降钙素原在诊断新生儿败血症中的价值

Significance of procalcitonin in diagnosis of neonatal sepsis

目的探讨降钙素原(PCT)在诊断新生儿败血症中的价值。方法选择日龄0-28d新生儿分为三组:A组188例,日龄0-3d,非感染性新生儿,依据入院时龄分为六个亚组;B1组30例,日龄4-28d,诊断新生儿败血症;B2组30例,日龄4-28d,非感染性新生儿。采血以分别进行PCT、C反应蛋白(CRP)、血培养及血常规检测。结果 A组的非感染性新生儿在出生后24-36h血清PCT浓度达到高峰(1.27-2.94μg/L),48h后逐渐降至正常范围(0.24-0.41μg/L)。以PCT≥0.68μg/L作为新生儿败血症的诊断指标,其灵敏度、特异度、阳性预测值、阴性预测值、准确性、约登指数分别为90.0%、93.3%、93.1%、90.3%、91.7%、83.3%,优于CRP≥7.5mg/L的80.0%、86.7%、85.7%、81.3%、83.3%、66.7%。结论新生儿PCT浓度在出生后0-3d存在生理性高峰。PCT≥0.68μg/L对于诊断新生儿败血症具有较高的灵敏度和特异度。

Objective To investigate the value of procalcitonin（PCT） in the diagnosis of neonatal sepsis. Methods Neonates aged 0-28 days were divided into three groups of A（188 cases, aged 0-3 days without neonatal infection）, B1 （30 cases, aged 3-28 days with neonatal sepsis） and B2 （30 cases, aged 3-28 days without neonatal sepsis）. Serum concentrations of PCT and C-reactive protein（CRP） were determined and blood culture and blood cell count were performed. Results Serum PCT peaked in 24-36 h after birth（1.27-2.94 g/L）, which recovered to normal range of 0. 24- 0.41μg/L 48 h later. Taking PCT≥0. 68 μg/L as a diagnostic marker, the sensitivity （90. 0%）, specificity（93.3%）, positive predict value （93.1%）, negative predict value （90. 3%）, accuracy （91.7%） and Youden＇ s index （83.3%） were all higher than 80.0%, 86.7%, 85.7%, 81.3%, 83.3%, and 66.7% by CRP. Conclusion Serum PCT concentration of newborns shows a physiological peak in 3 days after birth. Serum PCT concentration is a sensitive and specific marker in the diagnosis of neonatal septicemia when PCT≥0.68μg/L is taken as a diagnostic criterion.