降钙素原和C反应蛋白在新生儿败血症早期诊断中的价值

李维春 张克昌 杨续 王圣东

[摘要]目的 探讨降钙素原（PCT）和C反应蛋白（CRP）检测在新生儿败血症早期诊断中的临床价值。方法 选取2015年1月～2016年12月入住南京儿童医院滁州分院的113例新生兒作为研究对象，按照新生儿败血症的诊断标准及是否发生感染，将患儿分为败血症组（91例）和非感染组（22例）。比较败血症组与非感染组新生儿的CRP和PCT水平，比较32例败血症患儿治疗前后的PCT水平，分析CRP和PCT在诊断新生儿败血症中的敏感度、特异性、阳性预测值及阴性预测值。结果 败血症组患儿的CRP、PCT水平高于非感染组，差异均有统计学意义（P<0.05）。败血症组32例患儿治疗后的PCT水平显著低于治疗前，差异有统计学意义（P<0.01）。PCT≥2 μg/L诊断新生儿败血症的敏感度为74.74%，特异性为100.00%，CRP≥8 mg/L诊断新生儿败血症的敏感度为54.95%，特异性为81.82%。结论 降钙素原和C反应蛋白的检测在新生儿败血症早期诊断及疗效评价中具有一定的临床价值，联合检测降钙素原和C反应蛋白有助于提高诊断的敏感度和特异度。

[关键词]降钙素原；C反应蛋白；新生儿败血症；诊断

[中图分类号] R446.62 [文献标识码] A [文章编号] 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

新生儿败血症（neonatal septicemia），指的是新生儿期细菌或其它病原微生物侵入血循环并在其中生长繁殖，产生毒素所造成的全身性感染，是足月和早产新生儿发病和及死亡的主要原因之一[1]，根据发病时间为界限（出生后7 d），分为早发型败血症（early-onset sepsis，EOS）与晚发型败血症（late-onset sepsis，LOS）。2000年出版的16版Nelson教科书将真菌、病毒及原虫均已列入新生儿败血症的病原体。迄今为止，血培养仍然是新生儿败血症诊断的金标准，但由于其培养所需时间长、阳性率低，易出现假阴性和假阳性，往往不能达到早期诊断的目的[2-3]。本研究选取入住南京儿童医院滁州分院的113例新生儿作为研究对象，通过观察新生儿败血症患儿降钙素原和C反应蛋白水平的变化，探讨其在新生儿败血症早期诊断及疗效评价中的价值，现报道如下。