新生儿B族链球菌败血症临床特征分析及白细胞介素6检测的诊断价值

Clinical characteristics of neonatal septicemia caused by Group B Streptococcus and diagnostic utility of IL-6

目的分析新生儿B族链球菌(GBS)败血症临床特征,探讨白细胞介素6(IL-6)作为诊断参考的可行性。方法选取2016年1月-2018年12月在佛山市高明区人民医院产科经阴道分娩且患有败血症的新生儿共167例,根据血培养结果,将GBS阳性的患儿纳入GBS组(n=48),而GBS阴性的患儿纳入非GBS组(n=119)。收集新生儿的临床特征资料,包括性别、胎龄、出生体重、产妇分娩前情况、临床表现等,进行两组间比较。同时,检测新生儿的血清IL-6水平并进行组间比较,评估IL-6对GBS感染的诊断价值。结果GBS组新生儿惊厥、神经系统并发症、喂养不耐受及病理性黄疸的发生率显著高于非GBS组(P<0.05)。回顾产妇分娩情况,GBS组胎膜早破>18h和前一胎感染GBS的发生率显著高于非GBS组(P<0.05)。GBS组新生儿的血清IL-6水平显著高于非GBS组(P<0.05)。受试者工作特征(ROC)曲线显示,当血清IL-6的表达阈值设定为64.599ng/L,其对GBS诊断的特异度为0.639,灵敏度为0.667,曲线下面积为0.691。结论新生儿GBS败血症对患儿的神经系统损害较多,IL-6对鉴别新生儿败血症患儿是否GBS感染具有中等的特异度和灵敏度,有一定的临床参考价值。

Objective To investigate the clinical characteristics of neonatal septicemia caused by Group B Streptococcus(GBS)and study the utility of IL-6 in its diagnosis.Methods A total of 167 newborns with neonatal septicemia who were delivered in Gaoming District People's Hospital from January 2016 to December 2018 were included in this study.Patients with GBS positive blood culture were assigned into GBS group(n=48),and the other patients were assigned to non-GBS group(n=119).Clinical data including gender,age,body weight,pre-delivery condition and clinical manifestations were collected and compared between the two groups.Serum IL-6 level was measured and analyzed to evaluate its utility in diagnosis of GBS infection.Results Seizure,neurological complication,feeding intolerance,and pathologic jaundice were more prevalent in GSB group than in non-GSB group(P<0.05).GBS group was associated with significantly higher incidence of premature rupture of membrane>18 h and GBS infection in last childbirth than non-GBS group(P<0.05).Patients in GBS group showed significantly higher serum level of IL-6 than in non-GBS group(P<0.05).According to ROC curve,IL-6 at 64.599 ng/L showed specificity of 0.639 and sensitivity of 0.667 in diagnosis of GBS infection.The area under ROC curve was 0.691.Conclusions Neonatal septicemia caused by Group B Streptococcus could lead to much damage in nerve system.IL-6 provides moderate sensitivity and specificity in diagnosis of GBS infection in patients with neonatal septicemia.