感染标志物、炎症因子、血小板参数诊断新生儿早发型败血症的价值

Value of infectious markers,inflammatory factors and platelet parameters in the diagnosis of neonatal early-onset sepsis

目的分析感染标志物、炎症因子、血小板参数诊断新生儿早发型败血症(EOS)的价值,为优化临床诊断工作提供参考。方法选取2020年3月-2022年3月在海南医学院第二附属医院儿科就诊的156例细菌性感染新生儿作为研究对象,将其中39例发生EOS患儿作为研究组,将117例未发生EOS患儿作为对照组。对两组患儿出生36 h内的血清降钙素原(PCT)、C-反应蛋白(CRP)、白细胞介素(IL)-6、肿瘤坏死因子(TNF)-α水平及外周血白细胞计数(WBC)、中性粒细胞百分比(NEU%)、血小板计数(PLT)、平均血小板体积(MPV)、血小板分布宽度(PDW)进行检测,采用受试者工作特征(ROC)曲线分析实验室指标诊断EOS的价值。结果研究组患儿的PCT、CRP、IL-6、TNF-α、MPV水平均高于对照组(P<0.05),PLT水平低于对照组(P<0.05)。Logistic多元回归分析结果显示,EOS的发生与PCT、IL-6和MPV水平具有相关性(P<0.05)。PCT、IL-6、MPV诊断EOS的ROC曲线下面积(AUC)均有统计学意义(P<0.05),其中,MPV的AUC最高,为0.837,将三者联合检测时,AUC和敏感度分别提升至0.960和84.62%。结论EOS患儿在出生36 h内即可出现感染标志物、炎症因子和血小板参数的异常,其中,PCT、IL-6和MPV对于EOS的诊断具有辅助价值,将三者联合检测可提高诊断效能。

OBJECTIVE To analyze the value of infectious markers,inflammatory factors and platelet parameters in the diagnosis of early onset neonatal sepsis(EOS),so as to provide reference for optimizing clinical diagnosis.METHODS A total of 156 newborns with bacterial infections who were hospitalized in the Department of Pediatrics of our hospital from Mar 2020 to Mar 2022 were recruited as the research subjects,39 of which with EOS were devided into the research group,and 117 children without EOS were in the control group.The serum levels of procalcitonin(PCT),C-reactive protein(CRP),interleukin(IL)-6 and tumor necrosis factor(TNF)-αand the levels of white blood cell(WBC),percentage of neutrophil(NEU%),platelet count(PLT),mean platelet volume(MPV),platelet distribution width(PDW)in the peripheral blood within 36 hours after birth between the newborns of the two groups were measured.The receiver operating characteristic(ROC)curve was employed to analyze the value of laboratory indicators in diagnosing EOS.RESULTS The levels of PCT,CRP,IL-6,TNF-αand MPV in the newborns of the study group were higher than those of the control group(P<0.05),while the PLT level was lower than that in the control group(P<0.05).Multivariate logistic regression analysis showed that the incidence of EOS was correlated with PCT,IL-6 and MPV levels(P<0.05).The areas under ROC curves(AUC)of PCT,IL-6 and MPV in diagnosis of EOS were significant(P<0.05).Among them,AUC of MPV was the highest with 0.837.When the three indexes were combined,AUC and sensitivity were increased to 0.960 and 84.62%,respectively.CONCLUSION The newborns with EOS have abnormality of infectious markers,inflammatory factors and platelet parameters within 36 hours after birth.PCT,IL-6 and MPV are of auxiliary values in the diagnosis of EOS.The combined detection of PCT,IL-6 and MPV can improve the diagnostic efficiency.