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目的探讨血清降钙素原(PCT)、C-反应蛋白(CRP)、白细胞(WBC)在儿童原发性肾病综合征(PNS)细菌感染中的价值。方法回顾性分析承德医学院附属医院2012年1月-2015年12月住院的PNS患儿90例,及同期于住院的非PNS患儿90例。所有对象分为4组:PNS合并细菌感染组为A组(62例),PNS合并非细菌感染组为B组(28例),非PNS合并细菌感染组为C组(60例),非PNS合并非细菌感染组为D组(30例)。分别检测各组患儿PCT、CRP、WBC的水平,并进行阳性率比较。结果 A组PCT、CRP均明显升高,高于B组,差异有统计学意义(P<0.05);A组与B组中WBC比较,差异无统计学意义(P>0.05)。而C组PCT、CRP、WBC均明显升高,高于D组,差异均有统计学意义(P<0.05)。其中A组PCT监测细菌感染的敏感性为59.7%,特异性为85.7%,其阳性预测值为和阴性预测值分别为90.2%、49.0%;CRP的敏感性为80.6%,特异性为92.9%,其阳性预测值与阴性预测值分别为96.2%、68.4%。C组中PCT水平对细菌感染的敏感性为76.7%,特异性为70.0%,阳性预测值、阴性预测值分别为83.6%和60.0%;CRP的敏感性为63.3%,特异性为83.3%,阳性预测值和阴性预测值分别为88.4%、53.2%。另外,分别在A组、C组内对PCT、CRP两种炎性指标对细菌感染的敏感性进行比较,差异均有统计学意义(P<0.05)。结论联合监测PCT、CRP、WBC可提高对于PNS细菌感染时的灵敏度,减少漏诊,对PNS早期合并细菌感染具有诊断价值,但在患儿合并细菌感染时有无PNS原发性疾病两个炎性指标的敏感性有差异。
Objective To investigate the value of serum procalcitonin (PCT), C-reactive protein (CRP) and white blood cell (WBC) in children with primary nephrotic syndrome (PNS) bacterial infection. Methods A retrospective analysis of 90 hospitalized children with PNS from January 2012 to December 2015 in the Affiliated Hospital of Chengde Medical College and 90 hospitalized non-PNS patients were retrospectively analyzed. All subjects were divided into 4 groups: group A (n = 62), group B (n = 28), group P (n = PNS), group C The group of non-bacterial infection was group D (n = 30). The levels of PCT, CRP and WBC in each group were detected, and the positive rate was compared. Results The PCT and CRP in group A were significantly higher than those in group B, the difference was statistically significant (P <0.05). There was no significant difference in WBC between group A and group B (P> 0.05). The PCT, CRP and WBC in group C were significantly higher than those in group D, the difference was statistically significant (P <0.05). The sensitivity and the specificity of PCT were 59.7% and 85.7%, respectively. The positive predictive value and negative predictive value of PCT in group A were 90.2% and 49.0% respectively. The sensitivity and specificity of CRP were 80.6% and 92.9% , The positive predictive value and negative predictive value were 96.2%, 68.4% respectively. In PCT group, the sensitivity to PCT was 76.7%, the specificity was 70.0%, the positive predictive value and negative predictive value were 83.6% and 60.0% respectively. The sensitivity and specificity of CRP were 63.3% and 83.3% The positive predictive value and negative predictive value were 88.4%, 53.2% respectively. In addition, the sensitivity of PCT and CRP to bacterial infection in group A and group C were compared respectively, with statistical significance (P <0.05). Conclusions The combined monitoring of PCT, CRP and WBC can improve the sensitivity to PNS bacterial infection and reduce the misdiagnosis, which is of diagnostic value in the early stage of PNS combined with bacterial infection. However, there are two inflammatory diseases of PNS in children with bacterial infection Sensitivity of the indicators are different.