血清白蛋白水平与极低出生体重儿早发型败血症相关性研究

The relationship of serum albumin level and early-onset sepsis in very low birth weight infants

目的探讨生后首日血清白蛋白(serum albumin, ALB)水平在极低出生体重儿早发型败血症(early onset sepsis, EOS)中的预测价值。方法选择2015年1月至2020年12月西安市人民医院产科出生并入住新生儿科的胎龄<34周、出生体重<1 500 g的新生儿进行回顾性分析, 根据ALB水平分为高ALB组、中ALB组、低ALB组;根据最终诊断分为EOS组和非EOS组, 比较两组新生儿围产期情况、不同ALB组间C反应蛋白(C-reactive protein, CRP)与降钙素原(procalcitonin, PCT)水平, 以及ALB水平与EOS的相关性。采用受试者工作特征(receiver operating characteristic, ROC)曲线评价ALB对EOS的预测价值。结果共纳入183例, EOS组36例, 非EOS组147例;高ALB组62例, 中ALB组87例, 低ALB组34例。EOS组母亲羊膜腔感染发生率高于非EOS组(33.3%比6.8%, P<0.001)。低ALB组患儿CRP、PCT水平高于中、高ALB组, 中ALB组CRP、PCT水平高于高ALB组, 差异均有统计学意义(P<0.05)。EOS组ALB水平低于非EOS组[24.9(24.0, 28.5)g/L比29.5(27.4, 31.2)g/L], 低蛋白血症比例高于非EOS组(52.8%比10.2%), 差异均有统计学意义(P<0.001)。低ALB组EOS发生率高于中ALB组(55.9%比16.1%), 中ALB组EOS发生率高于高ALB组(16.1%比4.8%), 差异有统计学意义(P<0.001)。ALB预测EOS的ROC曲线下面积为0.795, 当临界值为27.0 g/L, 敏感度为69.4%, 特异度为79.6%。结论孕母羊膜腔感染、生后首日ALB<27.0 g/L的极低出生体重儿发生EOS的风险更高。

Objective To study the predictive value of serum albumin(ALB)on the first day of life for early-onset sepsis(EOS)in very low birth weight infants(VLBWI).Methods From January 2015 to December 2020,clinical data of VLBWI(gestational age<34 weeks,birth weight<1500 g)born and hospitalized in our hospital were collected.Based on the serum ALB level at admission,the infants were assigned into high,moderate and low ALB groups.C-reactive protein(CRP)and procalcitonin(PCT)levels among different ALB groups were compared.The infants were also assigned into EOS and non-EOS groups according to the occurrence of EOS and perinatal complications were compared between the two groups.The relationship between EOS and ALB level was analyzed.The predictive value of serum ALB was studied using receiver operating characteristic(ROC)curve analysis.Results A total of 183 infants were enrolled,including 62 in the high ALB group,87 in the moderate ALB group and 34 in the low ALB group;and 36 in EOS group and 147 in non-EOS group.The incidence of maternal chorioamnionitis was significantly higher in EOS group than non-EOS group[33.3%(12/36)vs.6.8%(10/147),P<0.001].Serum CRP and PCT in the low and moderate ALB groups were significantly higher than the high ALB group(P<0.05),and the low ALB group showed higher CRP and PCT than the moderate ALB group(P<0.05).Compared with the non-EOS groups,ALB in the EOS group was significantly lower[24.9(24.0,28.5)g/L vs.29.5(27.4,31.2)g/L,P<0.001]and the incidence of hypoproteinemia was significantly higher[52.8%vs.10.2%,P<0.001].As ALB decreased,the incidence of EOS increased.The incidence of EOS was 55.9%in the low ALB group,16.1%in the moderate ALB group and 4.8%in the high ALB group(P<0.001).The sensitivity and specificity of ALB predicting EOS was 69.4%and 79.6%,respectively,with a cut-off value of 27.0 g/L.Conclusions The VLBWI with maternal chorioamnionitis and serum albumin lower than 27.0 g/L on the first day of life have higher risk of EOS.