前降钙素检测在新生儿感染性疾病诊断中的临床应用探讨

The clinical application of procalcitonin in neonatal infectious diseases

目的探讨血清前降钙素(PCT)在新生儿感染性疾病的临床应用价值。方法新生儿败血症组60例,局部感染组56例,非感染组60例,入院时进行PCT、C反应蛋白(CRP)和外周血白细胞计数(WBC)检查,其中败血症组和局部感染组在抗感染治疗一周后复查PTC,并将结果进行分析。结果入院时败血症组的血PTC和CRP的平均值明显高于局部感染组和非感染组,差异均有统计学意义(P<0.01)。入院时局部感染组血PTC和CRP的平均值明显高于非感染组,差异有统计学意义(P<0.01)。败血症组外周血WBC与局部感染组和非感染组比较,差异无统计学意义(P>0.05)。局部感染组WBC和非感染组比较,差异无统计学意义(P>0.05)。PCT检测以2.5μg/L为临界点,对败血症的诊断敏感度是76.67%,特异度是80.17%;对所有感染的敏感度是54.31%,特异度是90.00%。CRP检测以8 mg/L为临界点,对败血症诊断的敏感度是55.00%,特异度是74.14%;对所有感染的敏感度是44.83%,特异度是81.67%。此外,败血症组和局部感染组在抗感染治疗一周后PTC都有明显下降,差异均有统计学意义(P<0.01)。结论与CRP比较,PTC诊断败血症和所有感染的敏感度和特异度均更高。PCT可作为新生儿细菌感染的检测指标,特别是对新生儿败血症的早期诊断、治疗、疗效评价和预后判定很有意义。

Objective To investigate the clinical value of serum procalcitonin （PCT） in the neonatal infectious disease. Methods Sixty patients with septicemia of newborn, fifty six patients with local infection, and sixty patients with non - infection were included into this study. All patients underwent PCT, C -reactive protein （CRP） and white blood cell count （WBC） examination at the admission. PTC was reexamined a week after anti - infection therapy in septicemia group and local infection group. Results The average value of PTC and CRP in the septicemia group was significantly higher than that of local infection group and non - infected group at admission, the differences were statistically significant （ P 〈0.01 ）. The average value of PTC and CRP in the blood of local infection group were higher than those of the average non - infected group, the difference was statistically significant （ P 〈0.01 ）. However, we did not found the significant difference of peripheral WBC count between sep- sis group and local infection group, infection group and non- infected group （ P 〉 0.05 ）. This study demonstrated that 2.5pxg/ L of PCT is a critical point The sensitivity of this value was 71.67%, the specificity is 80.17% in septicemia. The sensitivity of this value in all infectious pa- tient is 54.31% , the specificity was 90.00% of the diagnosis of sepsis and infection. If 8 mg/L of CRP is a critical point in the diagnosis of sepsis and infection, the sensitivity and specificity are 55.00% and 74.13% in the diagnosis of sepsis. The sensitivity and specificity are 44.82% and 81.67% in the diagnosis of infection. In addition, the value of PTC in Sepsis group and local infection group was decreased significantly after one week anti - infective treatment （ P 〈 0.01 ）. Conclusion It hints that the role of PTC was better than CRP in the diagnosis of sepsis and infec- tion. The PTC had higher sensitivity and specificity. PCT might be a detective indicator of neonatal bacterial infection, especially in the early diag- nosis of neonatal sepsis, treatment, evaluation of therapeutic efficacy and prognosis.