【摘要】 目的采用受试者操作特性曲线(ROC)评价C反应蛋白(CRP)对儿童外科感染的发生的预测价值。方法根据临床转归结果分组,对276名该院儿童外科患者分别逐日记录其住院期间的CRP、白细胞(WBC)水平及中性粒细胞比例(N%)进行ROC分析。结果各组患者感染比例由小到大依次为:未手术、Ⅰ类切口、Ⅱ类切口、Ⅲ类切口(P<0.01)。各组感染患者住院时间均长于无感染患者(P<0.01)。各组患者CRP、WBC拐点出现时间均在感染确诊前(P<0.01),中性粒细胞比例(N%)拐点时间与感染确诊时间无显著差异(P>0.05)。各组中感染组术后CRP的拐点值大于未感染组(P<0.01)。经ROC分析,术后CRP峰值达到32.7mg/dL以上的患儿存在较大的术后感染风险(P<0.01,预测敏感性为88.4%,特异性为94.4%)。并将ROC分析结果应用ACCESS数据库编程的方式,建立儿童术后感染的早期预测模型。结论术后CRP拐点值作为独立预测感染发生概率的指标较WBC及中性粒细胞比例有更高的敏感性和特异性,且CRP拐点出现时间早于后述两指标,使预测结果对于患者的及时救治有更积极的意义。数据编程的应用为模型的使用及大样本量数据的搜集提供了可能。更多还原

【Abstract】 Objective To evaluate the prediction of children surgery infection with C reactive protein by using ROC analysis.Methods C reactive protein (CRP),white blood cells (WBC) and neutrophils ratio (N%) were investigated daily in 276 children surgery patients during hospitalization period.ROC analysis was made basing on clinic outcomes.Results Infection incidences were lining up as non-surgery < type I incision < type II incision < type III incision (P<0.01).Hospitalization time was significantly longer in all infection groups than in correspondent non-infection groups (P<0.01),respectively.Inflection point of CRP and WBC appeared before infection was confirmed (P<0.01) in all groups,while the inflection point of N% not.The inflection point value was significantly higher in all infection groups than in correspondent non-infection groups (P<0.01),respectively.ROC analysis showed that children with CRP peak over 32.7 mg/dL after surgery had significantly higher infection risk (P<0.01,sensitivity 88.4%,specificity 94.4%).Conclusion Infection is a common complication of children surgery,and its incidence is associated with incision type.Hospitalization time will be prolonged once infection happens.It has higher sensitivity and specificity than either WBC or N% using the inflection point of CRP as an independent index of infection incidence.Moreover,as the inflection point of CRP appears earlier than both WBC and N%,children patients can be treated promptly after infection happens by using CRP to diagnose infection.更多还原