多种指标在新生儿重症感染早期诊断中的临床意义

Several indicators for the early diagnosis of neonatal severe infection

目的分析白细胞(WBC)、中性粒细胞比例(NEUT%)、血小板(PLT)、C反应蛋白(CRP)、降钙素原(PCT)和血清淀粉样蛋白A(SAA)等指标在新生儿重症感染早期诊断及感染严重程度判断中的临床意义。方法选取住院患儿158例,依据临床诊断分为重症感染组(53例)、局部感染组(46例)、非感染组(59例),检测各组WBC、NEUT%、PLT、CRP、PCT和SAA。采用受试者工作特征(ROC)曲线评价各项指标诊断新生儿重症感染的价值。结果重症感染组、局部感染组及非感染组之间WBC、PCT、SAA阳性率差异均有统计学意义(P<0.05)。重症感染组、局部感染组NEUT%、PLT阳性率与非感染组比较差异有统计学意义(<0.05)。重症感染组CRP阳性率显著高于其他2组(P<0.05)。重症感染组、局部感染组及非感染组之间PCT、hs-CRP、SAA水平差异均有统计学意义(P<0.05),重症感染组PLT、CRP水平与其他2组比较差异有统计学意义(P<0.05),局部感染组WBC水平与其他2组间差异有统计学意义(P<0.05),3组间NEUT%差异无统计学意义(P>0.05)。ROC曲线分析显示,PCT、CRP早期诊断新生儿重症感染的准确性较高,曲线下面积(AUC)分别为0.92、0.91。结论 WBC、NEUT%、PCT、CRP和SAA等指标对于新生儿重症感染的早期诊断均有一定的意义,其中PCT、CRP和SAA对于判断新生儿感染的严重程度有较大的临床意义。

Objective To evaluate the roles of several indicators,including white blood cell(WBC),neutrophil ratio(NEUT%),platelet(PLT),C-reactive protein(CRP),procalcitonin(PCT)and serum amyloid A(SAA)in the early diagnosis of neonatal severe infection and the assessment of neonatal infection severity.Methods A total of 158 newborns were enrolled.They were classified into severe infection group(53 cases),local infection group(46 cases)and non-infection group(59 cases)according to clinical diagnosis.WBC,NEUT%,PLT,CRP,PCT and SAA were determined.Receiver operating charateristic(ROC)curve was used to evaluate their roles in the diagnosis of neonatal severe infection.Results The positive rates of WBC,PCT,hs-CRP and SAA had statistical significance in severe infection group,local infection group and non-infection group(P<0.05).The positive rates of NEUT%and PLT had statistical significance in severe infection group,local infection group and non-infection group(P<0.05).The positive rate of CRP was higher in severe infection group than those in the other 2 groups(P<0.05).The levels of PCT and SAA had statistical significance in severe infection,local infection and non-infection groups(P<0.05).The levels of PLT and CRP had statistical significance between severe infection group and the other 2 groups(P<0.05).The level of WBC had statistical significance between local infection group and the other 2 groups(P<0.05).There was no statistical significance for NEUT%among the 3 groups(P>0.05).ROC curve analysis showed that PCT and CRP had high accuracies in the diagnosis of neonatal severe infection.The areas under curves(AUC)were 0.92 and 0.91.Conclusions WBC,NEUT%,PCT,CRP and SAA play roles in the early diagnosis of neonatal severe infection.The determinations of PCT,hs-CRP,CRP and SAA have clinical significance in the assessment of neonatal infection severity.