降钙素原在新生儿感染性疾病诊治中的价值初探

Procalcitonin in Diagnosis and Treatment of Neonatal Infection

目的:探讨血清降钙素原(PCT)对新生儿感染早期诊断及鉴别诊断的作用。方法:应用免疫色谱法对80例新生儿于入院时和入院后48h进行PCT水平测定,并比较血清C-反应蛋白(CRP)、外周血白细胞计数对感染性疾病的实验室诊断价值。将患儿按出院诊断分为重症感染组、一般感染组、非感染组进行分析。结果:重症感染组患儿血清PCT和CRP明显高于一般感染组和非感染组,差异有统计学意义(P<0.01);重症感染组患儿外周血白细胞计数与非感染组比较差异有统计学意义(P<0.05),与一般感染组比较差异无统计学意义(P>0.05);一般感染组与非感染组血清PCT、CRP比较差异有统计学意义(P<0.05),两组外周血白细胞计数比较差异无统计学意义(P>0.05)。以0.5ng/mL为临界值,PCT诊断重症感染的敏感度为90.63%,特异度为64.58%;以2ng/mL为临界值,诊断重症感染的敏感度为75.00%,特异度为89.50%。与CRP相比,PCT诊断感染特别是重症感染的敏感性、特异性更高。经有效抗生素治疗后,血清PCT下降幅度明显大于血清CRP下降幅度。结论:监测新生儿感染患儿血清中PCT水平,对疾病的早期诊断及鉴别诊断、病情程度判断、治疗效果的评价具有重要价值。

Objective：To investigate Procalcitonin （PCT） for early and differential diagnosis of neonatal infection. Methods：The serum PCT levels were measured with immune chromatography （PCT-Q） assay and compared with the serum C-reactive protein （CRP） and white blood cell count （WBC） in 80 neonates at admission and repeated 48 h later. Eighty neonates were divided into severe infection group,common infec-tion group and non-infection group according to discharge diagnosis. Results：Serum concentrations of PCT and CRP in neonatal severe infec-tion group were significantly higher than those in common group and non-infection group （all P 0.01）. The white blood cell count in neonates with severe infection cares were significantly higher than those with non-infection cares （P 0.05）. There was no significant difference in the white blood cell count between the common and severe infection groups （P 0.05）. Serum concentrations of PCT and CRP in neonates with common infection cares were significantly higher than those non-infection cares （P 0.05）. There was no significant difference in the white blood cell count between the common and non-infection cares. PCT was positive （≥0.5 ng/mL） in 90.63% severe infection cases,the specificity rate was 64.58%. PCT was positive （≥2 ng/mL） in 75% severe infection cases,the specificity rate was 89.50%. The sensitivity and specificity rate of PCT were much higher than that of CRP. The level of the serum PCT decreased rapidly during effective antibiotic therapy. Conclusions：The measurement of PCT will be very important to the early and differential diagnosis and judgment of therapeutic efficacy of neonatal infection.