血清降钙素原、超敏C反应蛋白单独及联合诊断新生儿细菌感染性肺炎的价值

Individual and combined diagnosis value of serum procalcitonin and high sensitivity C-reactive protein in neonatal bacterial infectious pneumonia

目的探讨血清降钙素原(PCT)、超敏C反应蛋白(hs-CRP)单独及联合诊断新生儿细菌感染性肺炎的价值。方法选取2017年1月～2018年1月于我院确诊的新生儿细菌感染性肺炎患儿80例(感染组)及健康体检新生儿60例(健康对照组)进行回顾性分析。比较两组的血清PCT、hs-CRP等指标水平,应用受试者工作特征曲线(ROC)比较各指标诊断新生儿细菌感染性肺炎的效能。结果感染组患儿的血清PCT和hs-CRP明显高于健康对照组(t=41.405,15.315,P=0.000,0.000)。ROC曲线显示,PCT与hs-CRP联合诊断新生儿细菌感染性肺炎的AUC最高(AUC=0.934,P=0.000),其次为PCT和hs-CRP(AUC=0.862,0.828,P=0.000,0.000),联合诊断的AUC高于PCT(Z=2.788,P=0.005)和hs-CRP(Z=3.232,P=0.001)。最佳截点为PCT>0.575μg/L和hs-CRP>8.639 mg/L,PCT与hs-CRP联合诊断的准确率高于PCT和hs-CRP(χ~2=3.968,6.130,P<0.05),灵敏度高于PCT和hs-CRP(χ~2=5.331,5.331,P<0.05)、特异度高于hs-CRP(χ~2=5.714,P<0.05),阴性预测值高于PCT和hs-CRP(χ~2=4.283,4.720, P<0.05),其余对比差异无统计学意义(P>0.05)。结论 PCT与hs-CRP联合诊断对新生儿细菌感染性肺炎具有更好的诊断效能,准确性、敏感性及特异性较高,值得临床推广。

Objective To explore the individual and combined diagnosis value of serum procalcitonin and high sensitivity C-reactive protein in neonatal bacterial infectious pneumonia.Methods From January 2017 to January 2018,80 neonates with bacterial infectious pneumonia(infection group)and 60 healthy children(healthy control group)were selected and analyzed retrospectively.Serum PCT,hs-CRP levels were compared between the two groups.The diagnostic efficiency of each index in neonatal bacterial pneumonia was compared applying the receiver operating characteristic curve(ROC).Results The levels of serum PCT and hs-CRP in the infection group were significantly higher than those in the healthy control group(t=41.405,15.315,P=0.000,0.000).The ROC curve showed that the area under the curve(AUC)in diagnosis of neonatal bacterial pneumonia of PCT combined with hs-CRP was the highest(AUC=0.934,P=0.000),followed by PCT and hs-CRP(AUC=0.862,0.828,P=0.000,0.000).AUC of combined diagnosis was higher than PCT(Z=2.788,P=0.005)and hs-CRP(Z=3.232,P=0.001).The best cut-off point was PCT>0.575μg/L and hs-CRP>8.639 mg/L.The accuracy of PCT combined with hs-CRP was higher than PCT and hs-CRP(χ^2=3.968,6.130,P<0.05),the sensitivity was higher than PCT and hs-CRP(χ^2=5.331,5.331,P<0.05),the specificity was higher than hs-CRP(χ^2=5.714,P<0.05),the negative predictive value was higher than PCT and hs-CRP(χ^2=4.283,4.720,P<0.05),and the other differences were not statistically significant(P>0.05).Conclusion PCT and hs-CRP combined diagnosis for neonatal bacterial infectious pneumonia has better diagnostic efficacy,diagnostic accuracy,sensitivity and specificity are higher.It is worthy of clinical promotion.