Objective To investigate the value of serum levels of procalcitonin in identifying acute gouty attack and bacterial infections.Methods Totally 152 cases of primary gout patients were selected and assigned into no fever group (n=35) and fever group (n=117) according to whether the body temperature of the admitted patients was equal to or higher than 37.5℃.No bacterial infection was found in no fever group.Based on clinical symptoms,imaging and etiological examination results and efficacy of antibiotic treatment,the patients in the fever group were further assigned into bacterial infection group (n=37) and non-bacterial infection group (n=80).The clinical data were collected and white blood cell (WBC) count,neutrophil percentage and serum C-reactive protein (CRP) and PCT levels were detected.The values of different indicators in identifying acute gouty attack and bacterial infections were analyzed by using receiver operating characteristic curve (ROC curves).Results The proportion of hypertension and the proportion of gouty tophus ulcerated in fever group were significantly higher than those in no fever group (47.9% vs 25.7%,61.5% vs 34.3%,respectively).The differences were statistically significant (χ2=8.233,P=0.041,χ2=9.528、P=0.023).The serum levels of PCT and CRP and the neutrophil percentage in fever group were (1.37±0.50)μg·L-1,(13.24±4.45)mg·L-1 and (0.84±0.08),respectively,which were higher than those in no fever group.The differences were statistically significant (P<0.05).Compared with non-bacterial infection group,the serum levels of PCT and CRP and the neutrophil percentage in bacterial infection group were increased,and the differences were statistically significant (P<0.05).ROC curve analysis showed that when serum PCT was used in identifying acute gouty attack and bacterial infections,the area under the curve was 0.821 (95% CI:0.725~0.916).When the serum PCT took cutoff 1.56 μg·L-1,the sensitivity was 70.3%,and specificity was 90.0%.When CRP,WBC and neutrophil percentage were used in identifying acute gouty attack and bacterial infections,areas under the curve were 0.662 (95% CI:0.554~0.769),0.597 (95% CI:0.479~0.714) and 0.676 (95% CI:0.566~0.787),respectively.The sensitivities were 51.4%,59.5% and 73.0%,respectively.The specificities were 80.0%,70.0% and 63.7%,respectively.Conclusions The serum PCT levels in acute gouty attack patients without fever were significantly lower than the fever patients,and lower than the bacterial infection patients.Therefore,serum PCT could be used as serological markers for identifying acute gouty attack and bacterial infections.%目的 探讨血清降钙素原(PCT)水平在鉴别慢性痛风急性发作和细菌感染中的价值.方法 选取原发性痛风急性发作病人152例,根据病人入院时是否体温≥37.5 ℃,将病人分为不伴发热组(n=35)和伴发热组(n=117),不伴发热组均排除细菌感染,根据临床症状、影像学、病原学检查结果及抗生素治疗有效,将伴发热组进一步分为细菌感染组(n=37)和非细菌感染组(n=80),收集临床资料,检测白细胞(WBC)计数、中性粒细胞比例及血清C-反应蛋白(CRP)和PCT水平,利用受试者工作特征曲线(ROC曲线)分析不同指标在鉴别慢性痛风急性发作和细菌感染中的价值.结果 伴发热组病人伴发高血压比例和痛风石破溃比例分别为47.9%、61.5%,均高于不伴发热组的25.7%、34.3%,均差异有统计学意义(χ2=8.233、P=0.041,χ2 =9.528、P=0.023);伴发热组病人血清PCT、CRP和中性粒细胞比例分别为(1.37±0.50)μg·L-1、(13.24±4.45)mg·L-1、(0.84±0.08),均高于不伴发热组,均差异有统计学意义(P<0.05),与非细菌感染组相比,细菌感染组病人血清PCT、CRP和中性粒细胞比例均升高,均差异有统计学意义(P<0.05);ROC曲线分析显示,血清PCT在鉴别慢性痛风急性发作和细菌感染时,曲线下面积0.821(95%CI:0.725~0.916),当血清PCT取界值1.56 μg·L-1时,灵敏度70.3%,特异度90.0%;CRP、WBC和中性粒细胞比例在鉴别慢性痛风急性发作和细菌感染时,曲线下面积分别为0.662(95%CI:0.554~0.769)、0.597(95%CI:0.479~0.714)和0.676(95%CI:0.566~0.787),灵敏度分别为51.4%、59.5%和73.0%,特异度分别为80.0%、70.0%和63.7%.结论 痛风急性发作不伴发热病人血清PCT水平显著低于伴发热病人,且低于细菌感染者,血清PCT可作为鉴别痛风急性发作和细菌感染的有效的血清学标志物.
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