新生儿脐血中Cyt-C和ELR及sTNFR-Ⅱ对早发型败血症发病风险的预测价值

Predictive value of Cyt-C,ELR and sTNFR-Ⅱ in neonatal cord blood for the risk of developing early-onset sepsis

目的 探讨新生儿脐血中细胞色素C(Cyt-C)、嗜酸性粒细胞/淋巴细胞比值(ELR)及可溶性肿瘤坏死因子受体Ⅱ(sTNFR-Ⅱ)对早发型败血症(EOS)发病风险的预测价值。方法 选取2019年1月至2021年8月在保定市儿童医院诊断为新生儿EOS患儿85例为研究组,另选取同期健康新生儿85例为对照组;两组均于胎儿娩出后留取脐血样本,比较两组脐血中Cyt-C、ELR及sTNFR-Ⅱ水平,分析三者对EOS发病风险的预测价值。结果 研究组与对照组的羊水性状(χ^(2)=6.010)、母亲发热(χ^(2)=6.168)的分布,以及孕周(t=8.920)、新生儿出生体重(t=10.746)比较差异均有统计学意义(P<0.05)。研究组脐血中的Cyt-C、ELR及sTNFR-Ⅱ水平均高于对照组,经比较差异均有统计学意义(t值分别为9.578、9.487、13.472,P<0.05)。ROC曲线分析显示,新生儿脐血中Cyt-C、ELR及sTNFR-Ⅱ预测EOS发病风险的曲线下面积(AUC)分别为0.709(95%CI:0.635~0.776)、0.756(95%CI:0.684~0.818)、0.744(95%CI:0.671~0.808);三者联合预测EOS发病风险的AUC为0.932(95%CI:0.884~0.965);脐血中Cyt-C、ELR及sTNFR-Ⅱ联合预测EOS发病风险的AUC均大于各指标的单独预测结果,经比较差异均有统计学意义(Z值分别为5.065、4.266、4.329,P<0.05)。结论 新生儿EOS患儿脐血中Cyt-C、ELR及sTNFR-Ⅱ水平均明显升高,联合检测具有良好地预测EOS发病风险的价值,对临床有一定的指导意义。

Objective To investigate the predictive value of cytochrome C(Cyt-C),eosinophil/lymphocyte ratio(ELR),and soluble tumor necrosis factor receptor Ⅱ(sTNFR-Ⅱ) in neonatal cord blood for the risk of developing early-onset sepsis(EOS).Methods A total of 85 children diagnosed with neonatal EOS in Baoding Children's Hospital from January 2019 to August 2021 were selected as the study group,and another 85 healthy newborns in the same period were selected as the control group.Cord blood samples were collected after delivery,and the levels of Cyt-C,ELR and sTNFR-Ⅱ in cord blood were compared between the two groups to analyze the predictive value of the three on the risk of developing EOS.Results The differences in amniotic fluid characteristics(χ^(2)=6.010),maternal fever(χ^(2)=6.168),gestational week(t=8.920) and neonatal birth weight(t=10.746) between the study group and the control group were statistically significant(P<0.05).The levels of Cyt-C,ELR and sTNFR-Ⅱ in cord blood were higher in the study group than in the control group,and the differences were statistically significant when compared(t=9.578,9.487 and 13.472,respectively,P<0.05).ROC curve analysis showed that the area under the curve(AUC) of Cyt-C,ELR and sTNFR-Ⅱ in cord blood of newborns to predict the risk of developing EOS were 0.709(95%CI:0.635-0.776),0.756(95%CI:0.684-0.818),and 0.744(95%CI:0.671-0.808),respectively.The AUC of the combination of the three predicted the risk of EOS was 0.932(95%CI:0.884-0.965).The AUCs of Cyt-C,ELR and sTNFR-Ⅱ in cord blood combined to predict the risk of EOS were all greater than the predicted results of each index alone,and the differences were statistically significant when compared(Z values were 5.065,4.266 and 4.329,respectively,P<0.05).Conclusion The levels of Cyt-C,ELR and sTNFR-Ⅱ in the umbilical cord blood of neonates with EOS showed a significant increase,and the combined test has a good predictive value and is of clinical guidance.