血清降钙素原对新生儿脓毒血症预后的应用价值

Value of serum procalcitonin on prognosis of neonatal sepsis

目的探讨血清降钙素原（PCT）对新生儿脓毒血症预后的预测价值。方法选取2012年1月~2015年1月住院的100例新生儿脓毒血症患儿作为研究对象。入院时检测血清PCT,根据患儿住院期间的临床结局,将患儿分为死亡组和存活组,对比这两组患儿入院时的血清PCT水平,并以14.86 ng/ml为临界值,观察PCT阳性组和阴性组患儿的危重程度,采用Kaplan-Meier法绘制不同PCT水平患儿的生存曲线。结果 100例患儿中,有38例患儿死亡,62例患儿成功存活,病死率为38%。存活组患儿与死亡组患儿的性别构成、平均日龄比较差异无统计学意义（P〉0.05）。与存活组相比,死亡组患儿入院时的血清PCT水平明显增高（P〈0.01）。100例患儿中,共有45例患儿PCT水平超过14.86 ng/ml,为阳性组,阴性组有55例患儿。两组患儿病情危重程度比较,差异有统计学意义（P〈0.01）,阳性组病情更严重。PCT阴性组患儿的生存曲线显示,其生存率较阳性组明显增加（P〈0.05）。采用受试者工作特征（ROC）曲线评价血清PCT水平对患儿住院期间发生死亡时间的预测效率。以14.86 ng/ml为临界值,其曲线下面积为0.82,PCT水平预测死亡情况的灵敏度达到72.83%,95%CI为0.50~0.89,特异度达到89.13%,95%CI为0.76~0.96。结论 PCT对新生儿脓毒血症的预后具有较高的预测价值。

Objective To investigate prediction value of serum procalcitonin（ PCT） for prognosis of neonatal sepsis.Methods 100 cases of neonatal sepsis admitted to hospital from January,2012 to January,2015 were selected as research objects.Serum PCT of all cases were detected on admission.All patients were divided into death group and surviving group according clinical outcomes during their hospitalization. Serum PCT of the two groups on admission were compared,and 14. 86 ng / ml was taken as critical value to observe severity degree of patients in positive PCT group and negative PCT group. And Kaplan-Meier method was used to draw survival curve of patients with different PCT levels.Results Among all the 100 patients,38 patients died and 62 patients successfully survived,case fatality rate was 38%.Difference of gender composition and average ages of the death group and surviving group was not statistically significant（ P 〉 0. 05）. Compared with the survival group,serum PCT on admission in the death group significantly improved（ P〈0.01）.Among all the cases,45 cases in positive PCT group with PCT levels higher than 14.86 ng / ml,and 55 cases in negative PCT group with PCT levels higher than 14.86 ng / ml.Difference of disease severity of the two groups was statistically significant（ P〈0.01）,disease of the positive PCT group was more serious.Survival curve of the negative PCT group showed that its survival rate increased more significantly than that in the positive PCT group（ P〈0.05）.Receiver operating characteristic（ ROC） curve was used to evaluate predictive efficiency of serum PCT level on death time of patients during their duration of hospital stay.With 14.86 ng / ml as critical value,its area under the curve was 0.82.Predicted sensitivity of PCT levels for deaths reached to 72.83%,95%CI was 0.50 ~ 0.89,and specificity reached to 89.13%,95%CI was 0. 76 ~ 0. 96. Conclusion Serum PCT has high prediction value in the prognosis of neonatal sepsis.