晚发型败血症早产儿的动脉血乳酸、降钙素原和C反应蛋白联合判读的临床意义

Clinical significance of lactate,procalcitonin combined with C reactive protein interpretation in premature infants with late-onset sepsis

目的探讨动脉血乳酸、降钙素原(PCT)、C反应蛋白(CRP)联合判读对早产儿晚发型败血症病情评估的临床意义。方法随机选取未发生感染的42例早产儿纳入对照组,并选取确诊晚发型败血症的107例早产儿纳入感染组,患儿入院后接受动脉血乳酸、PCT、CRP、血小板(PLT)、白细胞(WBC)检测。感染组患儿进行新生儿危重病例评分(NCIS),依据NCIS评估患儿病情后分为A组(非危重症,30例)、B组(危重症,34例),C组(极危症,43例),分析乳酸、PCT、CRP对早产儿晚发型败血症病情评估的意义。结果受试者工作特征(ROC)曲线分析显示,CRP、PCT及乳酸对早期诊断败血症的最佳截断点分别是10.05 mg/L、0.53 ng/m L、2.70 mmol/L,曲线下面积(AUC)分别为0.889、0.884、0.695,三者联合检测的AUC为0.941,三者联合检测对早产儿晚发型败血症的敏感度及特异度显著更高。C组乳酸、PCT、CRP水平高于B组、A组,B组乳酸、PCT、CRP水平高于A组,差异有统计学意义(P<0.05或P<0.01);C组PLT水平低于B组、A组,B组PLT水平低于A组,差异有统计学意义(P<0.05或P<0.01);3组WBC水平对比,差异无统计学意义(P>0.05)。结论采用乳酸、PCT、CRP联合判读评估早产儿晚发型败血症病情的严重程度,可更早、更准确地对患儿病情进行评估以指导临床治疗。

Objective To investigate the clinical significance of lactate,procalcitonin(PCT)combined with C reactive protein(CRP)interpretation in judgment of disease condition in premature infants with late-onset sepsis.Methods Totally 42 premature infants without infection were selected as control group,and 107 premature infants with late-onset sepsis were selected as infection group.Lactate,PCT,CRP,platelets(PLT)and white blood cell count(WBC)in serum were determined after hospital admission.According to assessment result of Neonatal Critical illness Score(NCIS),the infants in infection group were divided into group A(non critical cases,n=30),group B(critical cases,n=34)and group C(extremely critical cases,n=43).The significance of lactate,PCT and CRP in the evaluation of premature infants with late-onset sepsis was analyzed.Results Receiver-operating characteristic(ROC)curve analysis showed that the best cut-off points of CRP,PCT and lactate for early diagnosis of sepsis were 10.05 mg/L,0.53 ng/m L and 2.70 mmol/L respectively,area under curve(AUC)was 0.889,0.884 and 0.695 respectively,and AUC of combination of three indicators was 0.941,which revealed that the sensitivity and specificity of the combined detection of the three were indicators were significantly higher for diagnosis of premature infants with late-onset sepsis.The levels of lactate,PCT and CRP in group C were significantly higher than those in group B and A,and the levels of lactate,PCT and CRP in groupB were significantly higher than those in group A(P<0.05 or P<0.01).The level of PLT in group C was significantly lower than that in group B and A,and the level of PLT in group B was significantly lower than that in group A(P<0.05 or P<0.01).There was no significant difference in the level of WBC among the three groups(P>0.05).Conclusion For premature infants with late-onset sepsis,the combination of lactate,PCT and CRP can earlier and accurately evaluate the disease condition to guide clinical treatment.