降钙素原联合C反应蛋白检测在新生儿感染性肺炎中的诊疗价值

Value of procalcitonin combined with C-reactive protein detection in diagnosis and treatment of neonatal infectious pneumonia

目的探讨降钙素原联合C反应蛋白检测在新生儿感染性肺炎中的价值。方法选取2014年1月-2017年12月铜陵市妇幼保健院收治的380例新生儿感染性肺炎,其中分为尚未明确感染性质组115例,明确细菌感染组134例、混合感染组131例,对照组同期新生儿非感染疾病450例。观察新生儿降钙素原(PCT)、超敏C反应蛋白(hs-CRP)、血沉(ESR)、中性粒细胞百分比(N)、白细胞(WBC)计数及各指标的特异度及灵敏度。结果 (1)治疗前,与对照组比较,其他组ESR、N有显著差异(P<0.05),PCT、hs-CRP、WBC计数均无显著差异(P>0.05),细菌感染组及混合感染组PCT、hs-CRP、ESR、N、WBC计数显著上升(P<0.05);治疗后,细菌感染组及混合感染组PCT、hs-CRP、ESR、N、WBC计数显著下降(P<0.05),其他组PCT、hs-CRP无显著差异(P>0.05),ESR、N、WBC计数明显降低(P<0.05);而对照组hs-CRP、ESR、N及WBC计数无显著变化(P>0.05);(2)细菌感染组、混合感染组PCT阳性率73.13%、48.68%均显著高于其他组及对照组24.34%、31.11%(P<0.05),细菌感染组、混合感染组hs-CRP阳性率58.21%、51.91%均显著高于其他组及对照组32.17%、34.22%(P<0.05),细菌感染组、混合感染组ESR阳性率42.54%、46.56%均显著高于其他组及对照组26.08%、33.78%(P<0.05),细菌感染组、混合感染组N阳性率43.23%、45.04%均显著高于其他组及对照组38%、30.22%(P<0.05),四组间WBC计数无显著统计学差异(P>0.05),细菌感染组、混合感染组联合检测阳性率84.33%、58.20%均显著高于其他组及对照组50.43%、51.77%(P<0.05);(3)其他组、细菌感染组、混合感染组联合检测灵敏度分别为42.08%、92.39%、85.93%;(4)其他组、细菌感染组、混合感染组联合检测特异度分别为71.12%、91.35%、70.82%。结论降钙素原联合C反应蛋白检测对诊疗新生儿感染性肺炎意义非凡,对抗生素的应用、临床疗效及预后评价提供参考。

Objective To explore the value of procalcitonin（ PCT） combined with C-reactive protein（ CRP） detection in diagnosis and treatment of neonatal infectious pneumonia. Methods From January 2014 to December 2017,380 neonates with infectious pneumonia treated in Tongling Municipal Maternal and Child Health Care Hospital were selected and divided into unclear nature group（ 115 neonates）,bacterial infection group（ 134 neonates）,and mixed infection group（ 131 neonates）,450 neonates without infectious diseases during the same period were selected as control group. The levels of PCT,hypersensitive CRP,blood sedimentation（ ESR）,neutrophil percentage（ N）,white blood cell（ WBC） count,sensitivities and specificities of the indexes in the four groups were observed. Results Before treatment,there were statistically significant differences in ESR and N between control group and the other three groups（ P〈0. 05）,but there was no statistically significant difference in PCT,hs-CRP,and WBC count between control group and the other three groups（ P〈0. 05）,PCT,hs-CRP,ESR,N,and WBC count in bacterial infection group and mixed infection group increased significantly compared with control group（ P〈0. 05）; after treatment,the levels of PCT,hs-CRP,ESR,N,and WBC count in bacterial infection group and mixed infection group decreased significantly（ P〈0. 05）,but there was no statistically significant difference in PCT and hs-CRP in other groups（ P〈0. 05）,ESR,N,and WBC count decreased significantly（ P〈0. 05）; hs-CRP,ESR,N,and WBC count in control group didn＇t change significantly（ P〈0. 05）; the positive rates of PCT in bacterial infection group and mixed infection group were 73. 13% and 48. 68%,respectively,which were statistically significantly higher than those in the other two groups（ 24. 34% and 31. 11%）（ P〈0. 05）; the positive rates of hsCRP in bacterial infection group and mixed infection group were 58. 21% and 51. 91%,respectively,which were statistically significantly higher than those in the other two groups（ 32. 17% and 34. 22%）（ P〈0. 05）; the positive rates of ESR in bacterial infection group and mixed infection group were 42. 54% and 46. 56%,respectively,which were statistically significantly higher than those in the other two groups（ 26. 08% and 33. 78%）（ P〈0. 05）; the positive rates of N in bacterial infection group and mixed infection group were 43. 23% and45. 04%,respectively,which were statistically significantly higher than those in the other two groups（ 38. 00% and 30. 22%）（ P〈0. 05）;there was no statistically significant difference in WBC count among the four groups（ P〈0. 05）. The positive rates of joint detection in bacterial infection group and mixed infection group were 84. 33% and 58. 20%,respectively,which were statistically significantly higher than those in the other two groups（ 50. 43% and 51. 77%）（ P〈0. 05）; the sensitivities of joint detection in other groups,bacterial infection group,and mixed infection group were 42. 08%,92. 39%,and 85. 93%,respectively; the specificities of joint detection in other groups,bacterial infection group,and mixed infection group were 71. 12%,91. 35%,and 70. 82%,respectively. Conclusion PCT combined with CRP detection is of great significance in diagnosis and treatment of neonatal infectious pneumonia,which can provide a reference for application of antibiotics,clinical efficacy and prognosis evaluation.