| 张琳,许序云,李永琦,等.C反应蛋白、血清淀粉样蛋白 A水平检测对感染性疾病类型及病情的诊断价值[J].安徽医药,2025,29(4):783-788. |
| C反应蛋白、血清淀粉样蛋白 A水平检测对感染性疾病类型及病情的诊断价值 |
| Diagnostic value of C-reactive protein and serum amyloid A levels in the type and degree of infectious diseases |
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| DOI：10.3969/j.issn.1009-6469.2025.04.031 |
| 中文关键词: 感染性疾病 细菌感染 病毒感染 C反应蛋白 血清淀粉样蛋白 A 最，倍、5， |
| 英文关键词: Infectious diseases Bacterial infection Viral infection C-reactive protein Serum amyloid A |
| 基金项目:昆明市卫生科研项目( 2021-03-08-0010) |
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| 摘要点击次数: 238 |
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| 中文摘要: |
| 目的探究感染性疾病病人 C反应蛋白( CRP)、血清淀粉样蛋白 A(SAA)水平检测对感染类型的诊断价值及与感染程度的相关性。方法选取 2019年 1月至 2022年 12月昆明市第三人民医院门诊收治 102例急诊感染性疾病病人，依据感染类型分为细菌感染组(n=62)与病毒感染组(n=40)另选取同期健康体检者 60例作为健康对照组，均进行血清 CRP、SAA水平及血常规指标［白细胞计数、中性粒细胞百分比(NEU%)］，检测。比较各组血清 CRP、SAA水平及血常规指标，分析血清 CRP、SAA水平与血常规指标的相关性，评价血清 CRP、SAA水平与血常规指标联合诊断感染性疾病感染类型的诊断效能，比较不同病情程度病人血清 CRP、SAA水平，分析血清 CRP、SAA水平对感染性疾病病情加重的危险度及血清 CRP、SAA水平交互作用。结果细菌感染组白细胞计数、 CRP、NEU%、SAA均较病毒感染组、健康对照组高(P<0.05)。病毒感染组 SAA(65.12±9.84)mg/L、白细胞计数(10.13±2.44)×109/L均较健康对照组(7.14±3.02)mg/L、(8.25±1.43)×109/L高(P<0.05)。细菌感染组、病毒感染组病人血清 CRP、SAA水平均与白细胞计数、 NEU%呈正相关(P<0.05)。血清 CRP、SAA水平与血常规指标诊断感染性疾病感染类型的曲线下面积(AUC)及其 95%CI分别为 0.76(0.66，0.84)、0.75(0.65，0.83)、0.81(0.72，0.88)、 0.78(0.69，0.86)四者联合诊断 AUC为 0.94(0.88，0.98)，进一步对各诊断方案诊断价值比较显示，血清 CRP、SAA水平与血常规指标联合诊断 AUC大，为最优方案(P<0.05)。细菌感染病人血清 CRP、SAA水平与病情程度呈正相关关系(P<0.05)；病毒感染病人血清 SAA水平与病情程度呈正相关关系(P<0.05)血清 CRP与病情程度无关(P>0.05)。细菌感染 /病毒感染病人血清 CRP、SAA高水平时，病情加重风险是低水平的 7.31倍/1.66.76倍/2.41倍。细菌感染病人高 CRP、高 SAA之间存在交互作用， CRP、SAA同时暴露的交互效应的相对超危险度比为 1.22，归因交互效应百分比为 29.72%，交互效应指数为 1.65，二者同时存在时效应增强，联合暴露增强了细菌感染病人病情加重风险；病毒感染病人 CRP、SAA之间不存在交互作用。结论血清 CRP、SAA水平与血常规指标联合鉴别诊断感染性疾病感染类型具有较高诊断效能，且血清 CRP、SAA在细菌感染疾病病情加重中存在交互作用，高 CRP、SAA水平可显著增加病人病情加重风险。 |
| 英文摘要: |
| Objective To investigate the diagnostic value of C-reactive protein (CRP) and serum amyloid A (SAA) level tests in pa.tients with infectious diseases for the type of infection and the correlation with the degree of infection. Methods A total of 102 acute infectious disease patients admitted to the Outpatient Department of the Third People's Hospital in Kunming from January 2019 to De.cember 2022 were selected and divided into bacterial infection group (n=62) and viral infection group (n=40) according to the type of in.fection, and another 60 cases of healthy physical examination patients were selected as healthy control group during the same period,all patients were tested for serum CRP, SAA levels, and routine blood indicators [white blood cell count, neutrophil percentage(NEU%)]. The levels of serum CRP and SAA, as well as blood routine indicators, were compared among the groups. The correlation be.tween serum CRP, SAA levels and blood routine indicators was analyzed. The diagnostic efficacy of combining serum CRP, SAA levels,and blood routine indicators to diagnose the type of infectious disease infection was evaluated. The levels of serum CRP and SAA werecompared in patients with different degrees of illness. The risk of aggravation of infectious diseases and the interaction between serumCRP and SAA levels were analyzed. Results The white blood cell count, CRP, NEU% , and SAA levels in the bacterial infectiongroup were higher than those in the viral infection group and the healthy control group (P<0.05). The SAA (65.12±9.84) mg/L and white blood cell count (10.13±2.44)×109/L in the viral infection group were higher than those in the healthy control group (7.14±3.02) mg/L and (8.25±1.43)×109/L (P<0.05). The levels of serum CRP and SAA in patients with bacterial infection and viral infection were positive.ly correlated with white blood cell count and NEU% (P<0.05). The AUCs of serum CRP, SAA levels, and blood routine indicators for di.agnosing the type of infectious diseases were 0.76 (0.66, 0.84), 0.75 (0.65, 0.83), 0.81 (0.72, 0.88), and 0.78 (0.69, 0.86), respectively.The combined diagnostic AUC was 0.94 (0.88, 0.98). Further comparison of the diagnostic value of each diagnostic scheme showed thatthe combination of serum CRP, SAA levels, and blood routine indicators had the highest AUC for optimal diagnosis (P<0.05). The lev.els of serum CRP and SAA in patients with bacterial infection were positively correlated with the severity of the disease (P<0.05); The level of serum SAA in patients with viral infection was positively correlated with the severity of the disease (P<0.05), while serum CRP was not correlated with the severity of the disease (P>0.05). When the serum CRP and SAA levels of patients with bacterial infection/vi.ral infection were high, the risk of disease aggravation was 7.31 times/1.66 times and 5.76 times/2.41 times lower than that of patientswith low levels. There was an interaction between high CRP and high SAA in patients with bacterial infection. The relative excess riskratio of the interaction effect of simultaneous exposure to CRP and SAA was 1.22, the attributable interaction effect percentage was29.72%, and the interaction effect index was 1.65. When both were present, the effect was enhanced, and combined exposure increasesthe risk of exacerbation in patients with bacterial infection; There was no interaction between CRP and SAA in patients with viral infec.tion. Conclusion Serum CRP and SAA levels combined with routine blood indicators have high diagnostic efficacy in identifying thetype of infectious disease infection, and there is an interactive effect of serum CRP and SAA in the exacerbation of bacterial infections,with high CRP and SAA levels significantly increasing the risk of exacerbation. |
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