降钙素原在新生儿败血症早期诊断中的价值

The value of procalcitonin in the early diagnosis of neonatal sepsis

目的探讨降钙素原(PCT)在新生儿败血症早期诊断的临床价值。方法本实验选取2016年1月-2018年2月本院住院的118例败血症新生儿作为研究组和同期健康体检的新生儿43例作为对照组,比较二组外周血PCT、CRP、WBC和NEU的差异,制作ROC曲线研究单项指标或联合多项指标诊断新生儿败血症的价值。结果研究组患儿PCT、CRP和WBC计数均高于对照组患儿,差异有统计学意义(P<0.05),2组患儿的中性粒细胞百分比差异无统计学意义(P>0.05)。以临床新生儿败血症诊断标准绘制各项指标及其联合诊断新生儿败血症的ROC曲线,并计算AUC及95%CI。单项诊断指标中,WBC的AUC为0.601,CRP的AUC为0.900,PCT的AUC为0.919。PCT+CRP+WBC的AUC为0.993,显著提高了诊断性能。单项指标中PCT的敏感度最好,CRP特异度最好。PCT+CRP+WBC联合诊断,敏感度可达96.6%,特异度为100.0%。结论降钙素原、C-反应蛋白和白细胞的检测在新生儿败血症早期诊断中具有一定的临床价值,联合检测可以提高灵敏度和特异度,提高诊断效率。

Objective To investigate the clinical value of procalcitonin(PCT) in the early diagnosis of neonatal sepsis. Methods A total of 118 septic neonates hospitalized in our hospital from January 2016 to February 2018 were selected as the study group and 43 healthy newborns in the same period as a control group. The differences of PCT, CRP, WBC and NEU were compared between the two groups of peripheral blood, and the ROC curve was made to study the value of the single index or the combined multiple indicators in the diagnosis of neonatal sepsis. Results The PCT, CRP and WBC counts of the study group were higher than those of the control group, and the difference was statistically significant(P<0.05). There was no significant difference in the percentage of neutrophils between the two groups(P>0.05). The ROC curves of various indicators and their combined diagnosis of neonatal sepsis were drawn according to the diagnostic criteria for clinical neonatal sepsis, and AUC and 95% CI were calculated. Among the individual diagnostic indicators, the AUC of WBC was 0.601, the AUC of CRP was 0.900, and the AUC of PCT was 0.919. The AUC of PCT+CRP+WBC was 0.993, which significantly improved the diagnostic performance. Among the individual indicators, PCT had the best sensitivity and CRP had the best specificity. The combined diagnosis of PCT+CRP+WBC had a sensitivity of 96.6% and a specificity of 100.0%. Conclusion The detection of procalcitonin, C-reactive protein and leukocytes has certain clinical value in the early diagnosis of neonatal sepsis. Combined detection can improve sensitivity and specificity and improve diagnostic efficiency.