血清降钙素原在鉴别小儿不典型化脓性脑膜炎和病毒性脑炎的作用

目的 对比血清降钙素原(PCT)、C反应蛋白(CRP)、白细胞数(WBC)在鉴别不典型化脓性脑膜炎和病毒性脑炎中的价值.方法 把研究对象分为3组,分别为病毒性脑炎组(viral encephalitis)、不典型化脓性脑膜炎组(atypical bacterial meningitis)和典型化脓性脑膜炎组(typical bacterial meningitis),另选20名性别年龄匹配的正常儿童作为正常对照组(normal control group),分别测PCT值、CRP值和WBC值,各组指标比较应用独立样本t检验及卡方检验,并应用ROC曲线比较三者在鉴别病毒性脑炎和不典型化脓性脑膜炎的敏感性和特异性.结果 血清PCT在不典型化脓性脑膜炎、化脓性脑膜炎组与病毒性脑膜炎组、正常对照组之间差异有统计学意义;血清CRP在病毒性脑炎与化脓性脑膜炎之间差异有统计学意义,但在不典型化脓性脑膜炎与病毒性脑膜炎组之间差异无统计学意义;血清WBC在病毒性脑炎组和不典型化脓性脑膜炎组之间差异无统计学意义,但在典型化脓性脑膜炎组与病毒性脑膜炎组差异有统计学意义.不典型化脓性脑膜炎组与病毒性脑炎组中,PCT对不典型化脓性脑膜炎诊断的ROC曲线下面积93.9%,大于WBC和CRP.结论 不典型化脓性脑膜炎时,PCT升高,病毒性脑炎时PCT升高不明显.PCT在鉴别不典型化脓性脑膜炎和病毒性脑炎时有一定临床应用价值.

Value of serum procalcitonin in differential diagnosis of atypical bacterial meningitis and viral encephalitis in children

Objective To investigate the clinical value of serum procalcitonin(PCT)in differential diagnosis of atypical bacterial meningitis and viral encephalitis in children.Methods The children were divided into four groups:atypical bacterial meningitis group,viral encephalitis group,typical bacterial meningitis group and normal control group.The levels of PCT,CRP and WBC in serum were detected,and compared withχ2-test and one-way analysis of variance.The predictive abilities regarding atypical bacterial meningitis of PCT,CRP,and WBC were expressed as the area under the receiver operating characteristics curve(AUC-ROC).Results Atypical and typical bacterial meningitis groups were significantly different from control and viral encephalitis groups in PCT levels(P<0.05).There was no significant difference in PCT levels between viral encephalitis group and control group(P>0.05).The area under ROC for PCT diagnosis of atypical bacterial meningitis was 0.939,which was greater than WBC and CRP.Conclusion In atypical bacterial meningitis,PCT levels increase.Serum PCT levels have some clinical value in identifying atypical bacterial meningitis and its evolution.