降鈣素原和C反應蛋白在新生兒敗血癥早期診斷中的價值

李維春 張克昌 楊續 王圣東

[摘要]目的 探討降鈣素原（PCT）和C反應蛋白（CRP）檢測在新生兒敗血癥早期診斷中的臨床價值。方法 選取2015年1月～2016年12月入住南京兒童醫院滁州分院的113例新生兒作為研究對象，按照新生兒敗血癥的診斷標準及是否發生感染，將患兒分為敗血癥組（91例）和非感染組（22例）。比較敗血癥組與非感染組新生兒的CRP和PCT水平，比較32例敗血癥患兒治療前后的PCT水平，分析CRP和PCT在診斷新生兒敗血癥中的敏感度、特異性、陽性預測值及陰性預測值。結果 敗血癥組患兒的CRP、PCT水平高于非感染組，差異均有統計學意義（P<0.05）。敗血癥組32例患兒治療后的PCT水平顯著低于治療前，差異有統計學意義（P<0.01）。PCT≥2 μg/L診斷新生兒敗血癥的敏感度為74.74%，特異性為100.00%，CRP≥8 mg/L診斷新生兒敗血癥的敏感度為54.95%，特異性為81.82%。結論 降鈣素原和C反應蛋白的檢測在新生兒敗血癥早期診斷及療效評價中具有一定的臨床價值，聯合檢測降鈣素原和C反應蛋白有助于提高診斷的敏感度和特異度。

[關鍵詞]降鈣素原；C反應蛋白；新生兒敗血癥；診斷

[中圖分類號] R446.62 [文獻標識碼] A [文章編號] 1674-4721（2018）2（a）-0109-03

[Abstract]Objective To explore the clinical value of dection procalcitonin （CRP） and C reactive protein （PCT） in early diagnosis neonatal sepsis.Methods 113 newborn cases were collected in Chuzhou branch of Nanjing children′s hospital from January 2015 to December 2016 and were selected as the research objects and divided into the sepsis group （91 cases） and non-infected group （22 cases） according to the diagnostic criteria for neonatal septicemia and whether infection was occurred.The levels of PCT and CRP between the sepsis group and non-infected group were compared，the levels of PCT of 32 children in the sepsis group before and after treatment were compared，the sensitivity，specificity，positive predictive value and negative predictive value of PCT and CRP in the diagnosis of neonatal sepsis were analyzed.Results The levels of the PCT and CRP in the sepsis group were higher than those in the non-infected group，and the differences were statistically significant （P<0.05）.The PCT level of 32 children with septicemia after treament was significantly lower than before treatment，and the difference was statistically significant （P<0.01）.The sensitivity of PCT≥2 μg/L to the diagnosis of neonatal sepsis was 74.74%，specificity was 100.00%，the sensitivity of CRP≥8 mg/L to the diagnosis of neonatal sepsis was 54.95%，and the specificity was 81.82%.Conclusion There are clinical value of detection CRP and PCT in early diagnosis neonatal sepsis and the effect of treatment.Detected PCT combine with CRP were valuable to improve sensitivity and specificity in diagnosis neonatal sepsis.

[Key words]Procalcitonin；C reactive protein；Neonatal sepsis；Diagnosis

新生兒敗血癥（neonatal septicemia），指的是新生兒期細菌或其它病原微生物侵入血循環并在其中生長繁殖，產生毒素所造成的全身性感染，是足月和早產新生兒發病和及死亡的主要原因之一[1]，根據發病時間為界限（出生后7 d），分為早發型敗血癥（early-onset sepsis，EOS）與晚發型敗血癥（late-onset sepsis，LOS）。2000年出版的16版Nelson教科書將真菌、病毒及原蟲均已列入新生兒敗血癥的病原體。迄今為止，血培養仍然是新生兒敗血癥診斷的金標準，但由于其培養所需時間長、陽性率低，易出現假陰性和假陽性，往往不能達到早期診斷的目的[2-3]。本研究選取入住南京兒童醫院滁州分院的113例新生兒作為研究對象，通過觀察新生兒敗血癥患兒降鈣素原和C反應蛋白水平的變化，探討其在新生兒敗血癥早期診斷及療效評價中的價值，現報道如下。