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目的探讨检测血清降钙素原(PCT)水平在系统性红斑狼疮(SLE)发热患者感染与否的判断中的临床意义。方法检测48例伴有发热的SLE住院患者以及同期门诊缓解期SLE患者20例的PCT值、C反应蛋白(CRP)值、红细胞沉降率(ESR)、白细胞计数、免疫球蛋白、补体、24h尿蛋白定量、自身抗体系列、病原学检查等,比较PCT、CRP对诊断非病毒感染的敏感性、特异性,评价其在SLE患者发热的鉴别诊断中的意义。结果 PCT值在非病毒性感染(包括细菌、真菌、结核等)组为(1.95±0.67)μg/L,明显高于病毒感染组〔(0.30±0.11)μg/L,P<0.05〕、非感染组〔(0.13±0.03)μg/L,P<0.05〕及对照组PCT(0.12±0.04)μg/L,P<0.05〕;CRP值在非病毒感染组为(45.7±15.2)mg/L,明显高于病毒感染组〔(10.9±3.2)mg/L,P<0.05〕、非感染组〔(16.7±5.6)mg/L,P<0.05〕及对照组〔(2.80±0.9)mg/L,P<0.05〕;而血清PCT值在病毒感染组、非感染组及对照组之间的差异无统计学意义(P>0.05)。以PCT≥0.5μg/L为诊断非病毒感染的阳性阈值,其诊断敏感性为73.3%,特异性为93.9%;以CRP≥8mg/L为诊断非病毒感染的阳性阈值,其敏感性为86.7%,特异性为45.5%,PCT特异性明显高于CRP(P<0.05)。结论检测血清PCT对SLE患者并发非病毒性感染具有重要鉴别诊断意义。
Objective To investigate the clinical significance of detecting serum procalcitonin (PCT) level in the judgment of infection in patients with systemic lupus erythematosus (SLE) fever. Methods The PCT values, C-reactive protein (CRP) value, erythrocyte sedimentation rate (ESR), white blood cell count, immunoglobulin, complement, 24h urine in 48 patients with SLE inpatients with fever and patients with SLE in outpatients during the same period were detected. Protein quantification, autoantibodies series, etiological examination, etc. To compare the sensitivity and specificity of PCT and CRP in the diagnosis of non-viral infection and evaluate its significance in the differential diagnosis of fever in patients with SLE. Results The PCT value was (1.95 ± 0.67) μg / L in non-viral infection (including bacteria, fungi and tuberculosis), significantly higher than that in virus infection group (0.30 ± 0.11 μg / L, P <0.05) (0.13 ± 0.03) μg / L, P <0.05 in control group and PCT group (0.12 ± 0.04) μg / L in control group, P <0.05). The CRP level was (45.7 ± 15.2) mg / L (10.9 ± 3.2) mg / L, respectively (P <0.05), non-infected group (16.7 ± 5.6 mg / L, P <0.05) and the control group (2.80 ± 0.9 mg / L, P <0.05]. However, there was no significant difference in serum PCT value between virus infected group, non-infected group and control group (P> 0.05). With PCT≥0.5μg / L as the positive threshold for diagnosis of non-viral infection, the diagnostic sensitivity and specificity were 73.3% and 93.9% respectively. The sensitivity of non-viral infection with CRP≥8mg / L was 86.7 %, Specificity was 45.5%, PCT specificity was significantly higher than CRP (P <0.05). Conclusion Detection of serum PCT has important differential diagnosis in patients with SLE complicated by non-viral infection.