C反应蛋白和降钙素原在足月新生儿ABO溶血病中的临床应用

Clinical application of C reactive protein and procalcitonin in ABO hemolytic disease of full-term newborns

目的探讨C反应蛋白(CRP)和降钙素原(PCT)在足月新生儿ABO溶血病(ABO HDN)中的临床特点,为临床合理使用抗菌药物提供指导。方法选取2019年1-12月重庆市妇幼保健院新生儿科的足月新生儿黄疸患儿进行回顾性分析,分为溶血组及非溶血组,对比分析临床资料、入院第1天和第2天CRP及PCT值、抗菌药物使用及入院3 d内感染发生情况。结果共有482例患儿纳入研究,其中溶血组203例,非溶血组279例,溶血组中位入院日龄为3(2,4)d,明显低于非溶血组的7(5,9)d(P<0.05)。溶血组患儿入院第1天、第2天CRP及PCT值均高于非溶血组(P<0.05),溶血组入院第1天CRP和PCT值异常检出率均高于非溶血组(P<0.05)。溶血组与非溶血组患儿抗菌药物使用率分别为7.39%和1.79%,差异有统计学意义(P<0.05);溶血组与非溶血组患儿入院3 d内感染发生率比较差异无统计学意义(0.49%vs.0,P=0.241)。溶血组患儿入院时日龄与CRP(r=-0.314,P=0.000)及PCT(r=-0.744,P=0.000)分别存在负相关关系。结论足月ABO HDN患儿入院日龄较小且免疫性溶血反应可能导致入院早期CRP及PCT值均偏高,但其感染发生率与非溶血性新生儿黄疸患儿并无差异。

Objective To explore the clinical characteristics of C-reactive protein(CRP)and procalcitonin(PCT)in neonatal ABO hemolytic disease(ABO HDN),and to provide guidance for the clinical rational use of antibiotic.Methods Full-term neonates with jaundice admitted to Chongqing Health Center for Women and Children from January to December 2019 were selected for retrospective analysis.They were divided into the hemolytic group and the non-hemolytic group.The clinical data,CRP and PCT values on the first and second day of admission,antibiotic use and infection within 3 days after admission were compared and analyzed.Results A total of 482 full-term neonates with jaundice were enrolled in the study,including 203 cases in the hemolytic group and 279 cases in the non-hemolytic group.The median age of admission in the hemolytic group was 3(2,4)days,which was significantly lower than that in the non-hemolytic group[7(5,9)days],P<0.05.CRP and PCT values of the hemolytic group were higher than those of the non-hemolytic group both on the first and second day of admission(P<0.05).The abnormal rates of CRP and PCT in the hemolytic group were significantly higher than those in the non-hemolytic group on the first day of admission(P<0.05).The utilization rate of antibiotics in the hemolytic group and the non-hemolytic group were 7.39%and 1.79%,respectively,the difference was statistically significant(P<0.05).There was no significant difference in the incidence of infection within 3 days after hospitalization between the hemolysis group and the non-hemolysis group(0.49%vs.0,P=0.241).The admission age of the hemolytic group was negatively correlated with CRP(r=-0.314,P=0.000)and PCT(r=-0.744,P=0.000).Conclusion Full-term neonates with ABO HDN are admitted to the hospital at a younger age when compared with that of children with non-hemolytic neonatal jaundice,and immune hemolytic reaction may lead to high CRP and PCT values in the early stage of admission,but the incidence of infection is not different from that of children with non-hemolytic neonatal jaundice.