脐血中性粒细胞毒性改变联合降钙素原及超敏C反应蛋白在新生儿宫内细菌感染诊断中的价值研究

Study on the value of umbilical blood neutrophilic alteration combined with PCT and hs-CRP in the diagnosis of neonatal intrauterine bacterial infection

目的分析脐血中性粒细胞毒性改变、降钙素原(PCT)和超敏C反应蛋白(hs-CRP)在新生儿宫内细菌感染诊断中的价值,为临床提供参考。方法选取2020年5~12月出生的新生儿240例进行回顾性分析,其中临床确诊为宫内细菌感染87例(感染组),临床诊断为非感染153例(对照组)。分析比较两组新生儿的脐血中性粒细胞毒性改变(出现中毒颗粒、空泡变性、内外浆现象、杜勒氏小体之一)百分比、PCT值、hs-CRP值及其阳性率。结果感染组脐血中性粒细胞毒性改变百分比中位数(四分位数)为30(11,46)、PCT值中位数(四分位数)为1.28(0.19,10.67)、hs-CRP值中位数(四分位数)为8.2(1.7,26.3),高于对照组的中位数(四分位数)分别为3(0,10)、0.14(0.07,0.22),0.6(0.2,2.5),差异有统计学意义(均P<0.01)。感染组阳性率脐血中性粒细胞毒性改变百分比64.37%(56/87)、PCT 59.77%(52/87)和hs-CRP50.77%(44/87),均高于对照组的7.19%(11/153)、5.88%(9/153)、3.27%(5/153),差异有统计学意义(均P<0.01)。中性粒细胞毒性改变百分比灵敏度最高,达64.37%;hs-CRP的特异度最高,达96.73%;三项联合检测对宫内细菌感染的灵敏度、特异度、阳性预测值和阴性预测值分别为85.06%、86.93%、78.72%和91.10%。结论新生儿脐带血中性粒细胞毒性改变比例、PCT值和hs-CRP值能反映宫内细菌感染情况,对早期发现宫内细菌感染有重要意义,值得临床推广应用。

Objective To analyze the value of umbilical blood neutrophilic alteration,procalcitonin(PCT)and hypersensitive C-reactive protein(hs-CRP)in the diagnosis of neonatal intrauterine bacterial infection,so as to provide reference for clinical practice.Methods Retrospective analysis was conducted on 240 neonates born in hospital from May to December 2020.Among them,87 cases who were clinically diagnosed with intrauterine bacterial infection were selected as infection group,and 153 cases without intrauterine bacterial infection as control group.The percentage of neutrophilic changes in umbilical blood(toxic granules,vacuolar degeneration,internal and external plasma phenomenon,one of the Dullerian bodies),PCT value,hs-CRP value and their positive rates were analyzed and compared between the two groups.Results The percentage of median(quartile)of umbilical blood neutrophilic alteration,median(quartile)of PCT value and median(quartile)of hs-CRP value in the infection group were 30(11,46),1.28(0.19,10.67)and 8.2(1.7,26.3),respectively,which were significantly higher than those median(quartile)in the control group(3[0,10],0.14[0.07,0.22]and 0.6[0.2,2.5]),and difference was statistically significant(all P<0.01).The positive rate of percentage of neutrophil cytotoxicity change in cord blood,PCT value and hs-CRP value in the infection group were 64.37%(56/87),59.77%(52/87)and 50.77%(44/87),respectively,which were all higher than those in the control group(7.19%[11/153],5.88%[9/153]and 3.27%[5/153])in the control group,and difference was statistically significant(all P<0.01).The sensitivity of neutrophil cytotoxicity was the highest,up to 64.37%,the specificity of hs-CRP was the highest,up to 96.73%,and the sensitivity,specificity,positive predictive value and negative predictive value of the three combined tests for intrauterine bacterial infection were 85.06%,86.93%,78.72%and 91.10%,respectively.Conclusion The percentage of change of neutrophils toxicity,PCT value and hs-CRP value can reflect intrauterine bacterial infection,which is of great significance for early detection of intrauterine bacterial infection and worthy of clinical application and promotion.