降钙素原对儿童急性肾盂肾炎的诊断价值

Role of procalcitonin in the diagnosis of acute pyelonephritis in children

摘要:

目的：探讨降钙素原（PCT）对儿童急性肾盂肾炎（APN）的诊断价值。方法：回顾性分析2011年9月至2012年2月诊断为初发的尿路感染（UTI）且年龄<3岁患儿的病例资料，以核素肾静态扫描（99mTc-DMSA）结果作为诊断APN的金标准，比较上尿路感染（APN）及下尿路感染（非APN）患儿血清PCT、CRP的水平，并绘制二者诊断APN的受试者工作特征曲线（ROC曲线），判断其诊断性能。结果：共65例UTI患儿纳入研究，其中APN 39例，下尿路感染者26例，前者的血清PCT、CRP水平显著高于后者（分别 3.08 ng/mL vs 0.37 ng/mL；6.25 mg/L vs 3.01 mg/L；均P<0.01）。血清PCT诊断APN的敏感性为84.6%，特异性为88.5%，曲线下面积为0.873（95%可信区间为0.781~0.965），最佳阈值为1.03 ng/mL；血清CRP诊断APN的敏感性为71.8%，特异性为69.2%，曲线下面积为0.735（95%可信区间为0.612~0.858），最佳阈值为3.91 mg/L。结论：PCT对儿童APN的诊断具有较高的敏感性及特异性，有助于临床对APN的早期识别。

Abstract:

OBJECTIVE: To study the role of procalcitonin (PCT) in the diagnosis of acute pyelonephritis (APN) in children. METHODS: Retrospective analysis was performed on the clinical records of children aged under 3 years who were diagnosed with primary urinary tract infection (UTI) from September 2011 to February 2012. These children were divided into those with upper UTI (UUTI) (APN) and those with lower UTI (LUTI) (non-APN) based on 99mTc-dimercaptosuccinic acid (DMSA) renal scan results as a gold standard. The UUTI and LUTI groups were compared in terms of serum levels of PCT and C-reactive protein (CRP). Receiver operating characteristic (ROC) curves were drawn to evaluate the diagnostic values of serum PCT and CRP. RESULTS: Sixty-five children with UTI, including 39 cases of APN and 26 cases of LUTI, were included in this study. The APN cases had significantly higher serum levels of PCT (3.08 ng/mL vs 0.37 ng/Ml; P<0.01) and CRP (6.25 mg/L vs 3.01 mg/L; P<0.01) than the LUTI cases. The sensitivity and specificity of serum PCT level for APN were 84.6% and 88.5%, respectively, with an area under the ROC curve (AUC) of 0.873 (95%CI=0.781-0.965) and an optimal threshold point of 1.03 ng/mL. The sensitivity and specificity of serum CRP level for APN were 71.8% and 69.2%, respectively, with an AUC of 0.735 (95%CI=0.612-0.858) and an optimal threshold point of 3.91 mg/L. CONCLUSIONS: As a result of its high sensitivity and specificity for the disease, serum PCT can be used as a marker in the early diagnosis of APN in children.