血清降钙素原水平检测对系统性红斑狼疮发热鉴别诊断的意义

目的探讨检测血清降钙素原(PCT)水平在系统性红斑狼疮(SLE)发热患者感染与否的判断中的临床意义。方法检测48例伴有发热的SLE住院患者以及同期门诊缓解期SLE患者20例的PCT值、C反应蛋白(CRP)值、红细胞沉降率(ESR)、白细胞计数、免疫球蛋白、补体、24h尿蛋白定量、自身抗体系列、病原学检查等,比较PCT、CRP对诊断非病毒感染的敏感性、特异性,评价其在SLE患者发热的鉴别诊断中的意义。结果 PCT值在非病毒性感染(包括细菌、真菌、结核等)组为(1.95±0.67)μg/L,明显高于病毒感染组〔(0.30±0.11)μg/L,P<0.05〕、非感染组〔(0.13±0.03)μg/L,P<0.05〕及对照组PCT(0.12±0.04)μg/L,P<0.05〕;CRP值在非病毒感染组为(45.7±15.2)mg/L,明显高于病毒感染组〔(10.9±3.2)mg/L,P<0.05〕、非感染组〔(16.7±5.6)mg/L,P<0.05〕及对照组〔(2.80±0.9)mg/L,P<0.05〕;而血清PCT值在病毒感染组、非感染组及对照组之间的差异无统计学意义(P>0.05)。以PCT≥0.5μg/L为诊断非病毒感染的阳性阈值,其诊断敏感性为73.3%,特异性为93.9%;以CRP≥8mg/L为诊断非病毒感染的阳性阈值,其敏感性为86.7%,特异性为45.5%,PCT特异性明显高于CRP(P<0.05)。结论检测血清PCT对SLE患者并发非病毒性感染具有重要鉴别诊断意义。

The clinical significance of detecting serum PCT level on differentiating diagnosis of the fever in the patients with SLE

Objective To assess the clinical value of detecting serum procalcitonin (PCT) level on the etiologic diagnosis of the fever in patients with systemic lupus erythematosus (SLE). Methods Forty-eight hospitalized patients with SLE complicated fever and 20 SLE patients of remission stage referred to outpatient department were enrolled in this study.The patients were divided into 4 groups:non-viral infection group (n=15) including the infections of bacteria,fungi and tuberculomyces,viral infection group (n=6),non-infection group (n=27) and control group (n=20) according to the etiology.The levels of PCT,C-reactive protein (CRP),erythrocyte sedimentation rate (ESR),white cell count (WBC),immunoglobulin,compliment,quantitation of 24h urine protein,autoimmunologic antibody series,etiology,etc.were measured in all patients.The sensitivity and specificity of PCT and CRP for diagnosing non-viral infection were compared,and the value of differentiation diagnosis for the SLE patients complicated fever was evaluated. Results The PCT level in non-viral infection group 〔(1.95±0.67) μg/L〕 was higher than that in viral infection group 〔(0.30±0.11) μg /L,P<0.05〕,in non-infection group 〔(0.13±0.03) μg /L,P<0.05〕and in control group 〔(0.12±0.04) μg /L,P<0.05〕;the CRP level in non-viral infection group 〔(45.7±15.2) mg/L〕 was also higher than that in viral infection group 〔(10.9±3.2) mg/L,P<0.05〕,in non-infection group 〔(16.7±5.6) mg /L,P<0.05〕and in control group 〔(2.8±0.9) mg /L,P<0.05〕;while there was no significant difference in serum PCT level among viral infection group,non-infection group and control group (P>0.05).If the positive threshold of diagnosing non-viral infection was defined as ≥0.5<μg /L of PCT,the sensitivity and specificity were 73.3% and 93.9%,respectively;If it was defined as ≥8mg/L of CRP,the sensitivity and specificity were 86.7% and 45.5%, respectively;The specificity of PCT for diagnosing non-viral infection was significantly higher than that of CRP (P<0.05). Conclusions Detecting serum PCT has an important value over CRP on differentiating diagnosis in SLE patients complicated fever.