新生儿感染性疾病127例临床研究

Clinical study on 127 cases with suspected early-onset sepsis

目的探讨新生儿感染性疾病实验室非特异性指标相关因素的诊断价值。方法选取2016年7月至2017年7月承德市中心医院NICU收治的127例出生0~3 d的感染性疾病患儿为感染组,103例0~3 d非感染性疾病新生儿为对照组,比较两组新生儿的临床症状、围产期因素以及实验室指标等。结果与对照组新生儿相比,感染组患儿喂养困难(15.7%)、呼吸困难(30.7%)、呻吟(31.5%)、皮肤黄染(18.1%)和窒息(5%)等初始症状差异均有统计学意义(χ~2=4.136、24.574、33.282、38.039,P均<0.001)。围产期因素中两组新生儿母亲孕晚期有感染病史和胎膜早破>18 h两个因素差异有统计学意义(χ~2=10.536、10.717,P均=0.001)。实验室指标结果显示,两组新生儿C-反应蛋白(CRP)、白细胞计数以及中性粒细胞百分比差异均有统计学意义(t=2.740、P=0.008,t=6.378、P<0.001,t=4.860、P<0.001)。感染组患儿ROC曲线分析显示:CRP、白细胞计数、中性粒细胞百分比最佳截断点分别为8.0 mg/dl、12.65×109/L和63.15%,敏感性分别为24.3%、62.2%和68.9%,特异性分别为99.0%、81.2%和84.4%,曲线下面积(AUC)分别为0.544、0.707和0.769;CRP、白细胞计数和中性粒细胞百分比三者联合敏感性为83.8%,特异性为75.0%,曲线下面积(AUC)为0.860,显著高于单项指标。结论新生儿感染性疾病的发生与多种围产期因素密切相关,以呼吸系统症状为始发临床表现多见。CRP、白细胞计数和中性粒细胞百分比联合诊断可以提高诊断价值。围产期因素、临床表现和实验室指标相结合,有利于早期识别新生儿感染性疾病。

Objective To investigate the diagnostic value of related nonspecific indexes in the laboratory factors for neonatal infectious diseases. Methods From July 2016 to July 2017, a total of 127 cases with infectious diseases in NICU of Chengde Central Hospital were selected as infection group, while 103 cases of non-infection newborns（0-3 day） were taken as the control group. Perinatal factors, laboratory indicators and other clinical factors were compared between the two groups. Results Compared with the control group, initial symptoms such as feeding difficulties（15.7%）, breathing difficulties（30.7%）, groans（31.5%）, yellow skin stains（18.1%） and suffocation（5%） were significantly different in the infection group（χ~2 = 4.136, 24.574, 33.282, 38.039; all P 0.001）. There were significant differences of perinatal factors between the two groups of newborns with a history of infection in the late stages of pregnancy and premature rupture of the fetal membrane 18 h（χ~2 = 10.536, 10.717; both P = 0.001）. The results of laboratory indicators showed that the C-reactive protein（CRP）, count of white blood cell（WBC） and percentage of neutrophils between newborns in the two groups were all significantly different（t = 2.740, P = 0.008; t = 6.378, P 0.001; t = 4.860, P 0.001）. The ROC curve analysis of infection group showed that the best cutoff points for CRP, count of WBC and neutrophils were 8.0 mg/dl, 12.65 × 109/L and 63.15%, respectively; the sensitivity were 24.3%, 62.2% and 68.9%, respectively; the specificity were 99.0%, 81.2% and 84.4%, respectively; and the area under the curve（AUC） were 0.544, 0.707 and 0.769, respectively. The combined sensitivity of CRP, count of WBC and neutrophils was 83.8%, the specificity was 75.0%, and the AUC was 0.860, which was significantly higher than the individual index. Conclusions The incidence of neonatal infectious diseases is closely related to many perinatal factors, and mainly showed the clinical manifestations of respiratory symptoms. The combined diagnosis of leukocyte count and neutrophil percentage could improve the diagnostic value. The combination of perinatal factors, clinical manifestations and laboratory indexes are beneficial to the early identification of neonatal infectious diseases.