标题：血清C反应蛋白、白介素-6及降钙素原联合检测对小儿脑膜炎的诊断价值

      作者：宁沛雯 1，候茜 2    (西安市儿童医院检验科 1、输血科 2，陕西 西安 710003)

      卷次： 2018年29卷15期

      【摘要】 目的 探讨血清C反应蛋白(CRP)、白介素-6 (IL-6)及降钙素原(PCT)联合检测对小儿脑膜炎的诊断价值。方法 选取2015年5月至2017年5月间西安市儿童医院儿科已经确诊为脑膜炎的患儿122例作为研究组，其中细菌性脑膜炎及病毒性脑膜炎各61例，同时期健康体检儿童61例作为对照组。检测并比较各组受检者的血清CRP、IL-6、PCT水平，分析三者联合检测对小儿细菌性脑膜炎的诊断效能。结果 对照组、病毒性脑膜炎组及细菌性脑膜炎组受检者的血清CRP水平分别为(3.53±0.46) mg/L、(10.94±1.27) mg/L和(60.76±7.34) mg/L，PCT水平分别为(0.31±0.04) ng/mL、(0.32±0.03) ng/mL和(5.73±0.72) ng/mL，IL-6水平分别为(4.32±0.47) ng/mL、(8.74±1.05) ng/mL和(118.65±13.75) ng/mL，CRP阳性率分别为0、9.84%和78.69%，PCT阳性率分别为0、8.20%和75.41%，IL-6阳性率分别为 0、11.48%和 73.77%。与对照组比较，研究组患儿的血清CRP、IL-6水平及CRP、IL-6、PCT阳性率较高，差异均有统计学意义(P<0.05)，与病毒性脑膜炎组比较，细菌性脑膜炎组患儿的血清CRP、IL-6水平及CRP、IL-6、PCT阳性率较高，差异均有统计学意义(P<0.05)。血清CRP、PCT、IL-6联合检测的灵敏度为 96.72%，Youden指数为0.852 4，阴性预测值为96.43%，均高于各指标单独检测及两两联合检测，差异均有统计学意义(P<0.05)；血清CRP、PCT、IL-6联合检测的特异度为88.52%，阳性预测值为89.39%，与各指标单独检测及两两联合检测比较差异均无统计学意义(P>0.05)。结论 细菌性脑膜炎患儿的血清CRP、PCT、IL-6水平及阳性率较高，联合检测上述指标有助于小儿脑膜炎的诊断和鉴别诊断，且灵敏度和准确度较好。
      【关键词】 小儿；脑膜炎；C反应蛋白；白介素-6；降钙素原；诊断
      【中图分类号】 R725 【文献标识码】 A 【文章编号】 1003—6350（2018）15—2122—04

Diagnostic value of combined detection of serum C reactive protein, interleukin-6 and procalcitonin in childrenwith meningitis.
NING Pei-wen 1, HOU Qian 2. Department of Clinical Laboratory 1, Transfusion Department 2, Xi'anChildren's Hospital, Xi'an 710003, Shaanxi, CHINA
【Abstract】 Objective To analyze the diagnostic value of combined detection of serum C reactive protein(CRP), interleukin-6 (IL-6) and procalcitonin (PCT) in children with meningitis. Methods A total of 122 children diag-nosed as meningitis in Department of Pediatrics in Xi'an children's Hospital from May 2015 to May 2017 were selectedas the study group, including 61 children of bacterial meningitis and 61 children of viral meningitis. Besides, 61 healthychildren were taken as control group during the same period. The serum levels of CRP, IL-6 and PCT were detected ineach group, and the diagnostic efficacy of combined detection of them in children with bacterial meningitis was also ana-lyzed. Results The levels of serum CRP in the control group, the viral meningitis group, and the bacterial meningitisgroup were (3.53±0.46) mg/L, (10.94±1.27) mg/L and (60.76±7.34) mg/L, respectively. The levels of PCT were (0.31±0.04) ng/mL, (0.32±0.03) ng/mL and (5.73±0.72) ng/mL, respectively, and the levels of IL-6 was respectively (4.32±0.47) ng/mL, (8.74±1.05) ng/mL and (118.65±13.75) ng/mL. The positive rates of CRP were 0, 9.84% and 78.69%, re-spectively, the positive rates of PCT were 0, 8.20% and 75.41% , respectively, and the positive rates of IL-6 were 0,11.48% and 73.77%, respectively. Compared with the control group, the serum levels of CRP, IL-6 and the positive ratesof CRP, IL-6, PCT in the study group were significantly higher (P<0.05). Compared with the viral meningitis group, theserum levels of CRP, IL-6 and the positive rates of CRP, IL-6, PCT in the bacterial meningitis group were higher, the dif-ferences were all statistically significant (P<0.05). Compared with the control group, the serum level of PCT in the bacteri-al meningitis group was significantly higher (P<0.05). The sensitivity, Youden index, and negative predictive value of com-bined detection of serum CRP, PCT and IL-6 was 96.72%, 0.852 4, 96.43%, which were significantly higher than those ofsingle detection and combined detection of two indexes (P<0.05). The specificity and positive predictive value of com-bined detection of serum CRP, PCT and IL-6 was 88.52% and 89.39%, which showed no statistically significant differ-ence with those of single detection and combined detection of two indexes (P>0.05). Conclusion The levels and positiverates of serum CRP, PCT, IL-6 are high in children with bacterial meningitis, and the combined detection of the abovemarkers is helpful for the diagnosis and differential diagnosis of meningitis in children, with high sensitivity and accuracy.
      【Key words】 Children; Meningitis; C reactive protein; Interleukin-6; Procalcitonin; Diagnosis·论 著·doi:10.3969/j.issn.1003-6350.2018.15.015