不同病原菌血流感染新生儿炎症指标差异性分析

Differential analysis of inflammatory indexes in neonates with bloodstream infection by different pathogens

目的探讨不同病原菌血流感染新生儿白细胞计数(WBC)、中性粒细胞分类百分比(NEU)、血小板计数(PLT)、C反应蛋白(CRP)、血清降钙素原(PCT)的差异性,为新生儿血流感染的早期诊断和治疗提供临床依据。方法选取该院2017年6月至2021年6月264例血培养阳性新生儿作为研究对象,按照病原菌种类分为革兰阴性菌(G-菌)组196例、革兰阳性菌(G+菌)组50例和真菌组18例;另随机选取同期184例血培养阴性新生儿作为对照组。根据患儿感染的主要病原菌类型分为大肠埃希菌组、肺炎克雷伯菌组、黏质沙雷菌组、肠球菌组、无乳链球菌组、金黄色葡萄球菌组,分别比较不同病原菌血流感染新生儿各项炎症指标的差异性,并且评价各项炎症指标的诊断效能。结果264例血培养阳性新生儿中感染G-菌196株(74.24%),感染G+菌50株(18.94%),感染真菌18株(6.82%)。G+菌组WBC均明显高于G-菌组和对照组,差异均有统计学意义(P<0.05)。G+菌组、G-菌组NEU均明显高于对照组和真菌组,差异均有统计学意义(P<0.05)。真菌组PLT低于G-菌组,G-菌组又低于G+菌组,G+菌组又低于对照组,4组间两两比较,差异均有统计学意义(P<0.05)。G-菌组、G+菌组、真菌组CRP水平分别与对照组比较,差异均有统计学意义(P<0.05)。G-菌组、G+菌组、真菌组PCT水平分别与对照组比较,差异均有统计学意义(P<0.05);G-菌组PCT水平高于G+菌组,G+菌组又高于真菌组,真菌组又高于对照组,差异均有统计学意义(P<0.05)。6种主要病原菌所致血流感染新生儿WBC两两之间比较,差异均无统计学意义(P>0.05)。无乳链球菌组NEU均明显高于大肠埃希菌组、肺炎克雷伯菌组、肠球菌组和金黄色葡萄球菌组,差异均有统计学意义(P<0.05)。肺炎克雷伯菌组、黏质沙雷菌组PLT降低幅度均明显高于大肠埃希菌组、肠球菌组和无乳链球菌组,差异均有统计学意义(P<0.05)。无乳链球菌组CRP水平高于肺炎克雷伯菌组和肠球菌组,差异均有统计学意义(P<0.05)。肺炎克雷伯菌组PCT水平明显高于大肠埃希菌组和肠球菌组,无乳链球菌组、黏质沙雷菌组PCT水平均明显高于肠球菌组,差异均有统计学意义(P<0.05)。PLT、CRP、PCT是新生儿血流感染G-菌的影响因素(P<0.05);CRP、PCT是新生儿血流感染G+菌的影响因素(P<0.05);PLT、CRP是新生儿血流感染真菌的影响因素(P<0.05)。结论WBC、NEU、PLT、CRP、PCT可提示新生儿血流感染病原菌的类型,为新生儿血流感染的早期诊断和治疗提供临床依据。

Objective To investigate the differences of white blood cell count(WBC),neutrophil differential percentage(NEU),platelet count(PLT),C-reactive protein(CRP)and serum procalcitonin(PCT)in neonates with bloodstream infection by different pathogens,to provide clinical basis for the early diagnosis and treatment of neonatal bloodstream infection.Methods A total of 264 neonates with positive blood culture from June 2017 to June 2021 in this hospital were selected as the research objects,and were divided into gram-negative bacteria(G-bacteria)group(196 cases),gram-positive bacteria(G+bacteria)group(50 cases)and fungus group(18 cases)according to the type of pathogenic bacteria.Another 184 neonates with negative blood culture were randomly selected as the control group during the same period.According to the main pathogenic bacteria type of infection in children,they were divided into Escherichia coli group,Klebsiella pneumoniae group,Serratia marcescens group,Enterococcus group,Streptococcus agalactiae group and Staphylococcus aureus group.The differences of each inflammatory index in neonates with bloodstream infection by different pathogens were compared,and the diagnostic efficacy of each inflammatory index was evaluated.Results Among the 264 neonates with positive blood culture,196 strains(74.24%)of G-bacteria infected,50 strains(18.94%)of G+bacteria infected,and 18 strains(6.82%)of fungi infected.The WBC in the G+bacteria group was significantly higher than that in the G-bacteria group and the control group,and the differences were statistically significant(P<0.05).The NEU in the G+bacteria group and the G-bacteria group were significantly higher than those in the control group and fungus group,the differences were statistically significant(P<0.05).The PLT in the fungus group was lower than that in the G-bacteria group,the G-bacteria group was lower than the G+bacteria group,and the G+bacteria group was lower than the control group,there were statistically significant differences among the 4 groups(P<0.05).Compared with the control group,the CRP levels in the G-bacteria group,the G+bacteria group and the fungus group were significantly different(P<0.05).Compared with the control group,the PCT levels in the G-bacteria group,the G+bacteria group and the fungus group were significantly different(P<0.05).The level of PCT in the G-bacteria group was higher than that in the G+bacteria group,the G+bacteria group was higher than the fungus group,and the fungus group was higher than the control group,and the differences were statistically significant(P<0.05).There was no significant difference in prairwise comparison of WBC in neonates with bloodstream infection caused by 6 major pathogens(P>0.05).The NEU in Streptococcus agalactiae group was significantly higher than that in Escherichia coli group,Klebsiella pneumoniae group,Enterococcus group and Staphylococcus aureus group,and the differences were statistically significant(P<0.05).PLT in Klebsiella pneumoniae group and Serratia marcescens group was significantly higher than that in Escherichia coli,Enterococcus and Streptococcus agalactiae group,and the differences were statistically significant(P<0.05).The CRP level in Streptococcus agalactiae group was higher than that in Klebsiella pneumoniae group and Enterococcus group,and the differences were statistically significant(P<0.05).The PCT level in Klebsiella pneumoniae group was significantly higher than that in Escherichia coli group and Enterococcus group,and the PCT levels in Streptococcus agalactiae group and Serratia marcescens group were significantly higher than that in Enterococcus group,the differences were statistically significant(P<0.05).PLT,CRP and PCT were influencing factors for neonatal bloodstream infection by G-bacteria(P<0.05);CRP and PCT were influencing factors for neonatal bloodstream infection by G+bacteria(P<0.05);PLT and CRP were the influencing factors for neonatal bloodstream infection by fungal(P<0.05).Conclusion WBC,NEU,PLT,CRP and PCT could indicate the type of pathogenic bacteria in neonatal bloodstream infection,and provide clinical basis for early diagnosis and treatment of neonatal bloodstream infection.