Page 47 - 南京医科大学学报自然科学版

第42卷第1期 南京医科大学学报（自然科学版）
2022年1月 Journal of Nanjing Medical University（Natural Sciences） · 41 ·

·临床研究·

补体C3在成人Still病和脓毒症中的鉴别诊断价值

李 洁，周 军，王雅曼，江家红

南京医科大学第一附属医院检验学部，江苏 南京 210029

［摘 要］ 目的：评价血清补体C3在成人Still病（adult⁃onset Still’s disease，AOSD）和脓毒症中的鉴别诊断价值。方法：收集
南京医科大学第一附属医院2016年1月—2019年12月AOSD患者58例、脓毒症患者50例，并选取50例健康体检者作为健康
对照。检测3组血清中补体C3水平，并比较AOSD患者和脓毒症患者各项实验室指标的差异，分析各变量与AOSD的关系，并
采用受试者工作特征（receiver operating characteristic，ROC）曲线探讨补体 C3 与血清铁蛋白水平对 AOSD 和脓毒症的诊断效
能。结果：AOSD组补体C3水平［（1.49±0.24）g/L］显著高于脓毒症组［（1.00±0.37）g/L］，两组高密度脂蛋白胆固醇、铁蛋白、补
体C3差异具有统计学意义。多因素Logistic回归分析显示铁蛋白≥472.20 ng/mL（OR=56.97，95%CI：2.22~1 463.44，P < 0.05）、
补体 C3≥1.20 g/L（OR=27.80，95%CI：3.22~240.28，P < 0.01）、高密度脂蛋白胆固醇≥0.82 mmol/L（OR=13.34，95%CI：1.01~
176.29，P < 0.05）与 AOSD 的发生独立相关。血清 C3 鉴别诊断 AOSD 和脓毒症患者的曲线下面积（area under curve，AUC）为
0.81（95%CI：0.63~1.00），当C3临界值为1.21时，诊断灵敏度为0.90，特异度为0.73，此时可达最大的诊断效能，然而当C3联合
铁蛋白鉴别诊断时，AUC则为0.86（95%CI：0.75~0.96）。结论：血清C3可作为AOSD和脓毒症的鉴别诊断指标，对AOSD的诊
断具有临床价值。
［关键词］ 成人Still病；脓毒症；补体C3
［中图分类号］ R631 ［文献标志码］ A ［文章编号］ 1007⁃4368（2022）01⁃041⁃06
doi：10.7655/NYDXBNS20220107

The differential diagnosis value of complement C3 in adult⁃onset Still’s disease and sepsis

LI Jie，ZHOU Jun，WANG Yaman，JIANG Jiahong
Department of Laboratory Medicine，the First Affiliated Hospital of Nanjing Medical University，Nanjing 210029，China

［Abstract］ Objective：To evaluate the differential diagnosis value of serum complement C3 in adult⁃onset Still’s disease（AOSD）
and sepsis. Methods：A total of 58 patients with AOSD and 50 patients with sepsis were collected from the First Affiliated Hospital of
Nanjing Medical University from 2016 to 2019，and 50 physical examinees were selected as health control. Serum complement C3
levels in the three groups were detected, and differences in other laboratory indicators were compared between AOSD patients and
sepsis patients. Univariate and multivariate factors were used to analyze the relationship between each variable and the occurrence of
AOSD. ROC curve was used to explore the diagnostic efficacy of complement C3 and serum ferritin levels in AOSD and sepsis.
Results：C3 level in AOSD group（1.49±0.24）g/L is significantly higher than that in sepsis group（1.00±0.37）g/L，there were statistical
significance in the high density lipoprotein cholesterol，ferritin，C3 between two groups. In multivariate analysis，ferritin≥472.20 ng/mL
（OR=56.97，95% CI：2.22~1 463.44，P < 0.05），C3≥1.20 g/L（OR=27.80，95% CI：3.22~240.28，P < 0.01）and high density
lipoprotein cholesterol≥0.82 mmol/L（OR=13.34，95%CI：1.01~176.29，P < 0.05）were independently related with AOSD. The area
under the curve（AUC）of serum C3 in the differential diagnosis of AOSD and sepsis was 0.81（95% CI：0.63~1.00），and the diagnostic
sensitivity and specificity were 0.90 and 0.73 when C3 critical value was 1.21，which reached the maximum diagnostic efficacy.
However，when C3 combined with ferritin was used for differential diagnosis，the AUC was 0.86（95%CI：0.75~0.96）. Conclusion：
Serum C3 can be used as a differential diagnostic index of AOSD and sepsis，and has clinical value in the diagnosis of AOSD.
［Key words］ adult⁃onset Still’s disease；sepsis；C3
［J Nanjing Med Univ，2022，42（01）：041⁃046］