新生儿宫内细菌性感染中脐血降钙素原的早期预警和诊疗价值探讨

Early warning and diagnosis value of umbilical cord blood procalcitonin in neonatal intrauterine bacterial infection

目的 探讨新生儿宫内细菌性感染中降钙素原的早期预警和诊疗价值。 方法 选取2013-2015年在湖南省妇幼保健院产科分娩、有宫内感染高危因素的新生儿,按感染结局分为败血症组、局部感染组,非感染疾病组和正常组,检测4组新生儿脐血PCT和CRP水平,比较4组新生儿在脐血炎症指标不同水平区间的分布频率,分析各指标对宫内感染诊断的敏感度和特异度。 结果 感染状态下降钙素原（PCT）、C反应蛋白（CRP）水平均增高,从各组在不同水平区间的分布来看,在PCT为0.05-0.5 ng/ml区间内,非感染疾病组分布频率最高（91.92%）,局部感染组和败血症组分别为40.32%和30.91%。在新生儿科收治患儿中,PCT 以0.5 ng/ml为临界值,诊断感染的敏感性和特异性分别为59.75%和93.94%;其中诊断败血症的敏感性为69.11%,特异性为60.70%;诊断局部感染的敏感性为67.74%,特异性为71.43%。PCT 以2 ng/ml为临界值诊断败血症敏感性和特异性分别为40.00%和84.91%。CRP 以2 mg/L为临界值,诊断感染的敏感性为42.32%,特异性为89.89%;其中诊断败血症的敏感性47.27%,特异性为69.82%;诊断局部感染的敏感性为40.86%,特异性为70.17%。 结论 0.5 ng/ml脐血PCT诊断感染的敏感性和特异性相对CRP高, 可作为宫内细菌感染早期预警和辅助诊断指标,特别是PCT 2.0 ng/ml以上时,诊断败血症特异性可达84.91%,对于感染程度的评估具有一定意义,可有效地指导临床抗生素的应用及评估疗效。

Objective To explore umbilical cord blood procalcitonin （PCT） as a marker for early warning and diagnosis of neonatal intrauterine bacterial infection. Methods Newborns with high-risk factors of intrauterine infection and born in Hunan Provincial Maternal and Child Health Care Hospital during 2013-2015 were selected and divided into 4 groups according to the infection outcomes, including septicemia group, local infection group, non-infectious disease group and normal group. The levels of PCT and C reactive protein （CRP） in umbilical cord blood of the neonates of the 4 groups were detected. The distribution frequencies of different levels of the 2 inflammatory markers were compared among the 4 groups, and the sensitivities and specificities of the 2 inflammatory markers were analyzed. Results The levels of PCT and CRP in umbilical cord blood in the infected neonates were both increased. When PCT was 0.05-0.5 ng/ml, the distribution frequency of the non-infectious disease group was the highest （91.92%）, and those of the local infection group and septicemia group were 40.32% and 30.91% respectively. Among the newborns hospitalized in the neonatal department, when 0.5 ng/ml was taken as the critical value of PCT, the sensitivity and specificity for the diagnosis of the infection were 59.75% and 93.94% respectively, of which those for the diagnoses of septicemia and local infection were 69.11% and 60.70%, 67.74% and 71.43% respectively. When 2.0 ng/ml was taken as the critical value of PCT, the sensitivity and specificity for the diagnosis of septicemia were 40.00% and 84.91% respectively. When 2 mg/L was taken as the critical value of CRP, the sensitivity and specificity for the diagnosis of the infection were 42.32% and 89.89% respectively, of which those for the diagnoses of septicemia and local infection were 47.27% and 69.82%, 40.86% and 70.17% respectively. Conclusions The sensitivity of 0.5 ng/ml umbilical cord blood PCT in the diagnosis of infection is higher than that of CRP, which can be used as a marker for early warning and auxiliary diagnosis of intrauterine bacterial infection. When PCT is above 2.0 ng/ml, the specificity for diagnosing septicemia reaches 84.91%. It is conducive to assessing different infection degrees and effectively guiding the clinical application of antibiotics and evaluation of curative effect.