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目的检测幼年特发性关节炎(JIA)血清降钙素原(PCT)改变,探讨PCT在JIA诊断中的临床意义。方法检测2011年1月至2012年12月湖北省武汉市妇女儿童医疗保健中心风湿免疫科150例JIA患儿血清PCT和C反应蛋白(CRP)值,比较PCT和CRP对诊断JIA细菌感染的敏感度、特异度、阳性预测值、阴性预测值。同时,检测PCT在JIA各种临床类型的表达情况。结果 JIA细菌感染组血清PCT与CRP值,均明显高于JIA病毒感染组、JIA活动不伴感染组及对照组,差异均有统计学意义(P均<0.05)。以PCT≥0.5μg/L及CRP≥8 mg/L为诊断细菌感染的阳性阈值,两指标敏感度分别为76.2%、85.7%,特异度分别为87.6%、51.9%,阳性预测值分别为50.0%、21.2%,阴性预测值分别为95.8%、95.4%,阳性似然比6.14、1.65,阴性似然比0.27、0.30。ROC曲线下面积:PCT为0.928,优于CRP(0.714),差异有统计学意义(u=2.19,P<0.05)。98.99%(98/99)JIA活动不伴感染组PCT值<0.5μg/L,中位数为0.2μg/L。66.7%(66/99)JIA活动不伴感染组PCT值<0.1μg/L。结论血清PCT值对JIA并发细菌感染具有重要鉴别意义,其预测感染价值优于CRP。推荐PCT值>0.5μg/L作为诊断JIA合并感染临界值。
Objective To detect the changes of serum procalcitonin (PCT) in juvenile idiopathic arthritis (JIA) and to explore the clinical significance of PCT in the diagnosis of JIA. Methods The serum PCT and C-reactive protein (CRP) values of 150 children with JIA from January 2011 to December 2012 in the Department of Rheumatology and Immunology of Women and Children’s Health Care Center in Wuhan were detected. The sensitivity of PCT and CRP to the diagnosis of JIA bacterial infection was compared Degree, specificity, positive predictive value, negative predictive value. At the same time, PCT detection in various JIA clinical types of expression. Results The serum PCT and CRP values of JIA bacterial infection group were significantly higher than those of JIA virus infection group, JIA activity was not associated with infection group and control group, the differences were statistically significant (P all <0.05). With PCT≥0.5μg / L and CRP≥8mg / L as the positive threshold for diagnosis of bacterial infection, the sensitivity of the two indexes were 76.2% and 85.7%, the specificity was 87.6% and 51.9% respectively, and the positive predictive values were 50.0 %, 21.2%, respectively. The negative predictive value was 95.8%, 95.4%, positive likelihood ratio 6.14, 1.65, negative likelihood ratio 0.27, 0.30. The area under the ROC curve: PCT was 0.928, better than CRP (0.714), the difference was statistically significant (u = 2.19, P <0.05). 98.99% (98/99) JIA activity without infection group PCT value <0.5μg / L, the median was 0.2μg / L. 66.7% (66/99) JIA activity without infection group PCT value <0.1μg / L. Conclusions The serum PCT value is of great significance for the identification of concurrent bacterial infections in JIA. The predicted value of PCT is better than that of CRP. Recommended PCT value> 0.5μg / L as diagnostic JIA co-infection threshold.