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目的探讨C反应蛋白(CRP)联合降钙素原(PCT)在鉴别系统性红斑狼疮(SLE)合并发热中的价值。方法回顾性分析65例SLE伴发热的患者,并与15例单纯感染患者对照,分为SLE并感染组(23例)、单纯SLE组(42例)及单纯感染组(15例),比较三组CRP、PCT水平、比较SLE并感染组治疗前后CRP、PCT水平,并分析SLE患者中CRP、PCT与狼疮活动指标的关系,比较CRP、PCT单独及联合检测在诊断SLE并感染的敏感性及特异性,以ROC曲线分析两者的诊断价值。结果 SLE并感染组CRP、PCT水平分别为(59.7±24.4)mg/L、(6.0±2.3)ng/L,明显高于单纯SLE组的(17.7±4.9)mg/L、(0.28±0.04)ng/L(均P<0.01);单纯感染组CRP及PCT均值分别为(63.2±15.1)mg/L、(7.8±3.1)ng/L,与SLE并感染组无统计学差异(均P>0.05),而与单纯SLE组的差异有统计学意义(P<0.01);SLE并感染组治疗后CRP、PCT分别为(9.3±3.2)mg/L、(0.16±0.07)ng/L,显著低于治疗前(均P<0.01);两SLE组CRP、PCT水平与ESR、抗ds-DNA、ANA、尿24 h蛋白定量、淋巴细胞计数及C3无明显关系(均P>0.05);两SLE组不同活动度间CRP及PCT水平无统计学差异(均P>0.05);ROC曲线分析提示CRP、PCT的AUC分别为0.79、0.90(均P<0.05);PCT的敏感性及特异性均较CRP高,但差异均无统计学意义(敏感性2=0.840,P=0.359;特异性2=0.491,P=0.483);CRP与PCT联合检测的敏感性及特异性明显高于单独检测CRP(敏感性2=3.86,P=0.049,特异性2=8.556,P=0.003),与单独检测PCT比较,敏感性无明显差异(2=1.15,P=0.284),而特异性显著提高(2=5.194,P=0.023)。结论 CRP、PCT水平在大部分合并感染的SLE患者中升高,对于鉴别狼疮活动与感染有一定价值,两者联合更可提高诊断价值。
Objective To investigate the value of C-reactive protein (CRP) combined with procalcitonin (PCT) in the differential diagnosis of systemic lupus erythematosus (SLE). Methods Sixty-five patients with SLE complicated with fever were retrospectively analyzed and compared with 15 patients with simple infection. The patients were divided into SLE group (23 cases), simple SLE group (42 cases) and simple infection group (15 cases) The levels of CRP and PCT were compared between the two groups. The levels of CRP and PCT in patients with SLE were compared before and after treatment. The relationship between CRP and PCT and the activity of lupus in SLE patients was analyzed. The sensitivity and specificity of CRP and PCT in diagnosing SLE were compared. Specificity, using ROC curve analysis of the diagnostic value of both. Results The levels of CRP and PCT in SLE group were (59.7 ± 24.4) mg / L and (6.0 ± 2.3) ng / L respectively, significantly higher than those in SLE group (17.7 ± 4.9) mg / L and (0.28 ± 0.04) (63.2 ± 15.1) mg / L and (7.8 ± 3.1) ng / L, respectively. There was no significant difference between the two groups (P> (P <0.01). The CRP and PCT in the SLE group were (9.3 ± 3.2) mg / L and (0.16 ± 0.07) ng / L, respectively, which were significantly higher than those in the simple SLE group (P <0.01). The levels of CRP and PCT in the two SLE groups were not significantly correlated with ESR, anti-dsDNA, ANA, 24 h proteinuria, lymphocyte count and C3 (all P> 0.05) There was no significant difference in CRP and PCT between SLE groups (all P> 0.05). The ROC curve analysis showed that the AUC of CRP and PCT were 0.79 and 0.90, respectively (all P <0.05). The sensitivity and specificity of PCT The sensitivity and specificity of combined detection of CRP and PCT were significantly higher than that of CRP alone (sensitivity 2 = 0.840, P = 0.359; specificity 2 = 0.491, P = 0.483) (Sensitivity 2 = 3.86, P = 0.049, specificity 2 = 8.556, P = 0.003). There was no significant difference in sensitivities compared with PCT alone (2 = 1.1 5, P = 0.284), while the specificity was significantly higher (2 = 5.194, P = 0.023). Conclusion The levels of CRP and PCT are elevated in the majority of SLE patients with combined infection, which is of value in identifying the activity and infection of lupus. The combination of the two can improve the diagnostic value.