血常规、C-反应蛋白和血培养对晚发型败血症早产儿继发新生儿坏死性小肠结肠炎的预测价值

Routine blood test,C-reactive protein and blood culture for predicting necrotizing enterocolitis in preterm infants with late-onset sepsis

目的探讨血常规、C-反应蛋白和血培养对晚发型败血症(late-onset sepsis,LOS)早产儿继发新生儿坏死性小肠结肠炎(necrotizing enterocolitis,NEC)的预测价值。方法回顾性纳入2015年1月1日至2020年1月1日陆军军医大学第一附属医院收治的80例LOS早产儿。根据是否继发NEC,分为NEC组(11例)和无NEC组(69例)。记录围产期情况以及LOS初期的血常规、C-反应蛋白及血培养结果,计算血红蛋白下降值(LOS发生前血红蛋白浓度-LOS初期血红蛋白浓度)。采用Mann-Whitney U检验、χ2检验或Fisher精确概率法比较组间围产期因素及血常规、C-反应蛋白及血培养结果的差异,采用二项逐步logistic回归分析评估LOS继发NEC的危险因素,并绘制受试者工作特征曲线,评估这些危险因素对LOS继发NEC的预测价值。结果(1)NEC组患儿胎龄、出生体重等围产期因素与无NEC组比较差异均无统计学意义(P值均>0.05)。(2)NEC组LOS初期平均血小板体积(mean platelet volume,MPV)、C-反应蛋白和血红蛋白下降值高于无NEC组[分别为11.7 fl(10.9~12.6 fl)与10.7 fl(10.3~11.6 fl),Z=-2.773;33.3 mg/L(21.3~92.9 mg/L)与13.5 mg/L(4.7~27.3 mg/L),Z=-2.662;25.0 g/L(18.0~36.0 g/L)与13.0 g/L(1.0~19.0 g/L),Z=-3.803;P值均<0.01]。(3)二项逐步logistic回归分析表明LOS初期MPV升高(OR=3.213,95%CI:1.104~9.354,P=0.032)和血红蛋白下降值大(OR=1.153,95%CI:1.057~1.257,P=0.001)是LOS早产儿继发NEC的独立危险因素。(4)MPV联合血红蛋白下降值对LOS早产儿继发NEC的预测界值分别为11.2 fl和14.0 g/L,灵敏度和特异度分别为1.00和0.71。结论MPV联合血红蛋白下降值也许有助于在LOS早期预测NEC的发生。

Objective To explore the value of blood routine indexes,C-reactive protein(CRP),and blood culture in predicting the occurrence of neonatal necrotizing enterocolitis(NEC)secondary to late-onset sepsis(LOS)in preterm infants.Methods This study retrospectively enrolled 80 premature infants with LOS admitted to the First Hospital Affiliated to Army Medical University from January 1,2015 to January 1,2020.Based on whether complicated by NEC or not,all the subjects were assigned into the NEC group(n=11)and non-NEC group(n=69).Laboratory data for perinatal conditions,complete blood cell count,CRP,and blood culture in the early stage of LOS were recorded,and the decreased value of the hemoglobin concentration before and at early stage of LOS was calculated.Mann-Whitney U test,Chi-square test or Fisher exact probability method was used to compare the differences in perinatal conditions,blood routine,CRP and blood culture results between different groups.Binomial stepwise logistic regression analysis and the receiver operating characteristic(ROC)curve were used to evaluate the risk factors and their predictive value for NEC secondary to LOS,respectively.Results(1)There was no significant difference in gestational age,birth weight or other perinatal factors between the NEC group and non-NEC group(all P>0.05).(2)Mean platelet volume(MPV),CRP,and the hemoglobin decreased value in NEC group were greater than those in non-NEC group[11.7 fl(10.9-12.6 fl)vs 10.7 fl(10.3-11.6 fl),Z=-2.773;33.3 mg/L(21.3-92.9 mg/L)vs 13.5 mg/L(4.7-27.3 mg/L),Z=-2.662;25.0 g/L(18.0-36.0 g/L)vs 13.0 g/L(1.0-19.0 g/L),Z=-3.803;all P<0.01].(3)Binomial stepwise logistic regression analysis suggested that higher MPV at early stage of LOS(OR=3.213,95%CI:1.104-9.354,P=0.032)and the decreased hemoglobin(OR=1.153,95%CI:1.057-1.257,P=0.001)were independent risk factors for NEC secondary to LOS in preterm infants.(4)The cut-off values of MPV combined with the decreased value of hemoglobin for predicting NEC in premature infants with LOS were 11.2 fl and 14.0 g/L,respectively,with a sensitivity of 1.00 and specificity of 0.71.Conclusions MPV combined with the decreased value of hemoglobin may help to predict NEC in the early stage of LOS for preterm infants.