血PCT、CRP、WBC及PLT水平变化与新生儿坏死性小肠结肠炎病情严重程度的相关性研究

Correlation between Changes of Blood PCT,CRP,WBC and PLT Levels and Severity of Neonatal Necrotizing Enterocolitis

目的:探究血降钙素原(PCT)、C反应蛋白(CRP)、白细胞计数(WBC)及血小板计数(PLT)水平变化与新生儿坏死性小肠结肠炎(NEC)病情严重程度的相关性。方法:回顾性分析笔者所在医院新生儿科92例NEC患儿(NEC组)和30例正常新生儿(对照组),NEC患儿根据Bell分期法进行病情分级(Ⅰ期、Ⅱ期、Ⅲ期),采集新生儿血液标本检测PCT、CRP、WBC、PLT水平,比较监测指标差异。结果:NEC组患儿PCT、CRP、WBC水平显著高于对照组(P<0.05),PLT水平显著低于对照组(P<0.05);NECⅠ期患儿PCT、CRP、WBC水平显著低于Ⅱ、Ⅲ期患儿(P<0.05),PLT水平显著高于Ⅱ、Ⅲ期患儿(P<0.05);Ⅱ期、Ⅲ期患儿PCT、WBC水平比较差异无统计学意义(P>0.05),Ⅱ期患儿CRP水平显著低于Ⅲ期患儿(P<0.05),PLT水平显著高于Ⅲ期患儿(P<0.05);Spearman等级相关分析显示,PCT、CRP、WBC与NEC Bell分期呈正相关(r=0.765,0.742,0.647,P<0.05),PLT水平与NEC Bell分期呈负相关(r=-0.384,P<0.05);ROC曲线分析可知,PCT、CRP、WBC、PLT鉴别NECⅠ期、Ⅱ期、Ⅲ期患儿的截断值为2.71、25.12、14.83、147.26,诊断敏感性为83.70%、89.13%、35.29%、36.76%,特异性为60.87%、61.54%、90.22%、100%。结论:NEC患儿血清PCT、CRP、WBC及PLT水平均存在异常变化,PCT、CRP、WBC水平与Bell分期法病情分期呈正相关,PLT水平与Bell分期法病情分期呈负相关,其中PCT及CRP可作为鉴别轻、重症患儿的检测指标。

Objective:To investigate the correlation between the changes of procalcitonin (PCT),C-reactive protein (CRP),white blood cell count (WBC) and platelet count (PLT) levels and the severity of neonatal necrotizing enterocolitis (NEC).Method:A total of 92 children patients with NEC (NEC group) and 30 normal neonates (control group) in the department of neonatology of the author’s hospital were retrospectively analyzed.The children with NEC were given disease grading (stageⅠ,stageⅡ,stageⅢ) according to the Bell stage method.The blood samples of neonates were collected to detect the levels of PCT,CRP,WBC and PLT,and the differences in monitoring indicators were compared.Result:The levels of PCT,CRP and WBC in NEC group were significantly higher than those in control group (P<0.05),while the level of PLT was significantly lower than that in control group (P<0.05).The levels of PCT,CRP and WBC of children patients with stageⅠ NEC were significantly lower than those of stageⅡ children and stageⅢ children (P<0.05),while the level of PLT was significantly higher than that of stageⅡ children patients and stageⅢ children patients (P<0.05).There were no statistically significant differences in the levels of PCT and WBC between stageⅡ children and stageⅢ children (P>0.05),and the CRP level of stageⅡ children was significantly lower than that of stageⅢ children,while the PLT level was significantly higher than that of stageⅢ children (P<0.05).Spearman rank correlation analysis showed that PCT,CRP and WBC were positively correlated with Bell stage of NEC (r=0.765,0.742,0.647,P<0.05),and PLT level was negatively correlated with Bell stage of NEC (r=-0.384,P<0.05).ROC curve showed that the cut-off values of PCT,CRP,WBC and PLT in identifying children with stageⅠ,Ⅱ,Ⅲ NEC were 2.71,25.12,14.83,147.26,and the diagnostic sensitivities were 83.70%,89.13%,35.29% and 36.76% and the specificities were 60.87%,61.54%,90.22% and 100%.Conclusion:There are abnormal changes in serum PCT,CRP,WBC and PLT levels in children with NEC.The levels of PCT,CRP and WBC are positively correlated with disease staging of Bell stage method,and the level of PLT is negatively correlated with disease staging of Bell stage method.PCT and CRP can be used as detection indexes to identify children patients with mild or severe illness.