CAJ | 학술논문

目的：评价血清降钙素原（PCT ）检测对成人斯蒂尔病（AOSD）细菌感染和非感染性发热的鉴别作用。方法采用前瞻性、临床病例观察方法，筛选符合全身性炎症反应综合征（SIRS）的患者，入院24 h内测定血清PCT、白细胞介素‐6（IL‐6）、C反应蛋白（CRP）、血清铁蛋白（SF）水平和白细胞（WBC）计数，将最后确诊AOSD活动或AOSD细菌感染的患者纳入研究，通过受试者工作特征（ROC）曲线及曲线下面积（AUC）评估PCT对鉴别AOSD细菌感染的准确性、敏感性和特异性。结果2010年4月至2014年4月符合入选条件的AOSD细菌感染患者（感染组）共9例，AOSD活动非感染患者（非感染组）共22例。感染组血清PCT水平[6.20（4.23，14.16）ng／mL]明显高于非感染组[0.59（0.46，0.68）ng／mL ，P＝0.001）]，而IL‐6[（979±451）ng／L]、CRP[（110±28） mg／L]略高于非感染组[（729±240）ng／L ，P＝0.740；（86±28）mg／L]；感染组的SF[（2381±1774）ng／mL]、WBC[（19.0±2.8）×109／L]与非感染组[（2312±1817）ng／mL ，（17.6±3.4）×109／L]相近。所有炎症指标中，PCT的截断点界值为1.11 ng／mL时，对AOSD感染的敏感性（100％）和特异性（95.5％）最高。与IL‐6、CRP等相比较，PCT对AOSD感染的辨别力最佳（AUC为1.000），PCT对AOSD患者细菌感染的预测能力最强；CRP的AUC为0.730，IL‐6的AUC为0.702，预测能力次之；WBC为0.609，预测能力较差；SF为0.566，预测能力最差。结论与IL‐6、CRP和WBC、SF相比较，PCT水平升高对AOSD细菌感染和非感染性发热有更好的鉴别作用。
목적：평개혈청강개소원（PCT ）검측대성인사체이병（AOSD）세균감염화비감염성발열적감별작용。방법채용전첨성、림상병례관찰방법，사선부합전신성염증반응종합정（SIRS）적환자，입원24 h내측정혈청PCT、백세포개소‐6（IL‐6）、C반응단백（CRP）、혈청철단백（SF）수평화백세포（WBC）계수，장최후학진AOSD활동혹AOSD세균감염적환자납입연구，통과수시자공작특정（ROC）곡선급곡선하면적（AUC）평고PCT대감별AOSD세균감염적준학성、민감성화특이성。결과2010년4월지2014년4월부합입선조건적AOSD세균감염환자（감염조）공9례，AOSD활동비감염환자（비감염조）공22례。감염조혈청PCT수평[6.20（4.23，14.16）ng／mL]명현고우비감염조[0.59（0.46，0.68）ng／mL ，P＝0.001）]，이IL‐6[（979±451）ng／L]、CRP[（110±28） mg／L]략고우비감염조[（729±240）ng／L ，P＝0.740；（86±28）mg／L]；감염조적SF[（2381±1774）ng／mL]、WBC[（19.0±2.8）×109／L]여비감염조[（2312±1817）ng／mL ，（17.6±3.4）×109／L]상근。소유염증지표중，PCT적절단점계치위1.11 ng／mL시，대AOSD감염적민감성（100％）화특이성（95.5％）최고。여IL‐6、CRP등상비교，PCT대AOSD감염적변별력최가（AUC위1.000），PCT대AOSD환자세균감염적예측능력최강；CRP적AUC위0.730，IL‐6적AUC위0.702，예측능력차지；WBC위0.609，예측능력교차；SF위0.566，예측능력최차。결론여IL‐6、CRP화WBC、SF상비교，PCT수평승고대AOSD세균감염화비감염성발열유경호적감별작용。
Objective To examine whether serum procalcitonin (PCT) concentrations are useful for distinguishing bacterial infections from disease flares in patients with active adult‐onset Still's disease (AOSD) .Methods Prospective , observational cohort study was conducted including patients with systemic inflammatory response syndrome (SIRS)who were admitted to our hospital .Serum PCT levels were measured with interleukin 6(IL‐6) ,C‐reactive protein (CRP) , white blood cell count (WBC) and serum ferritin (SF) in 31 inpatients with a diagnosis of AOSD .After careful microbio‐logic screening ,an infectious bacterial complication was diagnosed in 9 cases (Group A) while no obvious infection was demonstrated in 22 patients (Group B) .The diagnostic accuracy ,sensitivity ,and specificity for identifying a bacterial in‐fection were estimated using the receiver operating characteristic (ROC)curve .Results Serum PCT levels were higher in the bacterial infection group than those in the disease flare group [6 .20(4 .23 ,14 .16)ng/mL] vs [0 .59(0 .46 , 0.68) ng/mL ,P=0 .001];whereas the differences for IL‐6 ,CRP ,WBC and SF did not reach statistical signifi‐cance .In differentiating patients with bacterial infection from those with disease flare ,the AUC of the ROC curve for PCT ,IL‐6 ,CRP ,WBC and SF was 1 .000 ,0 .702 ,0.730 ,0 .609 ,0 .566 ,respectively .The best PCT cut‐off value was estimated to be 1 .11 ng/mL .The sensitivity and specificity of the best cut‐off value were 100% and 95.5% ,respectively .PCT ≥1 .11 ng/mL was significant for identifying bacterial infection .Conclusion In com‐parison with IL‐6 ,CRP ,WBC and SF ,the elevated serum PCT levels have a good specificity for diagnosing bacte‐rial infection from disease flares in febrile patients with AOSD .