本文選題：肺炎　切入點(diǎn)：細(xì)菌性　出處：《中國(guó)全科醫(yī)學(xué)》2017年03期

【摘要】：背景目前國(guó)內(nèi)尚缺乏對(duì)發(fā)熱就診的肺炎患兒是否為細(xì)菌感染做出快速判斷的簡(jiǎn)易方法,容易引起漏診及抗生素的濫用。目的建立預(yù)判發(fā)熱就診的肺炎患兒是否為細(xì)菌感染的簡(jiǎn)單模型。方法回顧性選取2012—2013年溫州醫(yī)科大學(xué)附屬第二醫(yī)院育英兒童醫(yī)院符合納入標(biāo)準(zhǔn)的以發(fā)熱就診的肺炎患兒538例為研究對(duì)象。根據(jù)疾病原因?qū)⒒純悍譃榧?xì)菌感染組(133例)和非細(xì)菌感染組(405例)。從538例患兒中隨機(jī)選取54例作為驗(yàn)證集(細(xì)菌性肺炎13例,非細(xì)菌性肺炎41例)。收集患兒一般資料、實(shí)驗(yàn)室檢測(cè)結(jié)果,建立5個(gè)診斷細(xì)菌性肺炎的模型〔F1=C反應(yīng)蛋白(CRP)×降鈣素原(PCT)、F2=CRP2×PCT、F3=CRP×PCT2、F4=性別權(quán)重×就診季節(jié)權(quán)重×喘息癥狀系數(shù)×(CRP×PCT)、F5=性別權(quán)重×就診季節(jié)權(quán)重×喘息癥狀系數(shù)×(CRP×PCT2)〕,繪制其診斷細(xì)菌性肺炎的ROC曲線(xiàn),確定最優(yōu)模型。結(jié)果兩組患兒性別、就診季節(jié)、寒戰(zhàn)發(fā)生率、呼吸加快發(fā)生率、喘息發(fā)生率、嘔吐發(fā)生率、腹瀉發(fā)生率、哭鬧發(fā)生率、干Up音發(fā)生率、濕Up音發(fā)生率、發(fā)熱持續(xù)天數(shù)、最高體溫、白細(xì)胞計(jì)數(shù)(WBC)、CRP水平、PCT水平比較,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。單獨(dú)CRP診斷細(xì)菌性肺炎的ROC曲線(xiàn)下面積(AUC)為0.969,95%CI(0.955,0.979),臨界值為48.5 mg/L,靈敏度為88.0%,特異度為93.6%;單獨(dú)PCT診斷細(xì)菌性肺炎的AUC為0.974,95%CI(0.959,0.989),臨界值為0.5 g/L,靈敏度為92.5%,特異度為84.0%;F1診斷細(xì)菌性肺炎的AUC為0.983,95%CI(0.973,0.993),臨界值為17.4,靈敏度為92.5%,特異度為96.3%;F2診斷細(xì)菌性肺炎的AUC為0.981,95%CI(0.971,0.992),臨界值為241.1,靈敏度為97.7%,特異度為90.6%;F3診斷細(xì)菌性肺炎的AUC為0.983,95%CI(0.973,0.993),臨界值為6.3,靈敏度為94.0%,特異度為96.3%;F4診斷細(xì)菌性肺炎的AUC為0.987,95%CI(0.980,0.996),臨界值為1.1,靈敏度為94.7%,特異度為95.6%;F5診斷細(xì)菌性肺炎的AUC為0.988,95%CI(0.981,0.997),臨界值為0.2,靈敏度為97.7%,特異度為94.3%。根據(jù)單獨(dú)CRP、單獨(dú)PCT、F5的臨界值,對(duì)驗(yàn)證集患兒進(jìn)行診斷,結(jié)果顯示,單獨(dú)CRP診斷驗(yàn)證集患兒細(xì)菌性肺炎的靈敏度為76.9%,特異度為97.6%,正確率為92.6%;單獨(dú)PCT診斷驗(yàn)證集患兒細(xì)菌性肺炎的靈敏度為84.6%,特異度為97.6%,正確率為94.4%;F5診斷驗(yàn)證集患兒細(xì)菌性肺炎的靈敏度為92.3%,特異度為97.6%,正確率為96.3%。結(jié)論對(duì)于因發(fā)熱就診的肺炎患兒,可以通過(guò)F5模型〔F5=性別權(quán)重×就診季節(jié)權(quán)重×喘息癥狀系數(shù)×(CRP×PCT2)〕計(jì)算得到相應(yīng)的結(jié)果,若結(jié)果大于0.2,可診斷細(xì)菌性肺炎,建議早期使用抗生素治療。
[Abstract]:Background at present, there is a lack of a simple method for the rapid diagnosis of bacterial infection in children with pneumonia. Objective to establish a simple model for predicting bacterial infection in children with febrile pneumonia. Methods A retrospective study was conducted to select Yuying Children's Hospital of the second affiliated Hospital of Wenzhou Medical University in 2012-2013. A total of 538 children with pneumonia with fever were included in the study. According to the causes of the disease, the children were divided into bacterial infection group (133 cases) and non-bacterial infection group (405 cases). From 538 children, 54 cases were randomly selected as the validation set. (13 cases of bacterial pneumonia). General data and laboratory results of 41 cases of non-bacterial pneumonia were collected. To establish five models for the diagnosis of bacterial pneumonia: CRP) 脳 procalcitonin, CRP2 脳 PCT _ 2, CRP 脳 PCT _ 2F _ 4 = sex weight 脳 seasonal weight 脳 wheezing symptom coefficient 脳 sex weight 脳 seasonal weight 脳 wheezing symptom coefficient 脳 panting symptom coefficient 脳 CRP 脳 PCT _ 2, and its diagnostic bacteria were plotted. ROC curve of pneumonia, Results Sex, consultation season, shivering rate, respiratory acceleration rate, wheezing rate, vomiting rate, diarrhea rate, crying rate, dry up sound rate, wet up sound rate were determined in the two groups. The duration of fever, the highest body temperature, the WBCU CRP level and the PCT level were compared. The area under the ROC curve of CRP alone for the diagnosis of bacterial pneumonia was 0.969 ~ 95%, the critical value was 48.5 mg / L, the sensitivity was 88.0 and the specificity was 93.60.The AUC of single PCT for the diagnosis of bacterial pneumonia was 0.9749% CI0.95999, the critical value was 0.5 g / L, the sensitivity was 92.5 mg / L, the sensitivity was 92.5 mg / L, the critical value was 0.5 g / L, and the sensitivity was 92.5 mg / L, respectively. The AUC for diagnosing bacterial pneumonia in F _ 1 was 0.983C _ (95), the critical value was 17.4, the sensitivity was 92.5, the AUC for F _ 2 was 0.981C _ (95) CI 0.9922.The critical value was 241.1, the sensitivity was 97.7m, the AUC for diagnosis of bacterial pneumonia was 0.98395 C _ (3) 0.9730.993T, the critical value for diagnosis of bacterial pneumonia was 0.98395 C _ (2), the critical value was 0.9921, the critical value was 97.7%, and the specificity was 0.98395% (0.9730.993N). The AUC, the critical value, the sensitivity, the specificity, the critical value, the sensitivity, the AUC, the critical value, the sensitivity, the AUC, the critical value and the specificity for the diagnosis of bacterial pneumonia were 0.98895CI0.9810.997, 0.98895CI0.991, 0.98895CI0.991, 0.98895CI0.991, 0.98895CI0.991, 0.98895CI0.9810.997and 0.98895CI0.9810.997.The critical value, sensitivity and specificity were 0.98895CI0.9810.997and 0.98895CI0.9810.997. Critical value of individual PCTN F5, The diagnosis of children with validation set showed that, The sensitivity, specificity and accuracy of single CRP diagnostic verification set were 76.9, 97.6and 92.6percent respectively, and the sensitivity, specificity and accuracy of single PCT diagnosis and verification set were 84.6, 97.6and 94.4g respectively. The sensitivity, specificity and accuracy of bacterial pneumonia were 92.3%, 97.6 and 96.3.Conclusion for pneumonia children with fever, the sensitivity is 92.3%, the specificity is 97.6%, and the accuracy rate is 96.3.Conclusion:. The corresponding results can be calculated by F5 model: F5 = sex weight 脳 seasonal weight 脳 wheezing symptom coefficient 脳 CRP 脳 PCT2P). If the result is greater than 0.2, bacterial pneumonia can be diagnosed and antibiotics should be used early.
【作者單位】： 溫州醫(yī)科大學(xué)附屬第二醫(yī)院育英兒童醫(yī)院內(nèi)分泌遺傳代謝科;
【基金】：浙江省溫州市科技局科研基金資助項(xiàng)目(Y20120122)
【分類(lèi)號(hào)】：R725.6

【相似文獻(xiàn)】

相關(guān)期刊論文 前10條

1 尹本義;人類(lèi)免疫缺陷病毒感染與細(xì)菌性肺炎[J];中國(guó)臨床醫(yī)生;2001年02期

2 田莉 ,孫力軍,史彥筠;卡氏肺孢子蟲(chóng)肺炎誤診細(xì)菌性肺炎1例[J];遼寧醫(yī)學(xué)雜志;2002年06期

3 江明榮;黃循斌;謝曉彬;;可溶性髓系細(xì)胞觸發(fā)受體-1對(duì)細(xì)菌性肺炎的評(píng)價(jià)及臨床意義[J];南昌大學(xué)學(xué)報(bào)(醫(yī)學(xué)版);2013年04期

4 史廣超;邢亞恒;李景釗;;左氧氟沙星注射液聯(lián)合咳露口服液治療細(xì)菌性肺炎的臨床觀察[J];中國(guó)醫(yī)學(xué)創(chuàng)新;2013年26期

5 江開(kāi)勇,顧鴻雁;兩葉性細(xì)菌性肺炎1例[J];實(shí)用醫(yī)學(xué)雜志;1998年09期

6 陳健;安絡(luò)欣治療細(xì)菌性肺炎120例[J];藥學(xué)實(shí)踐雜志;2000年02期

7 段鵬程,方娟娟;治療112例細(xì)菌性肺炎的用藥調(diào)查[J];中國(guó)藥師;2000年01期

8 陳運(yùn)琴;細(xì)菌性肺炎69例的X錢(qián)表現(xiàn)及其吸收情況分析[J];實(shí)用醫(yī)技;2000年10期

9 張曉戰(zhàn) ,劉志燕,張東藩,張琦;肺結(jié)核及細(xì)菌性肺炎患者血漿內(nèi)皮素_(-1)水平改變及其意義[J];陜西醫(yī)學(xué)雜志;2002年03期

10 李廣如,李響;細(xì)菌性肺炎116例臨床治療觀察[J];臨床軍醫(yī)雜志;2005年03期

相關(guān)會(huì)議論文 前6條

1 李建生;張艷霞;周紅艷;余海濱;喬翠霞;;細(xì)菌性肺炎痰熱證模型的建立與評(píng)價(jià)[A];第九屆中國(guó)中西醫(yī)結(jié)合實(shí)驗(yàn)醫(yī)學(xué)學(xué)術(shù)研討會(huì)論文匯編[C];2009年

2 黃美杏;陳斯寧;韋思尊;譚玉萍;梁愛(ài)武;楊益寶;潘玲;古立新;;痰熱清注射液合抗生素治療細(xì)菌性肺炎的療效觀察[A];第七次全國(guó)中西醫(yī)結(jié)合呼吸病學(xué)術(shù)交流大會(huì)論文匯編（一）[C];2004年

3 劉陽(yáng);;血清降鈣素原測(cè)定在細(xì)菌性肺炎和肺結(jié)核鑒別診斷中的意義[A];結(jié)核病和呼吸疾病診治進(jìn)展及治療中肝損害專(zhuān)題研討會(huì)資料匯編[C];2013年

4 朱康元;童武華;過(guò)勇杰;;降鈣素原、C反應(yīng)蛋白在細(xì)菌性肺炎診斷價(jià)值研究[A];重癥醫(yī)學(xué)十年回顧與展望——2012年浙江省重癥醫(yī)學(xué)學(xué)術(shù)年會(huì)論文匯編[C];2012年

5 李國(guó)勤;;臨床辨治細(xì)菌性肺炎的體會(huì)[A];第十次全國(guó)中西醫(yī)結(jié)合防治呼吸系統(tǒng)疾病學(xué)術(shù)研討會(huì)論文集[C];2009年

6 王曉莉;;新生兒細(xì)菌性肺炎高危因素分析及防治探討:附82例臨床分析[A];2006（第三屆）江浙滬兒科學(xué)術(shù)會(huì)議暨浙江省兒科學(xué)術(shù)年會(huì)論文匯編[C];2006年

相關(guān)重要報(bào)紙文章 前10條

1 徐濟(jì)民;冬春之交謹(jǐn)防細(xì)菌性肺炎[N];新華日?qǐng)?bào);2007年

2 ;細(xì)菌性肺炎不是傳染病[N];大眾衛(wèi)生報(bào);2004年

3 復(fù)旦大學(xué)附屬中山醫(yī)院呼吸科 副教授 李華茵;肺炎[N];家庭醫(yī)生報(bào);2009年

4 彭再梅;細(xì)說(shuō)細(xì)菌性肺炎[N];大眾衛(wèi)生報(bào);2003年

5 ;治細(xì)菌性肺炎驗(yàn)方[N];農(nóng)村醫(yī)藥報(bào)（漢）;2005年

6 本報(bào)特約記者 張獻(xiàn)懷;非典型肺炎并不可怕[N];健康時(shí)報(bào);2003年

7 張獻(xiàn)懷;春季謹(jǐn)防肺炎發(fā)生[N];大眾科技報(bào);2003年

8 本報(bào)記者 白毅;肺炎非老弱專(zhuān)利 強(qiáng)壯成年患者更易忽視[N];中國(guó)醫(yī)藥報(bào);2014年

9 熊志偉;如何預(yù)防冬春傳染病[N];大眾衛(wèi)生報(bào);2007年

10 遼寧中醫(yī)學(xué)院教授 趙秋英;流感都有哪些并發(fā)癥[N];上海中醫(yī)藥報(bào);2006年

相關(guān)博士學(xué)位論文 前1條

1 焦揚(yáng);解毒活血法治療耐藥細(xì)菌性肺炎的臨床與實(shí)驗(yàn)研究[D];北京中醫(yī)藥大學(xué);2003年

相關(guān)碩士學(xué)位論文 前7條

1 李妍;新鄉(xiāng)地區(qū)細(xì)菌性肺炎病原菌分布、耐藥特點(diǎn)及同源性分析[D];新鄉(xiāng)醫(yī)學(xué)院;2015年

2 廖婷婷;60例嬰幼兒細(xì)菌性肺炎病例分析[D];廣西醫(yī)科大學(xué);2012年

3 李鳴;血清降鈣素原在細(xì)菌性肺炎中的臨床價(jià)值探討[D];福建醫(yī)科大學(xué);2012年

4 許麗萍;降鈣素原檢測(cè)對(duì)嬰幼兒細(xì)菌性肺炎病情和預(yù)后的指導(dǎo)價(jià)值及意義的探討[D];鄭州大學(xué);2014年

5 孫曉鳳;肺炎合劑對(duì)細(xì)菌性肺炎患兒血清PCT、hs-CRP、WBC變化的影響的觀察[D];新疆醫(yī)科大學(xué);2014年

6 蘇冠琴;SARS與細(xì)菌性肺炎的CT影像對(duì)比研究[D];天津醫(yī)科大學(xué);2004年

7 阮永春;血清sTREM-1及PCT測(cè)定在BP及IPIF診斷中的意義[D];浙江大學(xué);2010年

，

本文編號(hào)：1663643