CAJ | 학술논문

目的：探讨血降钙素原（PCT）在糖尿病酮症酸中毒（DKA）发热鉴别诊断中的价值。方法回顾性分析厦门市第三医院2009年9月至2014年5月收治的158例DKA伴发热住院患者的临床资料，根据患者的临床症状及体征、病原学和影像学资料，将其分为细菌感染发热组（118例）和其他原因发热组（40例）。并选取同期未伴发热及感染的42例DKA患者作为对照组。分析三组患者的外周血白细胞（WBC）、C 反应蛋白（CRP）、血PCT 水平，以外周血WBC＞10×109 L-1、CRP≥10 mg/L和血PCT≥0.5 ng/mL为诊断感染的阳性阈值，根据最终临床感染诊断比较WBC、CRP和PCT在预测细菌感染发热中的价值。结果细菌感染发热组患者血PCT、CRP及WBC水平明显高于其他原因发热组及对照组，差异均有统计学意义（P＜0.05）；其他原因发热组患者血PCT、CRP水平与对照组比较，差异均无统计学意义（P＞0.05），而其他原因发热组WBC水平高于对照组，差异有统计学意义（P＜0.05）。细菌感染发热组患者血PCT、CRP及WBC阳性率均高于其他原因发热组，差异均有统计学意义（P＜0.01）。3个指标的灵敏度和阴性预测值比较，差异均无统计学意义（P＞0.05），PCT的特异度及阳性预测值明显高于其他2个指标，差异均有统计学意义（P＜0.01），且其阴性似然比大于10。PCT 的受试者特征工作曲线下面积最大（0.959），优于 WBC（0.747）和 CRP（0.925），差异均有统计学意义（P＜0.05）。结论在DKA发热的鉴别诊断中，PCT比CRP、WBC更特异，为诊断或排除感染较好的指标，更具有临床实用价值。
목적：탐토혈강개소원（PCT）재당뇨병동증산중독（DKA）발열감별진단중적개치。방법회고성분석하문시제삼의원2009년9월지2014년5월수치적158례DKA반발열주원환자적림상자료，근거환자적림상증상급체정、병원학화영상학자료，장기분위세균감염발열조（118례）화기타원인발열조（40례）。병선취동기미반발열급감염적42례DKA환자작위대조조。분석삼조환자적외주혈백세포（WBC）、C 반응단백（CRP）、혈PCT 수평，이외주혈WBC＞10×109 L-1、CRP≥10 mg/L화혈PCT≥0.5 ng/mL위진단감염적양성역치，근거최종림상감염진단비교WBC、CRP화PCT재예측세균감염발열중적개치。결과세균감염발열조환자혈PCT、CRP급WBC수평명현고우기타원인발열조급대조조，차이균유통계학의의（P＜0.05）；기타원인발열조환자혈PCT、CRP수평여대조조비교，차이균무통계학의의（P＞0.05），이기타원인발열조WBC수평고우대조조，차이유통계학의의（P＜0.05）。세균감염발열조환자혈PCT、CRP급WBC양성솔균고우기타원인발열조，차이균유통계학의의（P＜0.01）。3개지표적령민도화음성예측치비교，차이균무통계학의의（P＞0.05），PCT적특이도급양성예측치명현고우기타2개지표，차이균유통계학의의（P＜0.01），차기음성사연비대우10。PCT 적수시자특정공작곡선하면적최대（0.959），우우 WBC（0.747）화 CRP（0.925），차이균유통계학의의（P＜0.05）。결론재DKA발열적감별진단중，PCT비CRP、WBC경특이，위진단혹배제감염교호적지표，경구유림상실용개치。
Objective To evaluate the value of serum procalcitonin(PCT) for the fever differentiation diagnosis in the patients with diabetic ketoacidosis(DKA). Methods The clinical data in 158 inpatients with DKA complicating fever in the Xiamen Municipal Third Hospital from September 2009 to May 2014 were analyzed retrospectively. These inpatients were divided into the bacterial infection fever group(118 cases) and the other reasons fever group(40 cases) accorded to the clinical symptoms, signs,pathogenic and imaging data. Contemporaneous 42 DKA inpatients without fever and infection were selected as the control group. The peripheral blood white blood cell (WBC) count,C reactive protein (CRP) and serum procalcitonin (PCT) levels were analyzed in 3 groups. With peripheral blood WBC≥10×109/L,CRP≥10 mg/L and serum PCT≥0.5 ng/mL as the positive thresh-old values for diagnosing infection,the values of WBC,CRP and PCT for predicting bacterial infectious fever were compared ac-cording to the finally clinical infection diagnosis. Results Blood PCT,CRP and WBC count levels in the bacterial infection fever group were significantly higher than those in the other reasons fever group and the control group ,the differences were statistically significant(P<0.05);the PCT and CRP levels had no statistical difference between the other reasons fever group and the control group(P>0.05),but the WBC count in the other reasons fever group was significantly higher than that in the control group ,the difference was statistically significant(P<0.05). The positive rate of blood PCT and CRP,and WBC in the fever infection group was higher than that in the other reasons fever group,the differences were statistically significant(P<0.01). The sensitivity and negative predictive value had no statistical difference among 3 indicators (P>0.05). The specificity and positive predictive value of PCT were significantly higher than those in the other two indicators,the differences were statistically significant(P<0.01),moreover its negative likelihood ratio was more than 10. The area under ROC curve of PCT was maximal (0.959),which was superior to WBC (0.747) and CRP(0.925),the differences were statistically significant(P<0.05). Conclusion PCT is more specific than WBC and CRP in the differentiation diagnosis of DKA fever and is a better indicator with more clinical practical value for diagnosing and excluding infection.