降钙素原水平检测与脓毒血症新生儿预后的相关性

Relationship between PCT level and prognosis of neonates with sepsis

目的探讨降钙素原(PCT)检测水平在脓毒血症新生儿中的变化情况及其在患儿预后判断中的应用价值。方法选取本院新生儿科2012年9月至2014年12月收治的98例脓毒症新生儿作为研究组,同期40例健康新生儿作为对照组,比较两组新生儿入院时的PCT、C反应蛋白(CRP)、白细胞(WBC)、急性生理与慢性健康评分(APACHEⅡ)差异,并根据新生儿危重病例评分(NCIS)的对脓毒症患儿进行分组比较,采用受试者工作曲线(ROC)分析PCT对判断脓毒症新生儿预后的临床价值。结果研究组患儿的PCT为(15.37±7.16)ng/L、CRP为(39.82±11.75)mg/L、WBC为(15.8±3.17)×10~9/L值均显著的高于对照组新生儿组的PCT:(0.84±0.72)ng/L、CRP:(1.96±1.35)mg/L、WBC:(9.4±2.1)×10~9/L,且差异均具有统计学意义(t值分别为12.78、20.28、11.75,均P<0.05)。非危重患儿有36例、危重患儿33例、极度危重患儿29例,PCT、CRP、WBC及APACHEⅡ评分的组间比较结果为非危重组<危重组<极危重组患儿(F值分别为14.09、14.18、10.05、7.88,均P<0.05),并且组间两两比较结果差异均具有统计学意义(两两比较采用LSD—t检验,均P<0.05)。PCT≥14.86μg/L组患儿43例中有21例患儿死亡,死亡率为48.84%,显著高于<14.86μg/L组的14.55%,并且差异具有统计学意义(X^2=13.62,均P<0.05)。绘制ROC曲线显示,PCT预测患儿不良预后的曲线下面积AUC为0.862,大于0.800。结论 PCT检测水平在脓毒血症患儿显著高于正常新生儿,同时与患儿的病情程度有一定的关系,PCT作为一种对脓毒血症患儿预后进行预测的临床指标具有一定的价值。

Objective To investigate the changes of procalcitonin （PCT） level in neonatal sepsis and its value in the prognosis of patient neonates .Methods From September 2012 to December 2014 98 cases of neonatal sepsis admitted in pediatric department of Maternal and Child Health Hospital of Zhejiang City were selected in study group , and 40 healthy neonates selected at the same period were in control group.Two groups were compared in PCT , C reactive protein, white blood cell （WBC）, and acute physiology and chronic health score （APACHE II）, and neonatal critical illness score （NCIS） was used to group neonates with sepsis .Receiver operating characteristic curve （ ROC） was used to analyze the clinical value of PCT on judging the prognosis of sepsis in neonates .Results In study group PCT , CRP and WBC were 15.37 ±7.16ng/L, 39.82 ±11.75mg/L and （15.8 ±3.17） ×10^9/L, respectively, and they were significantly higher than those in the control group [0.84 ±0.72ng/L, 1.96 ±1.35mg/L, （9.4 ±2.1） ×109/L] （t value was 12.78, 20.28 and 11.75, respectively, all P〈0.05）.There were 36 cases of non-critically ill neonates, 33 critical ill neonates and 29 extreme ill neonates.Group comparison showed that PCT , CRP, WBC and APACHEⅡwere lowest in non-critically ill group , followed by critical ill group and extreme critically ill group （F value was 14.09, 14.18, 10.05 and 7.88, respectively, all P〈0.05）, and the differences revealed in group comparison were statistically remarkable （P〈0.05）.In the group with PCT≥14.86μg/L, 21 of 43 cases died with mortality of 48.84%, which was remarkably higher than 14.55%in the group with PCT 〈14.86μg/L （χ2 =13.62,P〈0.05）.ROC revealed that AUC of PCT predicting poor prognosis was 0.862, which was higher than 0.800.Conclusion PCT level is significantly higher in neonates with sepsis than in normal neonates , and it has certain relationship with the severity of disease in neonates .It has certain value as a clinical index to predict the prognosis of neonates with sepsis .