新生儿败血症超敏C反应蛋白诊断界值探讨

Diagnostic threshold value of high-sensitivity C-reactive protein test in neonatal septicemia

目的探讨超敏C反应蛋白(hs-CRP)在新生儿败血症诊断中的价值。方法选取2010年10月至2011年10月重庆医科大学附属儿童医院收治的确诊败血症新生儿81例、临床诊断败血症新生儿152例和非败血症新生儿103例,比较三组间hs-CRP浓度;以血培养为金标准,通过绘制ROC工作曲线,确定hs-CRP诊断新生儿败血症的最佳诊断界值点;同时对比分析hs-CRP、传统C-反应蛋白(CRP)、白细胞(WBC)计数、未成熟中性粒细胞与中性粒细胞总数比值(I/T)及血小板(PLT)计数在新生儿败血症诊断的灵敏度、特异度等。结果确诊新生儿败血症组、临床诊断新生儿败血症组及非败血症组hs-CRP中位数分别为15.0、11.0和1.0mg/L;hs-CRP诊断新生儿败血症的ROC曲线下面积为0.851,最佳诊断界值点为3.0mg/L;hs-CRP、CRP、WBC、I/T、PLT诊断新生儿确诊败血症组与非败血症组的阳性率比较差异有统计学意义(P<0.05);其灵敏度分别为90.1%、42.0%、34.6%、16.0%和22.2%,特异度为66.0%、95.1%、87.4%、95.1%和97.1%。结论 hs-CRP是一项诊断新生儿败血症的理想的初筛项目。

Objective To evaluate the significance of high sensitive C-reactive protein（hs-CRP） test for the diagnosis of neonatal septicemia. Methods Eighty-one cases of confirmed septicemia, 152 cases of the clinical diagnosis of septi- cemia and 103 cases of non-septicemia who were admitted to neonatal department of Children＇s Hospital of Chongqing Medical University from October 2010 to October 2011 were enrolled for study. The hs-CRP concentration of the three groups were analyzed. Taking blood culture as the gold standard, receiver operating characteristic （ROC）curve was drawn, and the diagnostic threshold value of hs-CRP was determined. The hs-CRP, traditional C-reactive protein （CRP）, white cell count （ViBC）, ratio of immature neutrophils to total neutrophils （I/T） and platelet count （PLT）of all the cases were conducted and analyzed with their clinical characteristics. Results The hs-CRP concentration of con- firmed septicemia group, clinical diagnosis of septicemia group and non-septicemia group were 15.0rag/L, 11.0mg/L and 1.0mg/L, respectively. The area under the ROC curve of hs-CRP was 0.851, and the optimal threshold value was 3.0mg/ L. There was a significant difference （P〈 0.05）between confirmed septicemia group and non-septicemia group in hs-CRP, CRP, WBC, I/T and PLT. The sensitivity of each test was 90.1%, 42.0%, 34.6%, 16.0% and 22.2%, respective- ly; specificity was 66.0%, 95.1%, 87.4%, 95.1% and 97.1%, respectively. Conclusion The hs-CRP test is an ideal screening project for the diagnosis of neonatal septicemia.