血清PCT检测在小儿急性细菌性脑膜炎及病毒性脑炎鉴别诊断中的应用

摘要

Objective To observe and analyze the application ,sensitivity and specificity of serum procalcitonin (PCT ) in the dif‐ferential diagnosis of child acute bacterial meningitis and viral meningitis .Methods One hundred and sixty‐four children patients with bacterial meningitis ,98 children patients with viral meningitis and 60 healthy children were selected as the research subjects . The serum PCT ,white blood cell (WBC) count ,erythrocyte sedimentation rate (ESR) and C‐reactive protein (CRP) levels were detected by using electrochemical luminescence immunity assay .The laboratory detection results ,PCT detection results distribu‐tion ,sensitivity and specificity in the two groups were analyzed .Results The PCT ,CRP and WBC detection results in children pa‐tients with bacterial meningitis were higher than those in children patients with viral meningitis .The positive rates of PCT and WBC in the bacterial meningitis group were higher than those in the viral meningitis group ,while the constituent ratio of PCT detection distribution had statistically significant difference between the two groups(χ2 = 16 .151 ,P< 0 .01) .The sensitivity of PCT detection in differentially diagnosing viral meningitis was 97 .6% (160/164) ,the specificity was 95 .0% (57/60) and the misdiagnosis rate was 3 .1% (7/224) .The sensitivity of PCT detection in differentially diagnosing bacterial meningitis was 98 .0% (96/98) ,the specificity was 96 .7% (58/60) and the misdiagnosis rate was 2 .5% (4/158) .Conclusion The serum PCT as a differential diagnosis index of child acute bacterial meningitis and viral meningitis has good accuracy ,its combination with CRP ,WBC ,ESR in combined differenti‐al diagnosis can rapidly give accurate pathogenic diagnosis in the early stage ,thus increases the pertinence of clinical treatment ,re‐duces the occurrence of antibiotics abuse and is ,worthy of clinical popularization and application .%目的：观察分析血清降钙素原（PCT ）在小儿急性细菌性脑膜炎与病毒性脑膜炎鉴别诊断中的应用及其灵敏度与特异度。方法选取164例细菌性脑膜炎患儿与98例病毒性脑膜炎患儿及60例健康体检儿为研究对象，采用电化学发光免疫检测血清 PCT 、白细胞计数（WBC）、红细胞沉降率（ESR）及 C 反应蛋白（CRP），分析两组患者实验室检查结果、PCT 检测结果分布、灵敏度及特异度。结果细菌性脑膜炎患儿的 PCT 、CRP 、WBC 检查结果均高于病毒性脑膜炎患儿。而阳性率比较细菌组PCT 、WBC 阳性率高于对病毒性脑膜炎组，两组 PCT 检查分布构成比较有显著差异（χ2＝16．151，P＜0．01）。 PCT 检查鉴别诊断病毒性脑膜炎的灵敏度为97．6％（160／164），特异度为95．0％（57／60），误诊率为3．1％（7／224）。 PCT 检查鉴别诊断细菌性脑膜炎的灵敏度为98．0％（96／98），特异度为96．7％（58／60），误诊率为2．5％（4／158）。结论血清 PCT 作为小儿急性细菌性脑膜炎与病毒性脑膜炎的鉴别诊断指标准确性良好，结合 CRP 、WBC 、ESR 等联合鉴别诊断能够在早期快速给予准确的病原体诊断，从而提高临床治疗的针对性，减少抗菌药物滥用情况的发生，值得临床推广应用。