血清降钙素原鉴别成人化脓性关节炎与非化脓性关节炎的价值VIP免费

*国家自然科学基金资助项目(编号:31200726)，广州市应用基础研究专项项目(编号:2013J4100101)△通信作者。E－mail:louaiju@126．com临床研究血清降钙素原鉴别成人化脓性关节炎与非化脓性关节炎的价值*王簕，娄爱菊△，郭元，李文帧，张志，杨波，尹飚，唐龙广州医科大学附属第三医院骨科(广州510150)【摘要】目的评价血清降钙素原(PCT)鉴别成人化脓性关节炎与非化脓性关节炎的价值。方法选择47例急性关节炎患者，根据细菌学培养或染色结果，分为化脓性关节炎(病例组)和非化脓性关节炎(对照组)两组，比较两组间血清PCT、超敏C反应蛋白(hs－CＲP)、白细胞计数(WBC)、中性粒细胞计数(NEU)以及红细胞沉降率(ESＲ)水平的差异。根据受试者工作特征曲线(ＲOC曲线)，比较上述指标鉴别化脓性关节炎与非化脓性关节炎的效能。结果47例患者中，病例组13例，对照组34例。病例组PCT、hs－CＲP、ESＲ水平明显高于对照组(P＜0.01)，而两组间WBC、NEU比较差异无统计学意义(P＞0.05)。PCT的ＲOC曲线下面积最大，95%CI为0.83～0.99，其次分别是hs－CＲP和ESＲ，WBC和NEU的曲线下面积差异则无统计学意义(P＞0.05)。当PCT取大于截断点值0.93ng/mL诊断为化脓性关节炎时，其灵敏度可达到100.0%，特异度可达到71.0%。结论WBC和NEU在鉴别成人化脓性关节炎与非化脓性关节炎中意义有限，hs－CＲP和ESＲ可作为初筛检测指标，PCT对鉴别化脓性关节炎有更好的应用价值。【关键词】化脓性关节炎;非化脓性关节炎;降钙素原;白细胞计数;中性粒细胞计数;超敏C反应蛋白;红细胞沉降率Significanceofserumprocalcitoninfordiscriminationbetweenadultsepticandasepticarthritis．WANGLe，LOUAi－ju，GUOYuan，LIWen－zhen，ZHANGZhi，YANGBo，YINBiao，TANGLong．DepartmentofOrthopaedics，theThirdAffiliatedHospitalofGuangzhouMedicalUniversity，Guangzhou510150，ChinaCorrespondingauthor:LOUAi－ju．E－mail:louaiju@126．com【Abstract】ObjectiveToevaluatethesignificanceofserumprocalcitonin(PCT)fordiscriminationbetweenadultsepticandasepticarthritis．MethodsForty－sevenpatientswithacutearthritiswereincluded，anddividedintotwogroupsaccordingtotheresultsofbacterialculture，septicarthritisgroup(GroupS)andasepticarthritisgroup(GroupA)．ThelevelsofPCT，highsensitivityC－reactiveprotein(hs－CＲP)，whitebloodcellcount(WBC)，neutrophilegranulocytecount(NEU)anderythrocytesedimentationrate(ESＲ)werecompared．Thereceiveroperatorcharacteristiccurve(ＲOC)wasdrawnforeachmarkertoanalyzetheirefficaciesofdiscriminationbetweensepticandasepticarthritis．ＲesultsTherewere13patientsinGroupSand34patientsinGroupAincluded．ThelevelsofPCT，hs－CＲPandESＲinGroupSweresignificantlyhigherthanthoseinGroupA(P＜0.01)，whiletherewasnosignificantdifferenceinWBCorNEU(P＞0.05)．TheareaundertheＲOCofPCTwasthelargest(95%CI0.83～0.99)，andfollowedbyhs－CＲPandESＲ．TherewasnosignificantdifferenceintheareasundertheＲOCbetweenWBCandNEU(P＞0.05)．WhenthePCTwasusedfordiagnosisofsepticarthritisaccordingtoitsleveluptothecutoffvalueof0.93ng/mL，thesensitivityandspecificitywere100.0%and71.0%，respectively．ConclusionWBCandNEUarenotabletoidentifyallpatientswithsepticarthritis．ThelevelofserumPCTisausefullaboratorymarkertohelpthecliniciansatthetimeofinitialdiag-nosisofacuteadultsepticarthritis．Inaddition，ESＲandhs－CＲPcanprovidecomplementaryevidences．【Keywords】septicarthritis;asepticarthritis;procalcitonin;whitebloodcellcount;neutrophilegranulocytecount;highsensitivityC－reactiveprotein;erythrocytesedimentationrate降钙素原(procalcitonin，PCT)是降钙素的前体，由机体内甲状腺的C细胞分泌生成。正常情况下，体内外周血中PCT的水平应该低于0.10ng/mL［1］。1993年ASSICOT等［2］发现，通过检测患儿外周血中P...