【摘要】 目的:探讨血清降钙素原(PCT)在1型糖尿病(T1DM)继发感染患儿中的诊断价值。方法:选择34例T1DM患儿作为继发感染前组(n=34),其中发生院内感染的27例作为继发感染后组(n=27),另外从健康查体儿童中选择条件匹配的正常儿童40例作为正常对照组(n=40),采用免疫荧光定量法和免疫比浊法分别检测三组患儿的PCT水平及C反应蛋白(CRP)水平,并进行比较,预测PCT、CRP对T1DM患儿继发感染的敏感性、特异性等指标。结果:T1DM继发感染后组血清PCT、CRP水平中位数分别为5.9μg/L和74.6 mg/L,继发感染前组血清PCT、CRP水平中位数分别为0.5μg/L和5.3 mg/L,正常对照组儿童血清PCT、CRP水平中位数分别为0.4μg/L和4.7 mg/L,继发感染后组血清PCT、CRP水平明显升高,与继发感染前组、正常对照组比较差异均有显著统计学意义(P<0.01);抗生素药物治疗后,继发感染后组患儿血清PCT、CRP水平明显下降,与治疗前比较差异有显著统计学意义(P<0.01)。以PCT≥0.5μg/L为界,PCT诊断继发感染的敏感性为96.3%(26/27),特异性为85.3%(29/34),阳性预测值为83.9%(26/31),阴性预测值为96.6%(29/30);以CRP≥8 mg/L为界,CRP诊断继发感染的敏感性为96.3%(26/27),特异性为73.5%(25/34),阳性预测值为74.3%(26/35),阴性预测值为96.1%(25/26)。PCT特异性及阳性预测值显著高于CRP(P<0.01)。结论:PCT、CRP水平测定可用于T1DM患儿继发感染的早期诊断和指导有效治疗,且PCT比CRP具有更高的特异性,是一项灵敏度好、特异性高的具有重要临床意义的指标。更多还原

【Abstract】 Objective: To explore the diagnostic values of serum procalcitonin( PCT) level determination in children with type 1 diabetes mellitus( T1DM) combined with secondary infections. Methods: 34 children with T1DM were selected as before secondary infection group( n = 34),wherein,those with the nosocomial infections were used as after secondary infection group( n = 27). At the same time,40 matched healthy children were set as normal control group( n = 40). The levels of PCT and C-reactive protein( CRP)of the 3 groups were determined with immunofluorescence assay and immunoturbidimetry and compared. The sensitivity and specificity of PCT and CRP to thechildren with T1DM combined with secondary infections were predicted. Results: The medianserum PCT and CRP levelsof the after secondary infection group were 5.9 μ g/L and 74.6mg/L,while those of before secondary infection group and normal control group were 0.5 μ g/L and 5.3 mg/L as well as 0.4 μ g/L and 4.7 mg/L. The PCT and CRP levelsof the after secondary infection groupincreased significantly,and there were statistically significant differences between after secondary infection group and before secondary infection group as well as between after secondary infection group and normal control group( P<0.01). The levels of CRP and PCT decreased significantly after the effective antibiotic therapy of after secondary infection group,and the difference before and after the treatment was statistically significant( P<0.01). When PCT≥0.5 μ g/L,the sensitivity and the specificity of PCT in the diagnosis of secondary infectionwere 96.3%( 26/27) and 85.3%( 29/34),the positive predictive value was 83.9%( 26/31) and the negative predictive value was 96.6%( 29/30). While CRP≥8 mg/L,the diagnostic sensitivity and the specificity of CRP was 96.3%( 26/27)and 73.5%( 25/34),the positive predictive value was 74.3%( 26/35) and the negative predictive value was 96. 1%( 25/26). The specificity and positive predictive values of PCT were significantly higher than those of CRP( P < 0. 01). Conclusions: PCT and CRP level determination can both be usedin the early diagnosis of secondary infection in children with T1DM. PCT; however,PCT is more specific andsensitive than CRP,and is an important clinical index with good sensitivity and high specificity.更多还原