降钙素原在诊断早期新生儿感染中的意义

Diagnostic Value of Procalcitonin in Early Neonatal Infection Disease

目的评价降钙素原(PCT)、CRP、WBC总数及杆状核细胞对早期新生儿感染诊断的价值。方法选择本院产科出生且小于3 d的因血WBC、杆状核细胞和CRP增高诊断为新生儿感染的63例新生儿为研究对象。所有患儿入院后(抗生素使用前)立即取血做血常规、血培养及CRP、PCT检查,根据PCT结果将患儿分为PCT增高组(PCT≥2μg.L-1)和PCT正常组(PCT<2μg.L-1),治疗后复查上述指标。结果 63例患儿血培养均阴性,入院时血WBC(29.45±9.61)×109L-1,中性粒细胞为0.783 6±0.078 6,杆状核细胞为0.077 0±0.037 7,血小板为(241.44±9.30)×109L-1。PCT增高组28例,PCT中位数为7.07(2.02,53.57)μg.L-1,PCT正常组35例,PCT中位数为0.45(0.05,1.83)μg.L-1。2组胎龄、体质量、胎心异常史、羊水污染史、胎膜早破史、母亲发热史、母亲血象增高史、入院时血WBC及杆状核均无统计学差异,PCT增高组中5例CRP增高,PCT正常组CRP均正常。2组治疗前后各感染指标比较除血小板外差异均无统计学意义,PCT增高组治疗前后血小板均高于PCT正常组(Pa<0.01)。Spearman相关分析显示PCT与WBC总数及中性粒细胞杆状核细胞、血小板、CRP均无相关性(Pa>0.05)。结论早期新生儿轻症感染以血WBC增高及杆状核增高为主,可伴或不伴CRP增高,PCT大多正常,因此PCT对诊断早期新生儿轻症感染的意义不大。

Objective To study the role of procalcitonin（PCT）,C-reactive protein（CRP）,the number of white blood cell（WBC） and rod-shaped cells in establishing the diagnosis of early neonatal infection. Methods Sixty-three neonates with high white blood cells,rod-shaped cells,or CRP were enrolled in this study.All of them were less than 3 days old.Blood samples for determining serum PCT,CRP,WBC and blood culture were collected prior to treatment,and these investigations were repeated after treatment.According to PCT results,the neonates were allocated into PCT higher groups（PCT≥2 μg·L-1）and PCT normal groups（PCT2 μg·L-1）. Results Blood cultures were negative in 63 neonates,with the average count of WBC being（29.45±9.61）×109 L-1,and the average percentage of neutrophils was 0.783 6±0.078 6,while the percentage of rod-shaped nuclear was 0.077 0±0.037 7,platelet was（241.44±9.30）×109 L-1.Among them 28 neonates had abnormal PCT（≥2 μg·L-1） with median value 7.07（2.02,53.57） μg·L-1,and 35 neonates had normal PCT（2 μg·L-1）with median value PCT 0.45（0.05,1.83） μg·L-1.The gestational age,birth weight,abnormal history of fetal heart rate,the history of amniotic fluid contamination,premature rupture of membranes,the history of maternal fever,maternal infection,white blood cells count and the percentage of neutrophils and rod-shaped nuclear were not significantly different between the 2 groups.In the high PCT group,CRP increased in 5 neonates,but in normal PCT group all neonates had normal CRP.Platelet count was higher in high PCT group than that in the normal PCT group before and after treatment（Pa0.01）.Spearman correlation analysis showed that there was no correlation among white blood cells,rod-shaped nuclear,platelet,and CRP with PCT（Pa0.05）. Conclusions In early neonatal mild infection was mainly manifested by WBC and rod-shaped nuclear increase,with or without CRP increasing,PCT is mostly normal.Therefore,PCT is not a sensitive indicator in diagnosing early neonatal mild infection.