SAA及NGAL对早产儿脓毒症的预测价值

The value of serum amyloid A and neutrophil gelatinase-associated lipocalin in predication of neonatal sepsis

目的探讨血清淀粉样蛋白A(SAA)、人中性粒细胞明胶酶相关脂质运载蛋白(NGAL)在早产儿脓毒症中的预测价值。方法选取2014年1月至2015年1月入住该院新生儿重症监护室,日龄>7d,怀疑感染的68例早产儿作为研究对象,分为全身炎症反应综合征(SIRS)组、脓毒症组和严重脓毒症组,分别为16、31、21例;无感染早产儿19例纳入对照组;比较不同发病时间点、不同疾病严重程度患儿的SAA、NGAL、C反应蛋白(CRP)水平,同时采用受试者工作特征曲线比较上述指标的预测价值。结果发病当天,严重脓毒症组与SIRS组、对照组SAA、NGAL、CRP水平比较,差异有统计学意义(P<0.05);严重脓毒症组与脓毒症组SAA、NGAL水平比较,差异有统计学意义(P<0.05);脓毒症组与SIRS组CRP水平比较,差异有统计学意义(P<0.05)。发病4d及治疗结束时SAA、NGAL在严重脓毒症组中升高,与SIRS组、脓毒症组比较,差异有统计学意义(P<0.05);而CRP在发病4d及治疗结束时,严重脓毒症组及脓毒症组较SIRS组升高明显,差异有统计学意义(P<0.05);CRP在发病4d时严重脓毒症组及脓毒症组比较,差异无统计学意义(P>0.05);治疗结束时严重脓毒症组及脓毒症CRP水平差异有统计学意义(P<0.05)。发病当天,SAA、NGAL、CRP水平曲线下面积分别为0.97、0.89及0.85。结论 SAA及NGAL在早产儿脓毒症中有预测作用,随病情好转,该2项指标均下降,可用于指导临床治疗。

Objective To determine the value of serum amyloid A (SAA) and human neutrophil gelatinase-associated lipocalin (NGAL) in predication of neonatal sepsis. Methods A total of 87 infants were enrolled in this prospective study.The infants were divided into four groups including systemic inflammatory response syndrome (SIRS) group (16 cases),sepsis group (31 cases),severe sepsis group (21 cases),other 19 infants without sepsis in control group.SAA,NGAL and c-reactive protein (CRP) were compared at different time point and different disease severe degree.The receiver operating characteristic curve were drawn to evaluate the values of the three parameters in the forecast of neonatal sepsis. Results On the day of onset,the differences on SAA,NGAL and CRP levels between the severe sepsis group and those in the SIRS group and those in the control group were significant ( P < 0.05 ).SAA and NGAL levels in severe sepsis group and sepsis group were significantly different ( P <0.05).CRP level in sepsis group and SIRS group was statistically significant ( P <0.05).SAA and NGAL increased in severe sepsis group after onset 4 days and at the end of treatment,and the differences were statistically significant compared with that in SIRS group and sepsis group ( P <0.05).However,CRP was significantly higher in the severe sepsis group and the sepsis group than in the SIRS group after the onset 4 days and at the end of treatment,and the differences were statistically significant ( P <0.05).There was no significant difference in CRP between the severe sepsis group and the sepsis group after onset 4 days ( P >0.05).At the end of treatment,CRP levels in severe sepsis group and sepsis group were significantly different ( P <0.05).The area under the curve for SAA,NGAL and CRP at 0 h were 0.97,0.89 and 0.85 respectively. Conclusion SAA is useful at the onset of inflammation for rapid prognosis of neonatal sepsis and could be safely and accurately used in combination with other sepsis markers such as NGAL and CRP in diagnosis and follow-up of neonatal sepsis in preterm infants.