标题：血常规、CRP、SAA联合测定在儿童细菌感染早期诊断中的应用

      作者：程健国 1，邓学灵 2，李绍媚 3    1.广宁县人民医院新生儿科，广东 肇庆 526300；2.怀集县人民医院新生儿科，广东 肇庆 526400；3.广宁县人民医院体检中心，广东 肇庆 526300

      卷次： 2020年31卷11期

      【摘要】 目的 探讨血常规、C反应蛋白(CRP)、血清淀粉样蛋白A (SAA)联合测定早期诊断儿童细菌性感染的临床价值。方法 选取2016年12月至2018年12月广宁县人民医院收治的100例细菌感染患儿作为细菌组，同期选择100例病毒感染患儿作为病毒组，另外选取100例健康儿童为对照组。所有受检者均抽取空腹外周静脉血5 mL，分离血清后待测。采用酶联免疫吸附法、免疫荧光法测定血常规中白细胞计数(WBC)、CRP、SAA水平。比较三组受检者血清CRP、SAA、WBC水平，对比CRP、SAA、WBC单独检测与联合检测诊断儿童细菌性感染的灵敏度、特异性，并分析以上 3项生化检测指标间的相关性。结果 三组受检儿童中，细菌组患儿的CRP、SAA、WBC水平[(28.78±6.45) mg/L、(128.12±21.15) mg/L、(15.23±2.12)×109/L]明显高于病毒组[(21.15±5.89) mg/L、(78.23±10.12) mg/L、(10.17±2.09)×109/L]，病毒组明显高于健康对照组[(5.23±1.02) mg/L、(21.15±4.10) mg/L、(6.12±1.08)×109/L]，差异均有统计学意义(P<0.05)；CRP、WBC及SAA三项指标单独检测的灵敏度及特异度比较差异无统计学意义(P>0.05)；而联合检测的灵敏度(88.89%)及特异度(90.00%)明显高于单项检测CRP (55.56%、50.00%)、SAA (58.89%、60.00%)、WBC(62.22%、70.00%)，差异均有统计学意义(P<0.05)；CRP与SAA水平呈正相关(r=0.421，P=0.039)，CRP与WBC水平呈正相关(r=0.329，P=0.021)，SAA与WBC水平呈显著正相关(r=0.201，P=0.010)。结论 细菌感染儿童的血清CRP、SAA、WBC表达水平依次高于病毒感染患儿和健康儿童，CRP、SAA和WBC联合检测对细菌感染的早期诊断率最高。
      【关键词】 细菌感染；儿童；血常规；C反应蛋白；淀粉样蛋白
      【中图分类号】 R729 【文献标识码】 A 【文章编号】 1003—6350（2020）11—1405—04

Value of combined determination of blood routine, C-reactive protein, and serum amyloid A in the earlydiagnosis of bacterial infections in children.
CHENG Jian-guo 1, DENG Xue-ling 2, LI Shao-mei 3. 1.Department ofNeonatology, Guangning County People's Hospital, Zhaoqing 526300, Guangdong, CHINA; 2. Department of Neonatology,HUAIJI County People's Hospital, Zhaoqing 526400, Guangdong, CHINA; 3. Physical Examination Center, GuangningCounty People's Hospital, Zhaoqing 526300, Guangdong, CHINA
【Abstract】 Objective To explore the clinical value of blood routine, C-reactive protein (CRP), and serum amy-loid A (SAA) in early diagnosis of bacterial infection in children. Methods A total of 100 children with bacterial infec-tion from Guangning County People's Hospital were selected as bacterial infection group from December 2016 to De-cember 2018, 100 children with viral infection were selected as viral infection group at the same time, and 100 healthychildren were selected as control group. All subjects were sampled 5 mL of fasting peripheral venous blood and serumwas separated for testing. The levels of white blood cell (WBC), CRP, and SAA were measured by ELISA and immuno-fluorescence. The serum CRP, SAA and WBC levels of the three groups were compared, and the sensitivity and specifici-ty of CRP, SAA and WBC in the diagnosis of bacterial infection in children were compared. The correlation among theabove three biochemical indicators was analyzed. Results Among the three groups of children, the levels of CRP,SAA, and WBC in the bacterial infection group were (28.78±6.45) mg/L, (128.12±21.15) mg/L, (15.23±2.12)×109/L, sig-nificantly higher than (21.15±5.89) mg/L, (78.23±10.12) mg/L, (10.17±2.09)×109/L in the viral infection group, and thelevels in the viral infection group were significantly higher than (5.23±1.02) mg/L, (21.15±4.10) mg/L, (6.12±1.08)×109/Lin the control group, with statistically significant differences (P<0.05). The sensitivity and specificity of CRP, WBC, andSAA showed no statistically significant difference (P>0.05), but the sensitivity (88.89%) and specificity (90.00%) of com-bined detection were significantly higher than that of single CRP (55.56% , 50.00% ), SAA (58.89% , 60.00% ), WBC(62.22%, 70.00%), with statistically significant difference (P<0.05). There was a positive correlation between CRP andSAA (r=0.421, P=0.039), CRP and WBC (r=0.329, P=0.021), SAA and WBC (r=0.201, P=0.010). Conclusion The lev-els of serum CRP, SAA, and WBC in children with bacterial infection were higher than those in children with viral infec-tion and healthy children in turn, and the combined detection of CRP, SAA and WBC had the highest early diagnosis rateof bacterial infection.
      【Key words】 Bacterial infection; Children; Blood routine; C-reactive protein; Serum amyloid protein