摘要
目的 探讨血可溶性尿激酶型纤溶酶原激活物受体（soluble urokinase-type plasminogen activator receptor,suPAR）水平的动态变化,以及suPAR对新生儿晚发型败血症的预测价值.方法 选择2014年1月至2015年1月入住我院新生儿重症监护室、日龄＞7d确诊感染性疾病的新生儿为观察组,根据败血症诊断标准分为败血症组和非败血症感染组;同期选择本院住院、日龄＞7d、无感染的晚期新生儿为对照组.败血症组和非败血症感染组患儿于疑似感染症状1d内检测血培养,于发病后1d内、4d、10 d检测血suPAR及C反应蛋白（C-reactive protein,CRP）.对照组排除感染后检测血suPAR及CRP.比较各组新生儿在发病或排除感染后1d内血suPAR、CRP水平,以及败血症组与非败血症感染组存活患儿不同时间点血suPAR、CRP水平变化,并以败血症组患儿发病1d内血suPAR、CRP水平绘制预测败血症的受试者工作特征（receiver operating characteristic,ROC）曲线.结果 共纳入感染性疾病患儿65例,其中败血症组40例,非败血症感染组25例;对照组纳入20例.各组新生儿在发病或排除感染后1d内血suPAR与CRP水平差异均有统计学意义（P ＜0.001）.败血症组存活患儿suPAR水平随时间延长而明显下降,第10天明显低于发病后1d内[9.3（8.2,13.1）ng/ml比18.9（14.8,24.7） ng/ml],差异有统计学意义（P ＜0.05）;CRP水平则随时间变化先上升后下降,第4天与第10天相比差异有统计学意义[19.0（6.8,56.4） mg/L比6.4（2.5,12.0） mg/L,P＜0.05].非败血症感染组血suPAR与CRP水平无明显变化,差异均无统计学意义（P均＞0.05）.败血症组与非败血症感染组在发病后1d内均无死亡病例,存活患儿与后期死亡患儿发病后1d内血suPAR水平差异有统计学意义[15.4（10.6,21.6） ng/ml比22.6（15.4,31.9） ng/ml,Z=-2.063,P=0.039].败血症组患儿发病后1d内血suPAR ROC曲线下面积为0.955（95％CI0.906～1.000,P＜0.001）,当suPAR水平为10.9 ng/ml时,敏感度为90％,特异度为100％.结论 新生儿晚发型败血症早期血suPAR水平明显升高,并与病情严重程度有关.患病首日suPAR水平预测败血症的敏感度及特异度高,可辅助判断预后.
Objective To investigate the dynamic changes of soluble urokinase-type plasminogen activator receptor （suPAR） and its predictive value in late-onset sepsis in the newborn.Method To collect the data of neonates aged 7 days and older,who were diagonsed to have infections.They were admitted to neonatal intensive care unit of our Hospital from January 2014 to January 2015.The group of sepsis and nonseptic group were assigned according to the diagnostic criteria of sepsis,and a control group was selected without infection.Blood cultures were collected in patients on the first day when infection was identified and the serum suPAR and CRP were measured on the first day,fourth day and tenth day respectively.The controls were tested with suPAR and CRP when infection was excluded.The levels of blood suPAR and CRP in the three groups were compared and the receiver-operating characteristic curve was performed according to serum suPAR level of neonates with sepsis on the first day.Result A total of 65 infants with infections （40 were septic and 25 were non-septic） were enrolled in this study and 20 patients were selected as control group.There were significant differences in serum suPAR and CRP levels between the patients with and without infection （P 〈 0.001）.The level of suPAR in the survivors of the sepsis group was significantly decreased as time went by,and the difference was statistically significant on the 10th day compared with the 1 st day [9.3 （8.2,13.1） ng/ml vs.18.9 （14.8,24.7） ng/ml,P 〈 0.05].The level of CRP increased first initially and then decreased with time,while the highest level was on the 4th day and the difference was statistically significant compared with the 10th day [19.0 （ 6.8,56.4） mg/L vs.6.4 （2.5,12.0） mg/L,P 〈 0.05].The levels of serum suPAR and CRP in non-sepsis group were not significantly different （P 〉 0.05）.There were no deaths in the sepsis group and the non-septic group,but the levels of suPAR between survivals and deaths in the infection groups were statistically significant [15.4（10.6,21.6） ng/ml vs.22.6 （15.4,31.9） ng/ml,Z =-2.063,P =0.039].The area under the receiver-operating characteristic curve of serum suPAR was 0.955 （95% CI 0.906 ～ 1.000,P 〈0.001）,and the sensitivity was 90% and the specificity was 100% when the suPAR level was 10.9 ng/ml.Conclusion Early elevated serum suPAR levels were prominently related to the severity of neonatal late-onset sepsis.The level of first day suPAR has a high sensitivity and specificity in the prognosis of sepsis and can be helpful to predict the prognosis.
