Clinical value of fecal calprotectin combined with CD64 index and high sensitivity C-reactive protein in the diagnosis of bacterial enteritis in children
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摘要: 目的 探讨粪便钙卫蛋白(fecal calprotectin，FC)、CD64指数、超敏C反应蛋白(high sensitivity C-reactive protein，hs-CRP)在儿童细菌性肠炎诊断中的临床价值。方法 选取2021年1月—2022年9月徐州市儿童医院收治的100例感染性肠炎患儿为研究对象，根据肠道细菌病原学检查结果分为细菌性肠炎组(50例)和病毒性肠炎组(50例)；选取同时期50例健康体检儿童作为对照组。通过受试者工作特征曲线(receiver operating characteristic curve，ROC)分析FC、CD64指数、hs-CRP及联合指标在细菌性肠炎患儿中的诊断价值。结果 细菌性肠炎组患儿的FC、CD64指数、hs-CRP显著高于对照组，差异有统计学意义(P < 0.05)。病毒性肠炎组患儿的FC、hs-CRP与对照组相比，差异有统计学意义(P < 0.05)，CD64指数与对照组比较差异无统计学意义(P＞0.05)。细菌性肠炎组患儿的FC、CD64指数、hs-CRP显著高于病毒性肠炎组，差异有统计学意义(P < 0.05)。ROC曲线显示，FC、CD64指数、hs-CRP诊断细菌性肠炎患儿的ROC曲线下面积(area under the curve，AUC)分别是0.881、0.969、0.792；FC+CD64指数和FC+hs-CRP双项联合检测时AUC分别是0.969、0.884；FC+CD64指数+hs-CRP联合检测时AUC为0.967。通过比较发现，FC+hs-CRP与FC+hs-CRP+CD64指数的AUC差异有统计学意义(P < 0.05)，而FC+CD64指数与FC+hs-CRP+CD64指数差异无统计学意义(P＞0.05)。结论 FC+CD64指数联合检测以及FC+CD64指数+hs-CRP联合检测均能有效判断细菌性肠炎患儿，且诊断价值相当。基于简便性及成本考虑，临床上更推荐使用FC+CD64指数联合检测。Abstract: Objective To investigate the clinical value of fecal calprotectin(FC), CD64 index and high sensitivity C-reactive protein(hs-CRP) in the diagnosis of bacterial enteritis in children.Methods A total of 100 patients with infectious enteritis admitted to Xuzhou Children's Hospital from January 2021 to September 2022 were selected and divided into bacterial enteritis group(50 cases) and viral enteritis group(50 cases) according to the results of intestinal bacterial etiology examination. Fifty healthy children in the same period were selected as the control group. Receiver operating characteristic curve(ROC curve) was used to analyze the diagnostic value of FC, CD64 index, hs-CRP and their combined indexes in the diagnosis of bacterial enteritis in children.Results The FC, CD64 index and hs-CRP of bacterial enteritis group were significantly higher than those of the control group(P < 0.05). There were significant differences in FC and hs-CRP between the viral enteritis group and the control group(P < 0.05), but there was no significant difference in CD64 index between the viral group and the control group(P > 0.05). The FC, CD64 index and hs-CRP of bacterial enteritis group were significantly higher than those of the viral enteritis group, and the differences were statistically significant(P < 0.05). ROC curve showed that the area under the curve(AUC) of FC, CD64 index and hs-CRP in the diagnosis of bacterial enteritis were 0.881, 0.969 and 0.792, respectively. The AUC of FC+CD64 index and FC+hs-CRP were 0.969 and 0.884, respectively. The AUC of FC+CD64 index+hs-CRP was 0.967. The AUC of FC+hs-CRP and FC+hs-CRP+CD64 index was significantly different(P < 0.05), but there was no significant difference between FC+CD64 index and FC+hs-CRP+CD64 index(P > 0.05).Conclusion The combined detection of FC+CD64 index, and the combined detection of FC, CD64 index and hS-CRP can effectively determine bacterial enteritis, and the diagnostic value is similar. Based on the simplicity and cost, the combined detection of FC+CD64 index is more recommended in clinical practice.
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表 1 3组FC、CD64指数、hs-CRP水平的比较
X±S 组别 例数 FC/(μg/g) CD64指数 hs-CRP/(mg/L) 对照组 50 36.28±0.90 0.07±0.01 0.63±0.08 病毒性肠炎组 50 53.85±6.411) 0.11±0.02 11.52±3.241) 细菌性肠炎组 50 145.25±14.821) 0.41±0.031) 31.61±6.281) 与对照组比较，1)P < 0.05。 
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表 2 FC、CD64指数、hs-CRP单项检测和联合检测对细菌性肠炎的诊断价值
指标 AUC 最佳截断值 95%CI P 灵敏度 特异度 FC 0.881 55.84 μg/g 0.818~0.945 < 0.001 0.80 0.90 CD64指数 0.969 0.155 0.942~0.996 < 0.001 1.00 0.92 hs-CRP 0.792 2.15 mg/L 0.717~0.868 < 0.001 0.82 0.65 FC+CD64指数 0.969 0.943~0.995 < 0.001 1.00 0.90 FC+hs-CRP 0.884 0.822~0.946 < 0.001 0.86 0.83 FC+CD64指数+hs-CRP 0.967 0.941~0.994 < 0.001 1.00 0.89
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