值4项指标各有优势，在疾病初筛时，可以使用敏感度高的SAA/CRP比值，而在疾病确证时可以联合检测特异性强的指标，临床医生可以根据需要，将多指标串联或者并联进行联合检测，更利于疾病的诊断和疗效判断，值得临床推广。

Abstract:
ObjectiveTo investigate the application value of serum amyloid A (SAA), procalcitonin (PCT) and C-reactive protein (CRP) in the diagnosis of neonatal infectious pneumonia.
MethodsA series of 74 neonates diagnosed with infectious pneumonia and 98 neonates without infection in neonatology department of Yongkang Maternity and Children′s Hospital from June 2018 to May 2019 were enrolled in this study.Their serum levels of SAA, PCT and CRP were measured by electrochemiluminescence and immunoturbidimetry.Receiver operating characteristic curve was used to predict the diagnostic efficiency of the three biomarkers.
ResultsThe levels of SAA, PCT, CRP and SAA/CRP ratio in the bacterial infection group were all higher than those in the healthy control group (P < 0.01).There was no statistically significant difference in PCT level (0.09 ng/mL vs 0.12 ng/mL) between the viral infection group and the healthy control group (Z=-0.604,P=0.546), while the levels of SAA, CRP and SAA/CRP ratio in the viral infection group were all higher than those in the healthy control group (P < 0.01).The ROC curve showed that SAA had the largest area under the curve (AUC) in the diagnosis of both bacterial and viral pneumonia in neonates (0.971 and 0.858), indicating the highest diagnostic efficiency among the four indicators.SAA/CRP ratio had the best sensitivity (97.2%) and PCT the best specificity (100%) when the four indicators were used for the diagnosis of neonatal bacterial infectious pneumonia.The SAA/CRP ratio had the best sensitivity (87.5%) and CRP the best specificity (96.9%) when used in the diagnosis of neonatal viral pneumonia.
ConclusionAs a new infection biomarker, SAA can provide useful information for the diagnosis of neonatal infectious pneumonia.SAA, PCT, CRP and SAA/CRP ratio are all useful.SAA/CRP ratio can be used for disease screening and those biomarkers with high specificity can be used for disease confirming.The combined detections can improve the sensitivity and specificity of diagnosis, which is useful for clinical promotion.

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