【摘要】 目的 通过对广东地区8家三甲医院的2 459例受试对象的血清淀粉样蛋白A(SAA),超敏C反应蛋白(hs-CRP)和降钙素原(PCT)检测数据进行多中心分析,探讨联合检测三个参数在不同人群感染中的诊断效力。方法 受试对象按照年龄和感染类型分组,通过SAA和hs-CRP的年龄趋势性分析、年龄组间病毒和细菌感染组的配对t检验,通过ROC曲线和参数进行3个指标的感染判断效率分析,感染病原判断的二元Logistic-回归分析以及与细菌培养在阳性感染判断吻合性分析,确认联合诊断效力。结果 SAA和hs-CRP在低龄阶段的病毒和细菌组差异有统计学意义(P<0.001);低龄组SAA的AUC最高为0.824,敏感度71.8%,特异度82.6%,高龄组hs-CRP的AUC最高为0.806,敏感度84%,特异度65.1%;在低龄组能鉴别诊断细菌和病毒感染的准确率可达到78.8%,而高年龄组只达到65.1%;对细菌培养阳性病例的判断SAA的AUC最高为0.883,敏感度只有71.2%,但特异度达到90.7%,鉴别诊断准确率达到95.2%。结论 SAA和hs-CRP有明显的年龄趋势,SAA,hs-CRP和PCT 3个指标可单独和联合用于感染鉴别诊断,尤其是对低年龄人群有价值,SAA是单独鉴别诊断最好的指标,SAA/hs-CRP比值作为感染诊断指标的价值不大。更多还原

【Abstract】 Objective To evaluate combined effect on different population through 2 459 data of SAA,hs-CRP and PCT from8 three-level hospitals in Guangdong region.Methods Subjects were divided into five groups by ages,and every group had bacterial and virus type.In order to confirm diagnostic effect on infection,methods were performed including in tendency of SAA and hs-CRP,Paired t test between bacterial and virus group,efficiency of 3 indexes in judging infection depending on ROC and parameters,multiple logistic regression,consistency between positive bacterial infection and bacterial culture.Results There were statistically significant differences in SAA and hs-CRP between bacterial and virus in infants and children(P<0.001).SAA had the biggest AUC area 0.824 with sensibility 71.8%and specificity 82.6%in younger group.Corresponding,hs-CRP had the biggest area 0.806 with sensibility 84%.There was the accuracy of 78.8%for differential diagnosis in younger group,while 65.1%in elder group.AUC of SAA was 0.883 for positive bacterial culture with sensibility71.2%and specificity 90.7%,accuracy of 95.2%for differential diagnosi.s.Conclusion There wa.s obvious trend of age in SAA and hs-CRP.3 indexes could be used for differential diagnosis alone or combined,especially in younger group.SAA is the best index as a separated index.There is less value at ratio of SAA and hs-CRP.更多还原