实验室联合检测在新生儿败血症早期诊断中的应用

Application of combined laboratory detection in early diagnosis of neonatal sepsis

目的探讨降钙素原(PCT)、C-反应蛋白(CRP)、白细胞计数(WBC)和血小板(PLT)联合检测在新生儿败血症诊断中的应用。方法选取同期住院符合条件的败血症患儿37例、局部感染患儿36例、非感染患儿30例,用酶联荧光分析法定量测定PCT,用免疫比浊法检测CRP,用LH750血细胞分析仪检测白细胞计数和血小板。结果 PCT和CRP水平在败血症组治疗前均显著高于局部感染组和非感染组(P<0.01),且二者间呈显著正相关(P<0.05),经有效抗生素治疗后显著下降(P<0.01);而败血症组WBC计数和PLT水平与局部感染组和非感染组比较,差异无统计学意义(P>0.05)。PCT的敏感度、特异度、阳性预测值、阴性预测值、约登指数、阳性似然比分别为89.2%、90.0%、91.7%、87.1%、0.79和8.92,为4项指标中最高。联合检测PCT、CRP、WBC、PLT,则其诊断新生儿败血症的特异度和阳性预测值均达100%。4项指标受试者工作曲线(ROC曲线)下面积分别为0.970、0.733、0.580、0.621。结论联合检测PCT、CRP、WBC计数和PLT能提高新生儿败血症早期诊断的特异度,诊断价值比单项检测更高。

Objective To investigate the clinical diagnostic value of combined detection of procalcitonin （PCT） ,C-reactive protein（CRP） ,white blood cell count（WBC） and platelet（PLT） in early diagnosis of neonatal sep-sis .Methods PCT ,CRP ,WBC and PLT were detected in 37 cases with sepsis（sepsis group） ,36 cases with local in-fection（local infection group） and 30 non-infection cases（non-infection group） .Results The levels of serum PCT and CRP in sepsis group before treatment were significantly higher than local infection group and non-infection group （P0 .05） .The sensitivity ,specificity ,positive predictive value ,negative predictive value ,Youden in-dex and positive likelihood ratio of PCT were 89 .2% ,90 .0% ,91 .7% ,87 .1% ,0 .79 and 8 .92 respectively ,which were the highest in the four indicators .The specificity and positive predictive value of combined detection of PCT , CRP ,WBC and PLT were 100% .The area under the receiver operating characteristic （ROC） curve of PCT ,CRP , WBC and PLT were 0 .970 ,0 .733 ,0 .580 and 0 .621 ,respectively .Conclusion Combined detection of PCT ,CRP , WBC and PLT could improve the specificity of early diagnosis of neonatal sepsis ,with higher diagnostic value than separate detection .