血浆肝素结合蛋白在新生儿脓毒症早期诊断中的应用价值

The clinical value for plasma heparin-binding protein in the early diagnosis of the neonatal sepsis

目的 探讨血浆肝素结合蛋白（HBP）对早期诊断新生儿脓毒症（NS）及脓毒症严重度分级的临床价值.方法 回顾性研究方法,选取2016年12月至2017年8月在湖南省儿童医院NICU住院的一般脓毒症患儿39例、严重脓毒症患儿37例、脓毒性休克患儿16例分别作为相应试验组,并选取同时期在各新生儿科住院的局部感染患儿34例及非感染患儿35例分别作为相应对照组;分别测定各组患儿入院时的HBP、降钙素原（PCT）及超敏C反应蛋白（hs-CRP）水平并采用非参数统计方法比较各指标组间差异的显著性;运用受试者工作特征曲线（ROC）比较各指标对感染和脓毒症诊断的效能.结果 一般脓毒症组、严重脓毒症组及脓毒性休克组HBP（H=91.764,P〈0.01）、PCT （H=51.757,P〈0.01）及hs-CRP（H=28.418,P〈0.01）水平均显著高于局部感染组和非感染组,差异有统计学意义;严重脓毒症[52.35（33.65,88.15）（ng/ml）]和脓毒性休克组[73.55（60.61, 145.51）（ng/ml）]血浆HBP水平明显高于一般脓毒症组[34.12（23.04,41.79）（ng/ml）],差异有统计学意义（H=24.092,P〈0.01）;三组患儿血清PCT 与hs-CRP水平差异无统计学意义[（HPCT=1.909,Hhs-CRP=0.292）,P〉0.05];HBP诊断新生儿脓毒症和新生儿感染的曲线下面积（AUC）分别为0.885和0.904,均高于PCT和hs-CRP;当诊断阈值（cut-off值）取19.8 ng/ml时,HBP诊断新生儿感染的敏感度和特异度分别为85.7%和82.9%,当cut-off值取28.0 ng/ml时,HBP诊断新生儿脓毒症的敏感度和特异度分别为80.4%和88.4%.结论 HBP在新生儿脓毒症早期诊断及临床分级方面优于PCT和hs-CRP,可能具有较好的临床应用价值.

Objective To investigate the clinical value of plasmatic heparin-binding protein in early diagnosis and severity gradation of neonatal sepsis.Methods Thirty-nine patients with general sepsis,37 patients with severe sepsis and 16 patients with septic shock were recruited as corresponding study groups respectively,who all had been admitted to the Neonatal Intensive Care Units（NICU）of Hunan Children′s Hospital from December 2016 to August 2017,meanwhile,34 patients with local infection and 35 patients with non infection were enrolled as relevant control group respectively who all had been admitted to each neonatal ward in the retrospective study.The level of the heparin-binding protein（HBP）, procalcitonin （PCT）and high sensitive C-reactive protein（hs-CRP）of all patients were detected respectively at the beginning of hospitalization.The difference of each group was compared by use of nonparametric statistics and the efficacy of every index on diagnosis of infection and sepsis was assessed with the receiver operating characteristic curve（ROC）.Results The level of HBP in sepsis group,severe sepsis group and septic shock group HBP（H=91.764,P〈0.01）, PCT（H=51.757,P〈0.01）and hs-CRP（H=28.418,P〈0.01）are significantly higher than those in local infection group and non infection group;Plasmic HBP levels of severe sepsis group[52.35（33.65,88.15）（ng/ml）]and septic shock group[73.55（60.61,145.51）（ng/ml）]are statistically higher than general sepsis group[34.12（23.04,41.79）（ng/ml）]（H=24.092, P〈0.01）.There are no statistically differences of serum PCT and hs-CRP among these three groups[（HPCT=1.909,Hhs-CRP=0.292）,P〉0.05].The area under the curve（AUC）of HBP in diagnosis of neonatal sepsis and infection are 0.885 and 0.904 respectively,more higher than PCT and hs-CRP;With the cut off value of 19.8 ng/ml,the sensitivity and specificity of HBP on diagnosis of infection are 85.7%and 82.9%respectively;the sensitivity and specificity 80.4% and 88.4% for neonatal sepsis with the cut-off value of 28.0 ng/ml respectively.Conclusion HBP probably has the better clinical value than PCT and hs-CRP in the early diagnosis and severity gradation of neonatal sepsis.