CAJ | 학술논문

目的探讨血清降钙素原在鉴别慢性痛风性关节炎患者发热原因的价值.方法收集2011年12月至2013年12月在四川省人民医院风湿免疫科住院的原发性慢性痛风急性发作患者,共130例.其中100例为慢性痛风急性发作伴发热,包括非感染组68例、细菌感染组30例(排除2例多器官衰竭死亡患者).细菌感染组包括肺部感染6例、关节感染3例及皮肤软组织感染21例,排除因重症全身性感染而死亡2例.还有30例为慢性痛风急性发作无发热及感染.比较3组患者降钙素原(PCT)、红细胞沉降率(ESR)、C反应蛋白(CRP)、白细胞计数及中性粒细胞率.结果发热非感染组PCT≥0.5×103 ng/L者39例,占57.3％,发热伴细菌感染组PCT≥0.5×103 ng/L者20例,占66.7％,两者比较差异无统计学意义(P＞0.05).无发热组PCT≥0.5 ×103 ng/L者5例,占16.7％,与前两组比较差异均有统计学意义(均P＜0.05).发热两组间的ESR、CRP、白细胞计数及中性粒细胞率差异均无统计学意义(均P＞0.05).在慢性痛风伴发热患者中,PCT鉴别细菌感染的灵敏度是33.9％,特异度是74.4％,阳性预测值为36.9％,阴性预测值为71.9％.PCT、CRP、ESR、白细胞计数及中性粒细胞率的受试者工作特征曲线下面积值分别为0.598、0.636、0.612、0.596及0.727.结论在慢性痛风急性发作伴发热的患者中,PCT可能不是一个有效地鉴别细菌感染与非感染性发热的指标,还需大量的研究进一步评估其鉴别作用.
목적 탐토혈청강개소원재감별만성통풍성관절염환자발열원인적개치.방법 수집2011년12월지2013년12월재사천성인민의원풍습면역과주원적원발성만성통풍급성발작환자,공130례.기중100례위만성통풍급성발작반발열,포괄비감염조68례、세균감염조30례(배제2례다기관쇠갈사망환자).세균감염조포괄폐부감염6례、관절감염3례급피부연조직감염21례,배제인중증전신성감염이사망2례.환유30례위만성통풍급성발작무발열급감염.비교3조환자강개소원(PCT)、홍세포침강솔(ESR)、C반응단백(CRP)、백세포계수급중성립세포솔.결과 발열비감염조PCT≥0.5×103 ng/L자39례,점57.3％,발열반세균감염조PCT≥0.5×103 ng/L자20례,점66.7％,량자비교차이무통계학의의(P＞0.05).무발열조PCT≥0.5 ×103 ng/L자5례,점16.7％,여전량조비교차이균유통계학의의(균P＜0.05).발열량조간적ESR、CRP、백세포계수급중성립세포솔차이균무통계학의의(균P＞0.05).재만성통풍반발열환자중,PCT감별세균감염적령민도시33.9％,특이도시74.4％,양성예측치위36.9％,음성예측치위71.9％.PCT、CRP、ESR、백세포계수급중성립세포솔적수시자공작특정곡선하면적치분별위0.598、0.636、0.612、0.596급0.727.결론 재만성통풍급성발작반발열적환자중,PCT가능불시일개유효지감별세균감염여비감염성발열적지표,환수대량적연구진일보평고기감별작용.
Objective We assessed serum procalcitonin (PCT) levels to distinguish bacterial infections from non-bacterial infections in patients with fever and flare of chronic gouty arthritis.Methods One hundred febrile patients with chronic tophaceous gout flare-ups were collected consecutively between November 2011 and January 2014 from the Department of Rheumatology and Immunology,Sichuan Provincial People's Hospital.These patients were divided into non-infectious febrile group (68 patients) and bacterial infectious febrile group (32 paticnts,including 6 cases of pulmonary infection,3 cases of infectious arthritis and 21 cases of skin infection,2 patients died from severe infection were excluded),and 30 patients with flare of chronic gouty arthritis without fever and infection.Serum PCT,erythrocyte sedimentation rate (ESR),C-reactive protein (CRP),white blood cell (WBC) count and neutrophil ratio were determined.Results 57.3％ (39/68) patients in the non-infectious febrile group had PCT levels≥0.5 × 103 ng/L and the ratio in the infectious febrile group was 66.7％ (20/30).No statistically significant difference was detected between them (P ＞0.05).16.7％ (5/30) patients had PCT levels≥0.5 × 103 ng/L in the afebrile group and both the differences between the afebrile group and the two febrile groups were significant (P ＜ 0.05).The differences of ESR,CRP,WBC count and neutrophil ratio between the two febrile groups were not statistically significant (P ＞ 0.05).In the chronic gouty arthritis patients with fever,the sensitivity and specificity of high PCT level (≥0.5 × 103 ng/L) for detection of bacterial infections was 33.9％ and 74.4％,the positive predictive value was 36.9％ and the negative predictive value was 71.9％.The area under the curve (AUC) of PCT,CRP,ESR,WBC count and neutrophil ratio in patients with fever and chronic gouty arthritis was 0.598,0.636,0.612,0.596 and 0.727,respectively.Conclusions Serum PCT levels may be not a good marker for detection of bacterial infections in the patients with fever and flare of chronic gouty arthritis.Larger studies are needed to evaluate the value of PCT measurement in the patients with fever and flare of chronic gouty arthritis.