孕母B族链球菌筛查阳性新生儿的转归及早期炎性指标检测分析

Outcome of neonates delivered by group B Streptococcus positive pregnant women andanalysis of early inflammatory indicators detection

目的分析B族链球菌(group B Streptococcus,GBS)筛查阳性孕母所分娩新生儿的转归及早期炎性指标检测的临床应用价值。方法选取2017年10月至2021年10月解放军总医院第五医学中心收治的GBS筛查阳性孕妇所分娩的135例高危新生儿为研究对象,根据孕母产前是否应用抗生素分为抗生素组(n=77)及对照组(n=58)。比较两组孕母情况、患儿一般情况、病理性黄疸发生率、不同时间点白细胞(white blood cell,WBC)计数、C反应蛋白(C-reactive protein,CRP)、降钙素原(procalcitonin,PCT)水平。通过受试者操作特征(receiver operating characteristic,ROC)曲线分析不同时间点WBC、CRP、PCT的临床应用价值。统计学方法采用独立样本t检验、χ^(2)检验、秩和检验。结果抗生素组新生儿炎性指标异常率明显低于对照组[26.0%(20/77)与48.3%(28/55),χ^(2)=6.311,P=0.012]。两组患儿分娩方式、羊水污染率、胎膜早破率、病理性黄疸发生率比较,差异均无统计学意义(P值均>0.05)。抗生素组6、24 h CRP水平均低于对照组[0.2(0.1,0.3)mg/L与0.2(0.1,0.4)mg/L,2.3(1.0,6.0)mg/L与4.0(2.8,10.5)mg/L,t=-3.137、-3.010,P值均<0.05]。135例高危新生儿中,发生早发型GBS败血症2例(1.5%)。48例(35.6%)患儿炎性指标异常,平均住院时间(6.3±1.3)d,均痊愈出院。生后24 h WBC及CRP联合检测对于发现新生儿感染意义最大,曲线下面积(area under the curve,AUC)为0.882。结论对GBS筛查阳性孕母分娩前应用抗生素预防治疗可以减少新生儿感染的发生,生后24 h WBC及CRP联合检测对于早期发现新生儿感染有重要意义。

Objective To analyze the outcome of neonates delivered by group B Streptococcus(GBS)positive pregnant women and the clinical application value of early inflammatory indicators detection.Method A total of 135 high-risk neonates delivered by GBS positive pregnant women admitted to the FifthMedical Center of the PLA General Hospital from October 2017 to October 2021 were selected as the studyobjects,and divided into the antibiotic group(n=77)and the control group(n=58)according to whether thepregnant mothers used antibiotics before delivery.The maternal condition,general condition of neonates,therate of pathological jaundice,white blood cell(WBC)count,C-reactive protein(CRP)and procalcitonin(PCT)levels at different time points were compared between the two groups.The clinical application value of WBC,CRP and PCT in different time points was analyzed by receiver operating characteristic(ROC)curve.Thestatistical methods performed by independent sample t-test,χ^(2) test and rank sum test.Result The abnormal rate of neonatal inflammatory indicators in the antibiotic group were significantly lower than those in thecontrol group[26.0%(20/77)vs 48.3%(28/55),χ^(2)=6.311,P=0.012].There were no significant differences inthe delivery method,amniotic fluid contamination rate,premature rupture rate of membranes and incidence of pathological jaundice between the two groups(all P>0.05).The levels of CRP in the antibiotic group at6 h and 24 h was lower than that in the control group[0.2(0.1,0.3)mg/L vs 0.2(0.1,0.4)mg/L,2.3(1.0,6.0)mg/L vs 4.0(2.8,10.5)mg/L,t=-3.137,-3.010,all P<0.05].Among the 135 high-risk neonates,2 cases(1.5%)developed early onset GBS septicemia.48 cases(35.6%)with abnormal inflammatory indicators,and they were hospitalized for(6.3±1.3)days on average,and were cured and discharged from hospital.The combined detection of WBC and CRP at 24 h postnatal was the most significant for neonatal infection,and the area under the curve(AUC)was 0.882.Conclusion Prophylactic treatment with antibiotics forGBS positive pregnant women before delivery can reduce the incidence of neonatal infection.The combineddetection of WBC and CRP at 24 h postnatal is of great significance for early detection of neonatal infection.