联合非特异性指标对新生儿败血症早期诊断的价值研究

Early diagnostic value of combining non-specific indicators in neonatal septicemia

目的探讨联合非特异性指标即血常规、C-反应蛋白(CRP)、降钙素原(PCT)对早期新生儿败血症的诊断价值。方法通过查阅重庆医科大学附属儿童医院新生儿诊治中心2013年1月至2014年5月电子病历,收集确诊败血症新生儿95例、临床诊断败血症新生儿158例和非败血症新生儿160例,比较败血症组和非败血症组之间的血常规、CRP及PCT的差异;以血培养结果为金标准绘制ROC工作曲线,分析单项指标或联合多项指标诊断新生儿败血症的灵敏度、特异度等。结果败血症组和非败血症组之间PCT、CRP、WBC、I/T、PLT差异有统计学意义(P<0.05),曲线下面积(AUC)分别为0.892、0.847、0.828、0.700、0.681;5项指标对确诊组与非败血症组的诊断阳性率差异有统计学意义(P<0.05),单项指标以PCT诊断价值较高,其灵敏度和特异度分别为84.2%和66.9%;由二元Logistic回归分析所得拟合方程系数可知,联合PCT、CRP、WBC指标的AUC为0.974,其诊断的灵敏度和特异度分别为94.7%和87.5%,明显高于单项指标。结论联合PCT、CRP、WBC非特异性指标有助于早期诊断新生儿败血症。

Objective To evaluate the significance of routine blood test and C-reaction protein（CRP）,procalcitonin（PCT）in early diagnosis of neonatal septicemia.Methods Totally 95 cases of confirmed septicemia,158 cases of the clinical diagnosis of septicemia and 160 cases of non-septicemia who were admitted to Newborn Diagnosis and Treatment Center of Children′s Hospital of Chongqing Medical University from January 2013 to May 2014 were enrolled for this study.The routine blood test,CRP and PCT concentration of the three groups were analyzed.Taking blood culture as the gold standard,receiver operating characterristic（ROC）curve was drawn,sensitivity and specificity of single or combined indicator in early diagnosis of septicemia was analysed.ResultsThere was a significant difference between confirmed septicemia group and non-septicemia group in PCT,CRP,WBC,I/T,PLT（P〈0.05）;the area under the ROC curve（AUC）was 0.892,0.847,0.828,0.700,0.681,respectively;the five indicators for confirmed the diagnosis positive rate of septicemia group and non-septicemia group was statistically significant（P〈0.05）;the single indicator PCT had better diagnosis value,its sensitivity and specificity was 84.2%and 66.9%.With the application of regression of binary Logistic the AUC of combining PCT,CRP,WBC was 0.974,its sensitivity and specificity was 94.7%and 87.5%,which was higher diagnosis value than the only one indicator alone.Conclusion The combination of PCT,CRP and WBC have contribute to early diagnosis of neonatal septicemia.