标题：降钙素原、D-二聚体及血小板参数对儿童细菌性肺炎的鉴别诊断价值

      作者：赵凤华，李燕妮    玉林市红十字会医院检验科，广西 玉林 537000

      卷次： 2019年30卷11期

      【摘要】 目的 探讨降钙素原(PCT)、D-二聚体(D-D)及血小板数量(PLT)，血小板分布宽度(PDW)、平均血小板体积(MPV)、大血小板比例(P-LCR)在鉴别诊断儿童细菌性肺炎中的应用价值。方法 选取2018年1~12月在玉林市红十字会医院儿科治疗的 178例肺炎患儿作为研究对象，其中A组细菌性肺炎 77例，B组非细菌性肺炎 101例，B组又分为病毒性肺炎45例(B1组)及支原体肺炎56例(B2组)。治疗前检测各组患儿的PCT、D-D、PLT、PDW、MPV和P-LCR。采用受试者工作曲线(ROC)评价PCT、D-D、PLT、MPV、P-LCR五个指标单独诊断细菌性肺炎的效能。结果 A组患儿的PCT、D-D、PLT、MPV、P-LCR水平分别为(1.316±0.847) ng/mL、(1.258±0.802) mg/L、(404.88±61.271)×109/L、(9.469±0.834) fL、(20.475±5.321)%，B1组分别为(0.396±0.251) ng/mL、(0.649±0.325) mg/L、(295.33±59.901)×109/L、(9.011±0.713) fL、(15.056±4.916)%，B2组分别为(0.368±0.248) ng/mL、(0.624±0.323) mg/L、(311.04±74.818)×109/L、(9.036±0.709) fL、(17.111±5.419)%，A组均高于B1、B2组，差异均有统计学意义(P<0.05)，而B1与B2组比较差异均无统计学意义(P>0.05)；A组、B1组、B2组患儿的PDW比较差异无统计学意义(P>0.05)；绘制ROC曲线评价相关指标对细菌性肺炎的诊断效能：PCT、D-D、PLT、MPV、P-LCR的曲线下面积(AUC)分别为：0.867、0.769、0.848、0.704、0.731，均介于0.7~0.9 (P均<0.05)，敏感度分别为0.817、0.662、0.766、0.686、0.780，特异性分别为0.890、0.823、0.802、0.614、0.584。其中PCT的AUC最大，灵敏度和特异性最高。结论 PCT、D-D、PLT、MPV、P-LCR检测对儿童细菌性肺炎的诊断有一定价值，其中PCT的诊断价值最高。
      【关键词】 儿童；细菌性肺炎；降钙素原；D-二聚体；血小板
      【中图分类号】 R725.6 【文献标识码】 A 【文章编号】 1003—6350（2019）11—1365—04

Value of procalcitonin, D-dimer, and platelet parameters in differential diagnosis of bacterial pneumonia inchildren.
ZHAO Feng-hua, LI Yan-ni. Department of Clinical Laboratory, Yulin Red Cross Society Hospital, Yulin 537000,Guangxi, CHINA
【Abstract】 Objective To investigate the value of procalcitonin (PCT), D-dimer (D-D), and platelet count(PLT), mean platelet volume (MPV), platelet-large cell ratio (P-LCR) in the differential diagnosis of bacterial pneumoniain children. Methods A total of 178 pneumonia children in Yulin Red Cross Society Hospital from January, 2018 to De-cember, 2018 were respectively reviewed and assigned into group A (bacterial pneumonia, 77 cases) and group B(non-bacterial pneumonia, 101 cases), of which group B were further divided into group B1 (viral pneumonia, 45 cases)and group B2 (mycoplasma pneumonia group, 56 cases) according to the diagnostic criteria for pathogens causing pul-monary infections. PCT, D-D, PLT, MPV, P-LCR were detected in each group of children before treatment. The receiveroperating characteristic curve (ROC) was used to evaluate the effectiveness of PCT, D-D, PLT, MPV, P-LCR in individu-al diagnosis of bacterial pneumonia. Results The levels of PCT, D-D, PLT, MPV, P-LCR were (1.316±0.847) ng/mL,(1.258±0.802) mg/L, (404.88±61.271)×109/L, (9.469±0.834) fL, (20.475±5.321)% in group A, (0.396±0.251) ng/mL,(0.649±0.325) mg/L, (295.33±59.901)×109/L, (9.011±0.713) fL, (15.056±4.916)% in group B1, (0.368±0.248) ng/mL,(0.624±0.323) mg/L, (311.04±74.818)×109/L, (9.036±0.709) fL, (17.111±5.419)% in group B2; the levels were signifi-cantly higher in group A than group B1 and group B2 (P<0.05), but showed no significant difference between groupB1 and group B2 (P>0.05). PDW showed no significant difference among group A, group B1, and group B2 (P>0.05).ROC showed that the area under the curve (AUC) of PCT, D-D, PLT, MPV, P-LCR were 0.867, 0.769, 0.848, 0.704,0.731, which were all in the rage of 0.7 to 0.9 (all P<0.05), with the sensitivity of 0.817, 0.662, 0.766, 0.686, 0.780and specificity of 0.890, 0.823, 0.802, 0.614, 0.584. PCT had the largest AUC, and the highest sensitivity and specifici-ty. Conclusion PCT, D-D, PLT, MPV, P-LCR test had certain values in the differential diagnosis of children with bacte-rial pneumonia, and PCT has the highest diagnostic value among them.
      【Key words】 Children; Bacterial pneumonia; Procalcitonin; D-dimer; Platelet