血清淀粉样蛋白A联合降钙素原在鉴别诊断ANCA相关性血管炎患者肺部细菌感染与肺损害中的价值探讨

    Value of serum amyloid A plus procalcitonin in differential diagnosis of ANCA-associated vasculitis pulmonary involvement and pulmonary bacterial infection

      摘要
    • 摘要: 目的 探讨血清淀粉样蛋白（serum amyloid protein，SAA）联合降钙素原（procalcitonin，PCT）在鉴别诊断抗中性粒细胞胞浆抗体（anti-neutrophil cytoplasmic antibodies，ANCA）相关性小血管炎（antineutrophil cytoplasmic antibody associated with small vasculitis，AAV）患者肺部细菌感染与肺损害中的价值。方法 收集2016年1月至2021年1月期间于武汉大学人民医院初诊为AAV合并肺部病变患者的临床资料及实验室指标，依据是否合并肺部细菌感染分为肺部细菌感染组与非感染组。分析比较两组的临床资料、PCT、SAA等实验室指标，采用受试者工作特征曲线评估上述指标在鉴别诊断对AAV肺部损害和AAV合并肺部细菌感染的诊断价值。结果 本研究共纳入82例活动期AAV合并肺部病变患者，其中女性43例，男性39例，中位年龄64岁。肺部细菌感染组年龄及伯明翰疾病活动性评分（Birmingham Vasculitis Activity Score，BVAS）高于非感染组（P>0.05），血清PCT、C反应蛋白（C-reactive protein，CRP）、SAA、白细胞（white blood cell，WBC）、中性粒细胞绝对值（absolute neutrophil count，Neu）显著高于非感染组（P<0.05）。PCT、SAA与疾病活动性评分无相关性（P<0.05）。PCT联合SAA鉴别诊断AAV患者肺部细菌感染的ROC曲线下面积（AUC=0.899），均高于PCT、CRP、SAA、WBC、Neu、血小板计数（platelet count，PLT）（P<0.05）。PCT与SAA区分肺部细菌感染与AAV活动性肺损害的截点值分别为0.61 ng/mL、142.6 mg/L，二者联合诊断的敏感度和特异度分别为82.76%和87.50%。结论 PCT、SAA在AAV肺部细菌感染者中升高，SAA可以作为鉴别诊断AAV肺损害与感染的新指标，PCT联合SAA能够提高鉴别诊断AAV肺损害与肺部细菌感染的价值。

       

      Abstract: Objective To evaluate the value of serum amyloid A protein (SAA) plus procalcitonin (PCT) in the differential diagnosis of ANCA-associated vasculitis (AAV) pulmonary involvement and pulmonary bacterial infection.Methods From January 2016 to January 2021,AAV patients with pulmonary injury were recruited and divided into two groups of pulmonary involvement and pulmonary bacterial infection.Clinical characteristics,imaging features and laboratory parameters were retrospectively analyzed.Values of the above parameters in differential diagnosis of pulmonary involvement and pulmonary infection were evaluated by receiver operating characteristic (ROC) curve.Results A total of 82 AAV patients complicated with pulmonary lesions were included.There were 43 females and 39 males with a median age of 64(18-86) years.Age and Birmingham Disease Activity Score (BVAS) of pulmonary infection group were higher than those of uninfected group (P>0.05).Serum levels of procalcitonin (PCT),C-reactive protein (CRP),SAA,white blood cell (WBC) and neutrophil (Neu) were significantly higher in pulmonary bacterial infection group than those in non-pulmonary infection group (P<0.05).The area under the ROC curve (AUC=0.899) of PCT plus SAA for differential diagnosis of pulmonary infection was higher than that of PCT,CRP,SAA,WBC and Neu in AAV patients.The optimal cut-off values of serum PCT/SAA for differentiating pulmonary bacterial infection from AAV active pulmonary injury were 0.61 ng/mL and 142.6 mg/l respectively.Conclusion The serum level of PCT/SAA is significantly higher in AAV patients with pulmonary bacterial infection group than those with pulmonary involvement.SAA may be employed as a new parameter for distinguishing AAV patients with pulmonary involvement and pulmonary infection.PCT plus SAA can improve the value of differential diagnosis of AAV pulmonary involvement and pulmonary bacterial infection.

       

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