早产儿早期血清降钙素原与绒毛膜羊膜炎程度相关性分析

Analysis of correlation between chorioamnionitis and early serum PCT levels in premature infants

目的探讨早产儿早期血清降钙素原(procalcitonin,PCT)与胎盘组织学绒毛膜羊膜炎(histological chorioamnionitis,HCA)程度的相关性。方法回顾性选取2016年1月至2018年1月在银川市妇幼保健院产科出生并于生后2h内转入新生儿科的早产儿197例,根据胎盘病理检查结果分为HCA阳性组与阴性组,并根据绒毛膜羊膜炎分度标准分为轻度、中度及重度组,比较各组间的临床资料及实验室检查结果,探讨早产儿早期血清PCT水平与HCA程度的相关性,并判断其在预测早期感染的临床价值。结果HCA病理改变组的胎龄、出生体重较正常组低,PCT及总胆红素(total bilirubin,TB)较正常组高,差异有统计学意义(P<0.05);两组间性别、民族、全血白细胞(white blood cell,WBC)、中性粒细胞绝对值(neutrophil,NEUT)及C反应蛋白(C-reactive protein,CRP)差异无统计学意义(P>0.05)。不同程度HCA组在胎龄、WBC、CRP、PCT水平之间均有统计学具有统计学意义(P均<0.05),其中重度HCA组与轻度HCA组在胎龄、PCT、WBC差异具有统计学意义(P<0.01);HCA阳性早产儿组的胎龄与早期血清PCT水平存在负相关(r=-0.221,P<0.05),血清CRP水平与血清PCT水平存在正相关(r=0.445,P<0.01);早产儿入院血清PCT水平对判断宫内感染的灵敏度为52.3,特异度为82.5。生后2 h内的PCT水平在新生儿呼吸窘迫综合征时升高(P<0.05)。结论早产儿早期血清PCT水平随HCA炎症程度加重而升高,可作为早期判断是否存在宫内感染及部分新生儿感染性疾病的生化指标。PCT在新生儿呼吸窘迫综合征时升高,呼吸困难、胎龄及CRP值可影响HCA阳性早产儿的PCT水平。

Objective To explore the correlation between early serum procalcitonin level(PCT)and degree of placental histological chorioamnionitis(HCA)in premature infants.Methods A total of 197 premature infants born in the Obstetrics Department of Yinchuan Women and Children Health Care Hospital from January 2016 to January 2018 and transferred to the Neonatal Department within 2 hours after birth were retrospectively selected.They are divided into HCA positive group and normal group according to the placental pathological examination results.According to the chorioamnionitis classification criteria they werre divided into mild,moderate and severe groups.The clinical data and laboratory examination results were compared among the groups.The correlation between early serum PCT level and HCA degree in premature infants were studied,and its clinical value in predicting early infection was decided.Results The gestational age and birth weight of the HCA pathological change group were lower than those of the normal group,the PCT and total bilirubin(TB)levels were higher than those of the normal group,and there were statistical differences(P<0.05).There was no significant difference in gender,ethnicity,WBC,absolute neutrophil(Neutrophil,NEUT)or CRP between the two groups(P>0.05).There were statistical differences in gestational age,white blood cell(WBC),C-reactive protein(CRP),and PCT levels in different degrees of HCA groups(F=5.894~10.200,Z=7.281,P<0.05),in which the severe HCA group and the mild HCA group had significant statistical differences in gestational age,PCT,and WBC(P<0.01).The gestational age of HCA-positive preterm infants group was negatively correlated with early serum PCT levels(r=-0.221,P<0.05),while serum CRP levels were positively correlated with serum PCT levels(r=0.445,P<0.01).The sensitivity of serum PCT level of premature infants on admission to the hospital to determine intrauterine infection was 52.3,and the specificity was 82.5.The level of PCT within 2 hours after birth increased in neonatal respiratory distress syndrome(P<0.05).Conclusion The early serum PCT level of premature infants increases with the degree of HCA inflammation,which can be used as a biochemical indicator for early judgment of the presence of intrauterine infection and some neonatal infectious diseases.Dyspnea,gestational age,and CRP value can affect the PCT level of HCA-positive preterm infants.PCT increases in neonatal respiratory distress syndrome.