C反应蛋白、血小板计数在早产儿院内感染所致败血症中的临床应用

Clinical application of C-reactive protein and platelet count in sepsis caused by nosocomial infection in preterm infants

目的探讨C反应蛋白(CRP)、血小板计数(PLT)动态变化对早产儿(≤35周)院内感染所致败血症的早期诊断、病情监测及治疗效果评价中的临床应用价值。方法选取2013年2月~2016年2月期间,在我院NICU收治的20例发生院内感染的早产儿作为观察组,按1∶1比例选择同期入院的无任何感染症状的20例早产儿作为对照组,监测其在住院期间1 d、3 d、5 d、7 d、10 d的CRP及PLT的水平,并进行比较。结果观察组和对照组第1天的CRP的中位数分别为57.60(47.73~68.70)、2.25(1.38~3.52),差异有统计学意义(Z=-5.410,P<0.001);PLT中位数分别为46.00(35.00~61.25)、213.00(197.50~233.00),差异有统计学意义(Z=-5.411,P<0.001)。经有效治疗后CRP逐渐下降,CRP水平7 d时仍高于正常,与对照组相比,差异具有统计学意义(Z=-4.767,P=0.009);经有效治疗10 d后,CRP基本降至正常,与对照组相比差异无统计学意义(Z=2.32,P=0.136)。PLT水平随病情好转逐渐升高,在第7天时基本恢复至正常水平(Z=-1.475,P=0.140)。同时以ROC曲线确定的PLT的最佳截断值为103.5×10~9/L,PLT<103.5×10~9/L为阳性。CRP的最佳截断值为8.6 mg/L,CRP>8.6 mg/L为阳性。血培养结果提示早产儿败血症以革兰阴性菌为主,且药敏结果提示对抗生素均敏感。结论早产儿CRP及PLT的动态变化能敏感地监测到院内感染的发生,对早产儿院内感染的早期诊断、病情监测及治疗效果监测具较高临床价值。

Objective To investigate the clinical application value of dynamic changes of C-reactive protein （CRP） and platelet count （PLT） in the early diagnosis, disease surveillance and evaluation of therapeutic effect in sepsis caused by uosocomial infection in preterm infants （≤ 35 weeks）. Methods 20 preterm infants with nosocomial infection admitted in NICU of our hospital from February 2013 to February 2016 were selected as the observation group and 20 preterm infants without symptoms of infection who were hospitalized in the same period were selected as the control group according to the ratio of 1：1. The levels of CRP and PLT on the 1 d, 3 d, 5 d, 7 d, 10 d during hospitalization were mon- itored and compared. Results The median of CRP in the observation group and control group on the first day was 57.60 （47.73-68.70） and 2.25 （1.38-3.52） respectively, with significant difference（Z=-5.410, P〈0.001）. The median of PLT in the two groups was 46.00 （35.00-61.25） and 213.00 （197.50-233.00）, respectively, and the difference was statistically significant （Z=-5.411, P〈0.001）. After effective treatment, the CRP gradually decreased and the level of CRP was still higher than normal in the observation group on the 7th day. And the difference compared with the control group was statistically significant （Z=-4.767, P=0.O09）. After 10 days of effective treatment, the CRP in the observation group ba- sically dropped to normal, and there was no significant difference between the two groups （Z=2.32, P=0.136）. The level of PLT increased gradually with the improvement of the disease and recovered to the normal level on the 7th day （Z=-1.475, P=0.140）. At the same time, the optimal cutoff value of PLT determined by ROC curve was 103.5×109/L, and PLT〈103.5×109/L was positive. The best cut-off value of CRP was 8.6 mg/L, and CRP〉 8.6 mg/L was positive. Blood culture results suggested that pre-term sepsis were mainly Gram-negative bacteria, and susceptibility results suggested that the bacteria were sensitive to antibiotics. Conclusion The dynamic changes of CRP and PLT in preterm infants can sensitively monitor the occurrence of nosoeomial infections, which have a high clinical value in the early diagnosis of nosocomial infections, in the monitoring of their condition and therapeutic effects in preterm infants.