不同日龄降钙素原与C反应蛋白对新生儿早发型败血症的诊断价值

Diagnosis value of age-specific Procalcitionin and C-reactive protein on early-onset neonatal sepsis

目的比较出生后72 h内不同日龄降钙素原(PCT)与C反应蛋白(CRP)对新生儿早发型败血症(EONS)的诊断价值。方法分析2008年9月至2015年12月新生儿无严重并发症的EONS组96例(包括2例确诊败血症,94例为临床诊断败血症),同时期无感染对照组170例。266例新生儿共收集血样本605份。分别检测生后72 h内各日龄区间EONS组及对照组血清PCT于与CRP水平。比较PCT及CRP在出生后1~12 h、13~24 h、25~48 h与49~72 h不同日龄区间诊断EONS的诊断阈值、敏感性、特异性及曲线(ROC)下面积。结果在生后72 h内EONS组各日龄区间的血清PCT和CRP水平均高于对照组,差异均有统计学意义(P<0.05)。在出生后1~12 h、13~24 h、25~48 h、49~72 h不同日龄区间,PCT和CRP诊断EONS的诊断阈值分别对应为PCT 0.45、1.885、0.995、0.51,CRP 3.185、6.29、8.615、10.27、敏感性分别为PCT 84.2%、73.5%、82.4%、83.3%,CRP 68.4%、58.8%、54.3%、59.1%,特异性分别为PCT 74.4%、75%、74.1%、79.2%,CRP 82.1%、89.7%、93.9%、100%,ROC曲线下面积分别为PCT 0.767、0.754、0.755、0.8,CRP 0.773、0.8、0.815、0.789。结论在出生后72 h内,PCT与CRP对诊断无严重并发症的EONS各有日龄相关的诊断阈值,并均有中度的诊断准确性。两者在诊断EONS敏感性和特异性各有优势。PCT敏感性高于CRP可能更有助于EONS的早期筛查,而CRP的特异性高于PCT,但敏感性有限,对ENOS诊断可能有一定的局限性。

Objective To compare different diagnosis values of age-specific proealeitionin （PCT） and C- reactive protein （CRP） on early-onset neonatal sepsis （EONS） during the first 72h of life. Methods From September 2008 to December 2015, 96 neonates （including 2 confirmed sepsis and 94 clinical sepsis ） without severe complications were chosen as the EONS group and 170 non-infectious newborns as the control group. A total of 605 blood samples were collected from all 266 newborns. Serum concentration of PCT and CRP were measured in both the EONS group and the control group at each age over the first 72 h of life. The diagnostic value of PCT and CRP within 1 - 12 h and 13 - 24 h and 25 - 48 h and 49 - 72 h of life was evaluated by calculating the cut-off values, sensitivity, specificity, and the area under the receiver operating characteristic curve （ROC）. Results PCT and CRP levels of neonates within each age in the EONS group were significantly higher than those in the control group during the first 72h of life.（all P 〈 0.05）. Within 1 - 12 h, 13 - 24 h, 25 - 48 h and 49 - 72 h of life, the cut- off value of PCT was 0.45 μg/L （sensitivity 84.2%, specificity 74.4% ） , 1.885 μg/L （sensitivity 73.5%, specificity 75% ）, 0.995 μg/L （ sensitivity 82.4%, specificity 74.1% ） and 0.51 μg/L （ sensitivity 83.3%, specificity 79.2% ） respectively; that of CRP3 185 mg/L （sensitivity 68.4%, specificity 82.1% ）, 6.29 mg/L （sensitivity 58.8%, specificity 89.7% ）, 8.615 mg/L （sensitivity 54.3%, specificity 93.9% ） and 10.27 mg/L （sensitivity 59.1%, specificity 100% ） respectively, and the area under ROC of PCT for the diagnosis of EONS was 0.767, 0.754 and 0.755, and 0.8 respectively ; that of CRP 0.773, 0.8, 0.815 and 0.789 respectively. Conclusions There are age-specific cut-off values of PCT and CRP in the diagnosis of EONS without severe complications during the first 72 h of life. Both PCT and CRP are moderately accurate for the diagnosis of EONS. PCT may be more helpful for the early diagnosis of EONS for its higher sensitivity but CRP presents higher specificity.