血浆纤维蛋白原水平对新生儿脓毒症诊断及近期预后的价值

The value of plasma fibrinogen in the diagnosis and short-term prognosis of neonatal sepsis

目的探讨血浆纤维蛋白原水平对新生儿脓毒症诊断及近期预后的价值。方法选择2016年3月至2018年5月在孝感市妇幼保健院接受治疗的新生儿脓毒症患者48例(观察组)及健康新生儿48例进行研究。在进行抗生素治疗之前抽取血液样本,以枸橼酸三钠为抗凝剂,测定血浆纤维蛋白原水平。用标准血液学方法测定凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)和血小板计数。将观察组患儿根据严重程度分为两组:出现感染性休克和(或)弥散性血管内凝血(DIC)者为复杂脓毒症组,无此并发症者为单纯脓毒症组。比较两组血浆纤维蛋白原、PT、APTT及血小板计数。并比较28 d存活新生儿和死亡新生儿的上述参数。结果观察组患者纤维蛋白原、PT、APTT及血小板计数均明显高于对照组,差异有统计学意义(P<0.05)。复杂脓毒症患儿纤维蛋白原水平及血小板计数明显低于单纯脓毒症组,PT、APTT均明显高于单纯脓毒症组,差异均有统计学意义(P<0.05)。死亡组患儿纤维蛋白原水平及血小板计数明显低于存活组,PT、APTT均明显高于存活组,差异有统计学意义(P<0.05)。ROC曲线分析结果显示,血浆纤维蛋白原对新生儿脓毒症诊断截断值为301.90 mg/dL,AUC为0.729,P=0.023,灵敏度82.05%,特异度90.04%。结论血浆纤维蛋白原对新生儿脓毒症诊断截断值为301.90 mg/dL,同时该指标还可作为患儿近期预后预测指标。

Objective To investigate the value of plasma fibrinogen in the diagnosis and short-term prognosis of neonatal sepsis.Methods A total of 48 neonatal sepsis patients(observation group)and 48 healthy newborns who underwent treatment in Xiaogan City Maternal and Child Health Hospital from March 2016 to May 2018 were enrolled.Prior to antibiotic treatment.Blood samples were taken before antimicrobial therapy,and trisodium citrate was used as an anticoagulant to determine plasma fibrinogen levels.Plasma fibrinogen levels were determined using trisodium citrate as an anticoagulant.Prothrombin time(PT),activated partial thromboplastin time(APTT),and platelet count were determined using standard hematology methods.The children in the observation group were divided into two groups according to their severity:those with septic shock and/or disseminated intravascular coagulation(DIC)were in the complicated sepsis group,and those without complications were in the simple sepsis group.Plasma fibrinogen,PT,APTT and platelet counts were compared between the two groups.And compare the above parameters of 28 d surviving newborns and dead newborns.Results The fibrinogen,PT,APTT and platelet counts in the observation group were significantly higher than those in the control group(P<0.05).The levels of fibrinogen and platelet count in children with complex sepsis were significantly lower than those in the simple sepsis group,PT and APTT were significantly higher than those in the simple sepsis group(P<0.05).The levels of fibrinogen and platelet count in the death group were significantly lower than those in the survival group,and PT and APTT were significantly higher than those in the survival group(P<0.05).ROC curve analysis showed that the diagnostic cutoff value of plasma fibrinogen for neonatal sepsis was 301.90 mg/dL,AUC was 0.729,P=0.023,sensitivity was 82.05%,and specificity was 90.04%.Conclusion The diagnostic cutoff value of plasma fibrinogen for neonatal sepsis is 301.90 mg/dL,and this index can also be used as a predictor of short-term prognosis in children.