血清AT-Ⅲ、G6PD检测对新生儿败血症早期诊断及预后评估的价值分析

Value analysis of the serum levels of AT-Ⅲand G6PD in the early diagnosis and prognosis of neonatal sepsis

目的:通过检测新生儿败血症患儿血清中的抗凝血酶-Ⅲ(AT-Ⅲ)、6-磷酸葡萄糖脱氢酶(G6PD)表达水平,分析其在新生儿败血症的早期诊断及与预后评估的价值。方法:选取2018年1月至2020年1月确诊的新生儿败血症患儿77例为败血症组,确诊的细菌感染非败血症患儿50例为感染组,同时选取健康新生儿100名为对照组。采用发色底物法检测血清AT-Ⅲ的表达水平,简易比色法检测血清中G6PD的表达水平,全自动生化分析仪测定被试者血清中降钙素原(PCT)、白细胞计数(WBC),记录新生儿疾病危重评分(NCIS评分)。比较败血症组、感染组、对照组以及败血症患儿生存组与病死组患儿血清中AT-Ⅲ、G6PD表达水平的差异。分析血清AT-Ⅲ、G6PD表达水平对新生儿败血症及病死的诊断价值,确定影响新生儿败血症患儿病死的危险因素。结果:与对照组相比,感染组、败血症组血清AT-Ⅲ、G6PD表达水平均显著降低,且败血症组血清AT-Ⅲ、G6PD表达水平低于感染组,差异均有统计学意义(P<0.01)。血清AT-Ⅲ、G6PD水平对新生儿败血症的早期诊断曲线下面积(AUC)分别为0.811(95%CI:0.748~0.874)、0.847(95%CI:0.788~0.905)。与生存组相比,病死组新生儿血清中PCT、WBC水平均显著升高,NCIS评分、血清中AT-Ⅲ及G6PD表达水平均显著降低,差异有统计学意义(P<0.05~P<0.01)。血清AT-Ⅲ、G6PD水平检测诊断新生儿败血症病死的AUC分别为0.791(95%CI:0.671~0.911)、0.800(95%CI:0.678~0.922)。logistic回归分析结果表明,AT-Ⅲ、G6PD表达水平的降低是新生儿败血症病死的危险因素。结论:血清AT-Ⅲ和G6PD表达水平升高与新生儿败血症的发病及其不良预后联系密切,对新生儿败血症早期鉴别及不良预后的评估具有一定的价值。

Objective:To detect the serum levels of antithrombin-Ⅲ(AT-Ⅲ)and glucose-6-phosphate dehydrogenase(G6PD)in neonatal sepsis,and analyze its value in the early diagnosis and prognosis of neonatal sepsis.Methods:Seventy-seven children with neonatal sepsis,50 children with bacterial infection without sepsis and 100 healthy newborns from January 2018 to January 2020 were divided into the sepsis group,infection group and control group,respectively.The serum level of AT-Ⅲwas detected using the developing substrate method,the serum level of G6PD was detected using the simple colorimetric method,the serum procalcitonin(PCT)level and white blood cell count(WBC)were determined suing the automatic biochemical analyzer,and the neonatal critical disease score(NCIS score)was recorded.The differences of the serum levels of AT-Ⅲand G6PD among the sepsis group,infection group and control group,and between the good prognosis group and poor prognosis group were compared.The diagnostic value of serum levels AT-Ⅲand G6PD in the neonatal sepsis and death were analyzed,and the risk factors of affecting neonatal sepsis were determined.Results:Compared with the control group,the serum levels of AT-Ⅲand G6PD in the infection group and sepsis group significantly decreased,and the serum levels of AT-Ⅲand G6PD in sepsis group were lower than those in infection group(P<0.01).The area under the curve(AUC)of serum levels of AT-Ⅲand G6PD in the early diagnosis of neonatal sepsis were 0.811(95%CI:0.748-0.874)and 0.847(95%CI:0.788-0.905),respectively.Compared with the survival group,the serum levels of PCT and WBC significantly increased,the NCIS score and serum levels of AT-Ⅲand G6PD were significantly decreased,the differences of which were statistically significant(P<0.05 to P<0.01).The AUC of serum AT-Ⅲand G6PD were 0.791(95%CI:0.671-0.911)and 0.800(95%CI:0.678-0.922),respectively.The results of logistic regression analysis showed that the levels of AT-Ⅲand G6PD decreasing were the risk factors for neonatal septicemia death.Conclusions:The serum levels of AT-Ⅲand G6PD increasing are closely related to the pathogenesis and poor prognosis of neonatal sepsis,and which have certain value in the early diagnosis and poor prognosis of neonatal sepsis.