IL-6、ESR、CRP和常规生化检测用于诊断新型冠状病毒肺炎的临床价值分析

目的探讨白细胞介素-6(IL-6)、红细胞沉降率(ESR)和C反应蛋白(CRP)和常规生化指标在新型冠状病毒肺炎(COVID-19)诊断中的应用价值。方法收集2020年1-2月湖南中医药大学第一附属医院和厦门大学附属第一医院44例COVID-19确诊患者作为新冠肺炎组,30例体检健康者作为健康对照组。采集研究对象的血液标本,检测其IL-6、ESR、CRP和常规生化指标的水平,对IL-6、ESR、CRP作受试者工作特性曲线(ROC曲线),分析灵敏度和特异度,并且对IL-6、ESR、CRP和常规生化指标的结果进行综合比较。结果新冠肺炎组的IL-6水平为4.12(1.53~14.16)pg/mL,高于健康对照组,但差异无统计学意义(P>0.05);新冠肺炎组ESR和CRP的水平分别为61.50(19.75~85.00)mm/h、16.16(8.30~37.33)mg/L,显著高于健康对照组,差异有统计学意义(P<0.05)。IL-6、ESR和CRP单项检测诊断COVID-19的ROC曲线下面积(AUC)依次分别为0.577、0.872、0.905,灵敏度依次分别为38.6%、75.0%、72.7%,特异度依次分别为100.0%、96.7%、100.0%。CRP对COVID-19的诊断效能要优于ESR、IL-6,ESR对COVID-19的诊断效能要优于IL-6。而IL-6、ESR和CRP三项联合检测诊断COVID-19的AUC为0.939,灵敏度为86.4%,特异度为96.7%,要优于IL-6+ESR、IL-6+CRP、ESR+CRP两项联合检测及IL-6、ESR和CRP单项检测的诊断效能。同时40.91%的患者IL-6升高,79.55%的患者ESR升高,68.19%的患者CRP升高,93.18%的患者肌酸激酶(CK)正常,95.45%的患者肌酸激酶同工酶(CK-Mb)正常,48.00%的患者白细胞计数(WBC)正常,44.00%的患者WBC下降,64.00%的患者淋巴细胞百分率(LYMPH%)下降,52.00%的患者淋巴细胞计数(LYMPH)下降。结论IL-6、CRP和ESR三项指标联合检测的诊断效能优于IL-6、CRP、ESR单项检测和其他两项指标联合检测的诊断效能,所以IL-6、ESR和CRP对COVID-19有一定的诊断价值。

Analysis of the clinical value of IL-6,ESR,CRP and routine biochemical tests for the diagnosis of COVID-19

Objective To investigate application value of interleukin-6(IL-6),erythrocyte sedimentation rate(ESR),C reactive protein(CRP)and conventional biochemical indicators in diagnosis of the corona virus disease 19(COVID-19).Methods From January 2020 to February 2020,44 patients diagnosed with COVID-19 in the First Affiliated Hospital of Hunan University of Chinese Medicine and the First Affiliated Hospital of Xiamen University were collected as the new coronary pneumonia group,and 30 healthy subjects were used as the healthy control group.Collecting blood samples from the research subjects,check their levels of IL-6,ESR,CRP and conventional biochemical indicators,and using receiver operating characteristic curves(ROC curves),sensitivity and specificity for IL-6,ESR,CRP and comprehensively comparing the results of IL-6,ESR,CRP and conventional biochemical indicators.Results The level of IL-6 in the new coronary pneumonia group was 4.12(1.53-14.16)pg/mL higher than that in the healthy control group,but there was no statistical significance(P>0.05);The ESR and CRP levels in the new coronary pneumonia group were 61.50(19.75-85.00)mm/h,16.16(8.30-37.33)mg/L,significantly higher than the healthy control group,with statistical significance(P<0.05).The area under curve for the diagnosis of COVID-19 by IL-6,ESR,and CRP were 0.577,0.872,and 0.905,respectively,and the sensitivity were 38.6%,75.0%,and 72.7%,respectively,and the specificities were 100.0%,96.7%,and 100.0%.CRP was superior to ESR and IL-6 in diagnosis of COVID-19,and ESR was superior to IL-6 in diagnosis of COVID-19.The combined detection of IL-6,ESR and CRP for the diagnosis of COVID-19 was 0.939,the sensitivity was 86.4%,and the specificity was 96.7%,which was better than IL-6+ESR,IL-6+CRP,ESR+CRP.The diagnostic efficacy of the two combined tests of CRP and the individual tests of IL-6,ESR and CRP.At the same time,IL-6 increased in 40.91%of patients,ESR increased in 79.55%,CRP increased in 68.19%,creatine kinase(CK)was normal in 93.18%,and creatine kinase isoenzymes(CK-Mb)was normal in 95.45%.White blood cell(WBC)was normal in 48.00%of patients,but WBC in 44.00%of patients,LYMPH%in 64.00%of patients,and LYMPH in 52.00%of patients all reduced.Conclusion The diagnostic efficacy of the combined detection of IL-6,CRP and ESR is better than that of IL-6,CRP,ESR alone and the other two indicators.