NLR、SAA、hs-CRP对儿童1型糖尿病合并感染的诊断价值-现代医学

NLR、SAA、hs-CRP对儿童1型糖尿病合并感染的诊断价值

单位：中南大学湘雅医学院附属海口医院检验科, 海南海口 570208

关键词：1型糖尿病儿童感染中性粒细胞与淋巴细胞比值血清淀粉样蛋白A 超敏C反应蛋白诊断

分类号：R725.8;R446.1

出版年·卷·期（页码）：2020·39·第四期（427-432）

摘要：

目的：探讨中性粒细胞与淋巴细胞比值（NLR）、血清淀粉样蛋白A（SAA）和超敏C反应蛋白（hs-CRP）对儿童1型糖尿病合并感染的诊断价值。方法：选取2014年4月至2016年10月本院诊治的173例1型糖尿病患儿为研究对象，其中糖尿病合并细菌感染55例，合并病毒感染57例，未合并感染61例；以同期体检60例健康儿童作为对照，检测所有受试者外周血NLR及血清SAA、hs-CRP水平，采用受试者工作曲线（ROC）分析各指标对儿童1型糖尿病合并感染的诊断价值。结果：糖尿病患者未合并感染、合并细菌感染和合并病毒感染组血糖水平均高于对照组（P<0.05）；糖尿病组NLR、SAA、hs-CRP水平均明显高于对照组（P<0.05）；糖尿病合并细菌感染和合并病毒感染组NLR、SAA水平均明显高于糖尿病未合并感染组（P<0.05），且糖尿病合并细菌感染组hs-CRP水平明显高于糖尿病未合并感染组（P<0.05），糖尿病合并病毒感染组NLR和SAA水平明显高于糖尿病合并细菌感染组（P<0.05），hs-CRP水平明显低于糖尿病合并细菌感染组（P<0.05）。单项诊断糖尿病合并细菌感染时，三项指标中NLR的ROC曲线下面积（AUC）和灵敏度均最大或最高；单项诊断糖尿病合并病毒感染时，三项指标中NLR的AUC 和特异度均最大，SAA的灵敏度最高；与糖尿病合并细菌感染组相比，单项诊断糖尿病合并病毒感染时NLR和SAA的AUC均增大，SAA的灵敏度提高，而hs-CRP诊断时的AUC和灵敏度均减小或降低；与各指标单项诊断相比，NLR、SAA和hs-CRP三者联合诊断糖尿病合并细菌感染与合并病毒感染的AUC和灵敏度均增大或增高，但诊断糖尿病合并细菌感染时特异度降低；与糖尿病合并细菌感染相比，三者联合诊断糖尿病合并病毒感染的AUC和特异度均增大或增高，但灵敏度有所下降。结论：联合检测NLR、SAA、hs-CRP对儿童1型糖尿病合并感染的诊断具有重要价值，且联合诊断儿童1型糖尿病合并病毒感染的灵敏度优于联合诊断儿童1型糖尿病合并细菌感染的灵敏度。

Objective: To investigate the diagnostic values of netrophil-to-lymphocyte ratio (NLR), serum amyloid protein A (SAA) and hypersensitive C-reactive protein (hs-CRP) in children with type 1 diabetes mellitus complicated with infection. Methods: From April 2014 to October 2016,173 children with type 1 diabetes mellitus who were admitted to our hospital were selected as the subjects of study, including 55 cases of diabetes mellitus complicated with bacterial infection, 57 cases of complicated with viral infection and 61 cases of non-infection. 60 healthy children in the same period were used as control. All subjects were tested for NLR in peripheral blood, serum SAA and hs-CRP indicators. Receiver operating curve (ROC) was used to analyze the diagnostic value of each index in children with type 1 diabetes mellitus complicated with infection.Results: The blood glucose level in the group of uninfected, bacterial infection and viral infection of diabetic patients was higher than that in the control group (P<0.05); the levels of NLR, SAA and hs-CRP in diabetic group were significantly higher than those in control group (P<0.05); the levels of NLR and SAA in diabetes mellitus with bacterial infection and virus infection were significantly higher than those in diabetes mellitus without infection (P<0.05), and the level of hs-CRP in diabetic patients with bacterial infection was significantly higher than that in uninfected diabetic patients (P<0.05), the levels of NLR and SAA in diabetic patients with viral infection were significantly higher than those in diabetic patients with bacterial infection (P<0.05), the level of hs-CRP was significantly lower than that in diabetic patients with bacterial infection (P<0.05); The area under ROC curve (AUC) and sensitivity of NLR were the largest among the three indexes in the single diagnosis of diabetes mellitus complicated with bacterial infection, the AUC and specificityof NLR were the largest among the three indexes in the single diagnosis of diabetes mellitus complicated with viral infection, the sensitivityof SAA was the highest; compared with diabetes mellitus complicated with bacterial infection group, the AUC of NLR and SAA in the single diagnosis of diabetes mellitus complicated with viral infection were increased, and the sensitivity of SAA increased, while the AUC and sensitivity of hs-CRP decreased. Compared with single diagnosis, the AUC and sensitivity of NLR, SAA and hs-CRP combined diagnosis of diabetes mellitus complicated with bacterial infection and viral infection increased, but the specificity of diagnosis of diabetes mellitus with bacterial infection decreased; compared with diabetes mellitus complicated with bacterial infection, the AUC and specificity of the combined diagnosis of diabetes mellitus complicated with viral infection increased, but the sensitivity decreased. Conclusion: Combined detection of NLR, SAA and hs-CRP is of great value in the diagnosis of type 1 diabetes mellitus complicated with infection in children, and the sensitivity of combined diagnosis of type 1 diabetes mellitus complicated with viral infection in children is better than that of combined diagnosis of type 1 diabetes mellitus complicated with bacterial infection in children.

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