多指标联合检测在291例儿童不明原因发热中的诊断价值

目的探讨白细胞（WBC）计数、乳酸脱氢酶（LDH）、C 反应蛋白（CRP）、血沉（ESR）、降钙素原（PCT）5 指标联合检测在儿童不明原因发热中的诊断价值。方法收集2010 年6 月1 日至2015 年12 月31日因发热>2 周的住院患儿，出院诊断明确者291 例。其中感染组202 例，风湿组74 例，肿瘤组15 例。收集3组患儿WBC、LDH、CRP、ESR、PCT 值，求得均值进行比较，并通过ROC 曲线分析各组单独及联合检测对儿童不明原因发热中的诊断价值。结果3 组WBC、LDH、CRP、ESR、PCT 平均值均较正常值升高。风湿组患儿血清CRP、ESR、PCT 平均值较感染组高，肿瘤组LDH、CRP 和ESR 较感染组高。根据ROC 曲线下面积（AUC），感染组诊断价值较高者是CRP（0.672）和ESR（0.697），风湿组诊断价值较高者是CRP（0.739）和ESR（0.739）和PCT（0.835），而肿瘤组诊断价值较高者为PCT（0.827）和CRP（0.711）。感染组和肿瘤组5 项指标联合检测AUC 值较单独检测升高，风湿组5 项指标联合检测AUC 值低于PCT 单独检测时AUC 值，但高于其他4 项指标单独检测。结论WBC、LDH、CRP、ESR、PCT 各指标单独检测对风湿性疾病及肿瘤性疾病的诊断有一定的价值，对感染性疾病的诊断价值有限。5 项指标联合检测对儿童不明原因发热的病因诊断价值优于单独检测。

Value of combined parameters in etiological diagnosis of fever of unknown origin in 291 children

Objective To study the value of combined measurements of WBC, lactate dehydrogenase (LDH), Creactive protein (CRP), erythrocyte sedimentation rate (ESR) and procalcitonin (PCT) in the etiological diagnosis of long-range fever in children. Methods By querying the case management system in Xiangya Hospital, 291 cases with definite diagnosis were the objects of our study. They were sorted by infection ( n= 202), rheumatism (n = 74) and tumor ( n= 15). The quantitative values of serum WBC, LDH, CRP, ESR and PCT were collected and their average values of the groups were compared. The diagnosis value of each parameter or the five parameters together were analyzed using the receiver operating characteristic (ROC) curve. Results The average levels of serum WBC,LDH, CRP, ESR and PCT were all elevated in each group. LDH elevated most in the tumor group, so did PCT in the rheumatism group. When compared with the infection group, serum levels of CRP, ESR and PCT were higher in the rheumatism group and serum levels of CRP, ESR and LDH were higher in the tumor group. According to the area under the ROC curve (AUC), CRP (0.672) and ESR (0.697) had much higher diagnostic value in identification of infection, CRP (0.739), ESR (0.739) and PCT (0.835) served better in diagnosis of rheumatism, so did PCT (0.827)and CRP (0.711) for tumor diagnosis. CRP and ESR had the highest AUC and Youden''s index in the rheumatism group. PCT showed comparatively higher AUC, sensitivity, specificity and Youden''s index in the rheumatism group and the tumor group. The five parameters together had greater significance in diagnosis of long-range fever in children since they had larger AUC in both infection group and tumor group. When considering the rheumatism group, the AUC of combined measurement was larger than that of single parameter except PCT. Conclusons Serum levels of CRP, ESR and PCT are valuable in diagnosis of rheumatism and tumor in children with fever longer than 14 days. WBC and LDH only have limited significance in differentiation of etiologies of long-range fever in children.Compared with single parameter, combined measurements have showen higher efficiency in clinical diagnosis.