脐血炎症标志物预测胎膜早破新生儿败血症的价值

The Value of Umbilical Cord Blood Inflammatory Markers in Predicting Neonatal Sepsis with Premature Rupture of Membranes

目的探讨胎膜早破产妇新生儿脐血中白介素-6(IL-6)、超敏C反应蛋白(hsCRP)、血清淀粉样蛋白A(SAA)水平在新生儿败血症早期诊断中的价值。方法选择2019年1月-2020年7月在玉环市人民医院产科出生且母亲胎膜早破>18 h的160例新生儿作为观察组,母亲未发生胎膜早破的80例新生儿作为对照组。两组病例均检测脐血IL-6、hsCRP和SAA水平。观察组新生儿根据是否发生新生儿败血症,分为败血症组和非败血症组,比较各组脐血IL-6、hsCRP和SAA水平,并绘制其诊断新生儿败血症的ROC曲线。结果观察组IL-6、hsCRP、SAA水高于对照组(P<0.05);败血症组IL-6、hsCRP和SAA水平高于非败血症组(P<0.05);经ROC曲线分析显示,脐血IL-6、hsCRP、SAA及三者联合检测对诊断新生儿败血症准确性较高,曲线下面积分别为:0.943(95%CI:0.904~0.983)、0.897(95%CI:0.845~0.948)、0.885(95%CI:0.835~0.935)及0.967(95%CI:0.942~0.992)。脐血IL-6、hsCRP、SAA及三者联合检测诊断新生儿败血症的敏感度分别为76.21%、85.70%、88.11%及85.72%;特异度分别为:98.52%、80.31%、77.30%及94.42%。结论胎膜早破产妇新生儿发生败血症风险增加,脐血IL-6、hsCRP和SAA检测有助于早期诊断新生儿败血症,其中IL-6的特异度较高,SAA的敏感度较高,三者联合检测预测新生儿败血症准确性较高。

Objective To investigate the value of interleukin-6(IL-6),high-sensitivity C-reactive protein(hsCRP)and serum amyloid A(SAA)in the early diagnosis of neonatal sepsis in puerpera with premature rupture of membranes.Methods A total of 160 neonates born in the Department of Obstetrics of Yuhuan People's Hospital from January 2019 to July 2020 and whose mothers had premature rupture of membranes>18 h were selected as observation group,and 80 neonates whose mothers did not have premature rupture of membranes were selected as control group.The level of IL-6,hsCRP and SAA in cord blood were detected in both groups.The neonates in the observation group were divided into sepsis group and non-sepsis group according to whether neonatal sepsis occurred.The levels of IL-6,hsCRP and SAA in umbilical cord blood of each group were compared,and the ROC curve was drawn for the diagnosis of neonatal sepsis.Results The level of IL-6,hsCRP and SAA in the observation group were higher than those in the control group(P<0.05);the level of IL-6,hsCRP and SAA in sepsis group were higher than those in non-sepsis group(P<0.05).ROC curve analysis showed that cord blood IL-6,hsCRP,SAA and its combined detection had high accuracy in the diagnosis of neonatal sepsis,and the area under the curve was 0.943(95%CI:0.904-0.983),0.897(95%CI:0.845-0.948),0.885(95%CI:0.835-0.935)and 0.967(95%CI:0.942-0.992),respectively.The sensitivity of umbilical cord blood IL-6,hsCRP,SAA and its combined detection in the diagnosis of neonatal sepsis was 76.21%,85.70%,88.11%and 85.72%,respectively;the specificity was 98.52%,80.31%,77.30%and 94.42%,respectively.Conclusion There is an increased risk of sepsis in neonates with premature rupture of membranes.The detection of umbilical cord blood IL-6,hsCRP and SAA is helpful for the early diagnosis of neonatal sepsis,among which the specificity of IL-6 is high,the sensitivity of SAA is high,and the combined detection of the three has a high accuracy in predicting neonatal sepsis.