临床评估及RP对儿童严重细菌感染诊断的前瞻性研究.docVIP

临床评估及CRP对儿童严重细菌感染诊断的前瞻性研宄 酆奇1赵劲松、胡旭、周武、王建国 (湖南湘潭湘鹤医院儿科 411202) 】目的釆用受试者操作特性曲线(ROC)评价C反应蛋白(CRP)、白细胞 数(WBC)、中性粒细胞数(NEU)和临床评估结果，并分析各项指标对严重细 菌感染(SBI)患儿的临床诊断价值。方法于2009年-2013年在我院及湘潭市中 心医院门诊和住院部入组有发热但无明确感染灶的患儿(年龄在1-36月)做为 研究对象，检查血常规、血培养、血CRP、尿常规和尿培养。对CRP、WBC、NEU 水平进行测定和对SBI的概率进行临床评估。使用ROC测量曲线下面积(AUC) 进行统计分析。结果112例研宄对象中有18例诊断为SBI:包括14例尿路感染， 3例肺炎，1例菌血症。而CRP、WBC、NEU的统计结果表明有相似的AUC, CRP、 WBC、NEU三个指标和临床评沾比较爲有统计学差异(P0.05)，但临床评佔的 AUC只有0.676，表明临床评估对SBI的临床诊断价值较低。结论CRP、WBC、 NEU的测定对1-36月的SBI患儿具有几乎相同的诊断价值，而CRP、WBC、NEU 的诊断价值均优于临床评估。 关键词】C反应蛋白；白细胞；中性粒细胞；严重细菌感染；SBI Prospective study of clinical scores and CRP for diagnosis of children with serious bacterial infection Abstract】 Objective To evaluate the prediction of children with serious bacterial infection(SBI) with C reactive protein (CRP), white blood cells count (WBC), neutrophilic granulocyte(NEU) and clinical scores by using ROC analysis. Methods This study examined the 1-36 months children with SBI without identi#64257;ed source of infection. To choose outpatient and inpatient hospital of children from January 2009 to May 2013 in Hospital, blood routine, blood culture, Urine routine, blood culture, CRP and clinical scores were tested.ROC analysis was made basing on patients who were diagnose with urinary tract infections. Of the 3 patients who were diagnose with pneumonia. Of the 1 patient who was diagnose with bacteremia. The CRP, WBC and NEU had similar AUC. CRP, The level of AUC in CRP, WBC and NEU group was significantly higher than that in the clinical scores group(P0.05). Conclusion The CRP, WBC and NEU had similar diagnostic value. CRP, WBC and NEU were better than the clinical scores that examined the 1-36 months children with SBI without identi#64257;ed source of infection. Key Words］ C reactive protein； blood cells count； neutrophilic granulocyte； serious bacterial infection； SBI 随着人民生活水平的提高和医疗水平的不断发展进步，儿童重症细菌感 染己显著降低，特别是在3岁以下儿童的隐匿性菌血症患者冇了明显下降。尽管 如此，3岁以下儿童的无明确感染灶的SBI仍然是医疗界的一大难题［1】：如尿路 感染、肺部感染、菌血症等，因此，许多疾病的诊断需要儿科医生的临床