血清PCT、Cyt-C、PGRN、动脉血乳酸联合检测诊断新生儿早发型败血症的临床价值及与预后不良的关系研究

Clinical Value of Combined Detection of Serum PCT, Cyt-C, PGRN and Arterial Blood Lactic Acid in the Diagnosis of Neonatal Early-Onset Sepsis and its Relationship Study with Poor Prognosis

目的:探讨血清降钙素原(PCT)、细胞色素C(Cyt-C)、颗粒蛋白前体(PGRN)、动脉血乳酸联合检测诊断新生儿早发型败血症(EOS)的临床价值,分析其与患儿预后不良的关系。方法:选择2019年2月-2021年6月我院收治的EOS患儿115例作为EOS组,同期健康新生儿80例作为对照组,比较两组血清PCT、Cyt-C、PGRN、动脉血乳酸水平,并应用受试者工作特征(ROC)曲线分析血清PCT、Cyt-C、PGRN、动脉血乳酸对EOS的诊断价值。所有患儿出院后随访6个月,根据患儿预后结局分为预后良好组和预后不良组,应用单因素和多因素Logistic回归分析EOS患儿预后不良的危险因素。结果:EOS组血清PCT、Cyt-C、PGRN、动脉血乳酸水平显著高于对照组(P<0.05)。ROC曲线分析显示,血清PCT、Cyt-C、PGRN、动脉血乳酸联合检测对EOS诊断具有较高的敏感度、特异度、阳性预测值、阴性预测值,曲线下面积(AUC)为0.836。预后不良组血清PCT、Cyt-C、PGRN、动脉血乳酸水平显著高于预后良好组(P<0.05)。多因素Logistic回归分析结果显示,早产、低出生体重儿、病理性黄疸、颅内感染、血清PCT≥8.32 ng/L、血清Cyt-C≥42.52 ng/mL、血清PGRN≥48.83 ng/mL、动脉血乳酸≥5.21 mmol/L是EOS患儿预后不良的危险因素(P<0.05)。结论:EOS新生儿血清PCT、Cyt-C、PGRN、动脉血乳酸水平异常升高,其联合检测具有较高的诊断价值。早产、低出生体重儿、病理性黄疸、颅内感染、血清PCT、Cyt-C、PGRN、动脉血乳酸是EOS新生儿预后不良的危险因素,对于存在危险因素的新生儿应予以重视,早期采用干预措施,以改善其预后。

Objective: To explore the clinical value of the combined detection of serum procalcitonin(PCT), Cyt-C, progranulin(PGRN) and arterial blood lactic acid in the diagnosis of neonatal early-onset epsis(EOS), and to analyze the relationship between them and the poor prognosis of children. Methods: 115 children with EOS who were admitted to our hospital from February 2019 to June 2021were selected as EOS group, and 80 healthy neonatal in the same period were selected as control group. The levels of serum PCT, Cyt-C,PGRN and arterial blood lactic acid in the two groups were compared, and the diagnostic value of serum PCT, Cyt-C, PGRN and arterial blood lactic acid for EOS was analyzed by using receiver operating characteristic(ROC) curve. All children were followed up for 6months after discharge. According to the prognosis, they were divided into good prognosis group and poor prognosis group, the risk factors of poor prognosis in children with EOS were analyzed by univariate and multivariate Logistic regression. Results: The levels of serum PCT, Cyt-C, PGRN and arterial lactic acid in EOS group were significantly higher than those in control group(P<0.05). ROC curve analysis showed that the combined detection of serum PCT, Cyt-C, PGRN and arterial blood lactic acid had high sensitivity, specificity,positive predictive value and negative predictive value for the diagnosis of EOS, and the area under the curve(AUC) was 0.836. The levels of serum PCT, Cyt-C, PGRN and arterial lactic acid in the poor prognosis group were significantly higher than those in the good prognosis group(P<0.05). Multivariate Logistic regression analysis showed that premature birth, low birth weight infants, pathological jaundice,intracranial infection, serum PCT ≥8.32 ng/L, serum Cyt-C ≥42.52 ng/mL, serum PGRN ≥48.83 ng/mL, arterial blood lactic acid ≥5.21 mmol/L were the risk factors for poor prognosis in children with EOS(P<0.05). Conclusion: The levels of serum PCT, Cyt-C, PGRN and arterial lactic acid in neonatal with EOS are abnormally elevated, and their combined detection has high diagnostic value. Premature birth, low birth weight infants, pathological jaundice, intracranial infection, serum PCT, Cyt-C, PGRN and arterial blood lactic acid are risk factors for poor prognosis of neonatal with EOS. Attention should be paid to neonatal with risk factors and early intervention measures should be taken to improve their prognosis.