超敏C-反应蛋白与白蛋白比值对早产儿早发型感染的诊断价值

The diagnostic value of high-sensitivity C-reactive protein/albμmin ratio in evaluating early-onset infection in premature

目的探讨超敏C-反应蛋白与白蛋白比值（hs—CRP／ALB）在早产儿早发型感染中的诊断价值及临床意义。方法回顾性分析2013年7月至2015年7月山东省聊城市人民医院新生儿重症加强治疗病房（NICU）合并官内感染围生期高危因素早产儿的临床资料。根据早产儿感染结局分为感染组和非感染组；感染患儿再根据临床结局分为存活组和死亡组。收集并比较两组患儿前白蛋白（PA）、ALB、白细胞计数（WBC）、血小板计数（PLT）及人NICU时（0h）和24、48、72hhs—CRP水平的数值差异，采用受试者工作特征曲线（ROC）评价外周血hs-CRP／ALB对患儿住院期间发生感染的预测价值。结果共纳入符合条件的早产儿214例，感染组102例，非感染组112例；其中感染组患儿存活97例，死亡5例。①感染组和非感染组患儿人NICU后hs—CRP均升高，48h时感染组hs—CRP显著高于非感染组[mg/L：22．0（7．6，40。4）比18．3（12．9，23．4），Z=5．257，P=0．038]；之后非感染组hs—CRP开始下降，而感染组hs—CRP持续升高，至72h时明显高于非感染组[mg／L：25．5（9．8，43．5）比12．2（1．9，22．1），Z=5．879，P=0．042]。感染组患儿ALB、WBC均明显低于非感染组[ALB（g／L）：27．9±2．7比29．1±2．9，t=5．178，P=0．026；WBC（×109／L）：13．7±7．1比16．1±7．9，t=4．368，P=0．037]，48hhs—CRP／ALB明显高于非感染组[0．16（0．08，0．57）比0．07（O．00，0．23），z=3．436，P：0．042]，而PA和PLT与非感染组无差异。②在感染患儿中，与存活组比较，死亡组ALB降低（g／L：20．4±6．9比29．6±7．5，t=7．859，P=0．003），而48hhs-CRP和hs—CRP／ALB均明显升高[hs—CRP（mg／L）：25．8（15．6，54．8）比18．2（12．9，36．2），Z=-4．067，P=0．043；hs—CRP／ALB：0．31（0．28，0．76）比0．06（0．00，0．21），Z=-6．102，P=0．011]。⑧ROC曲线分析结果显示，48hhs—CRP／ALB预测感染的ROC曲线下面积（AUC）为0．765，当截断值为0．08时，敏感度为84．2％，特异度为76．3％。结论hs—CRP和ALB可以作为早期诊断新生儿早发型感染的有效指标，且入NICU48hhs—CRP／ALB升高可进一步提高诊断的敏感度，指导临床抗菌药物的使用。

Objective To observe the diagnostic value of high-sensitivity C-reactive protein/albμmin ratio （hs-CRP/ALB） in early-onset infection in premature and its clinical significance. Methods Clinical data of premature patients with high risk factors of intrauterine infection admitted to neonatal intensive care unit （NICU） of Liaocheng People＇s Hospital in Shandong Province from July 2013 to July 2015 were analyzed retrospectively. They were divided into infection and non-infection groups, as well as survival and death groups according to the outcome of the premature babies. The pre-albμmin （PA）, ALB, white blood cell count （WBC）, platelet count （PLT）, and hs-CRP at the moment of NICU admission （0 hour） and 24, 48 and 72 hours after NICU admission were compared. The receiver operating characteristic （ROC） curve was plotted for evaluation of the predictive value of serμm hs-CRP/ALB ratio for the babies during hospitalization. Results A total of 214 cases of premature infants were enrolled, with 102 cases in infection group, and 112 in non-infection group. In infection neonates, 97 of them survived, and 5 died. （1） The level of hs-CRP after NICU admission was increased in infection and non-infection groups, and it was significantly higher at 48 hours in infection group than that of the non-infection group ling/L： 22.0 （7.6, 40.4） vs. 18.3 （12.9, 23.4）, Z = 5.257, P = 0.038]. Then hs-CRP was decreased in non-infection, but it was persistently increased in infection group, and it was significantly higher at 72 hours in infection group than that of the non-infection group [mg/L： 25.5 （9.8, 43.5） vs.12.2 （1.9, 22.1）, Z = 5.879, P = 0.042]. The levels of ALB and WBC in infection group was significantly lower than those of the non-infection group [ALB （g/L）： 27.9±2.7 vs. 29.1 ±2.9, t = 5.178, P = 0.026; WBC （X 109/L）： 13.7±7.1 vs. 16.1 ±7.9, t = 4.368, P = 0.037], and at 48 hours hs-CRP/ALB in infection group was significantly higher than that of non-infection group [0.16 （0.08, 0.57） vs. 0.07 （0.00, 0.23）, Z = 3.436, P= 0.042]. There was no significant difference in PA and PLT between infection and non-infection groups. （2） In premature patients with infection, ALB in non-survival group was decreased （g/L： 20.4 ± 6.9 vs. 29.6 ±7.5, t = 7.859, P = 0.003）, and 48-hour hs-CRP and hs-CRP/ALB ratio was significantly increased when compared with that of survival group [hs-CRP （mg/L）： 25.8 （15.6, 54.8） vs. 18.2 （12.9, 36.2）, Z = 4.067, P = 0.043; hs-CRP/ALB： 0.31 （0.28, 0.76） vs. 0.06 （0.00, 0.21）, Z = 6.102, P = 0.011]. （3） It was shown by ROC curve analysis that the area under ROC curve （AUC） of g8-hour hs-CRP/ALB ratio for evaluating infection was 0.765, when the cut-off of 48-hour hs-CRP/ALB ratio was 0.08, the sensitivity was 84.2%, and the specificity was 76.3%. Conclusions The values of hs-CRP and ALB can be used as effective indexes in early diagnosis of intrauterine bacterial infection, and increase in 48-hour hs-CRP/ALB can improve the sensitivity of the diagnosis. Hs-CRP/ALB can be combined to guide rational use of antibiotics.