降钙素原和C反应蛋白水平差值在早产儿败血症中的诊断价值  

Diagnostic value of procalcitonin and C-reactive protein gradient in sepsis of premature infants

作　　者：陈素明[1] 何叶莉 赵利利 洪炜 王大刚[1] 王晗[1] CHEN Suming;HE Yell;ZHAO Lili;HONG Wei;WANG Dagang;WANG Han(Clinical Laboratory Medicine Center,302 Hospital of PLA,Beijing 100039,China)

机构地区：[1]中国人民解放军第三〇二医院临床检验医学中心,北京100039

出　　处：《检验医学与临床》2018年第18期2725-2728,共4页Laboratory Medicine and Clinic

摘　　要：目的探讨血清降钙素原(PCT)和C反应蛋白(CRP)变化差异在早产儿败血症中的诊疗价值。方法选取该院2016年6月至2017年6月收治,且临床确诊为败血症的25例早产儿为研究对象,将其与同期在该院接受治疗的30例非败血症早产儿的检测结果做对比分析。设初次血培养时间为d0,分析d-1,d0,d1,d2和d3的PCT、CRP及白细胞(WBC)检测值及差值变化。结果败血症早产儿PCT、CRP和WBC在d-1开始升高,d0达最高值,之后逐渐下降;PCTd0、CRPd0和WBCd0均值分别为12.09ng/mL,48.13mg/L,4.63×109g/L。非败血症早产儿未发现明显变化趋势;败血症早产儿△PCTd-1-0为10.87(0.16,57.13)显著高于非败血症早产儿△PCTd-1-00.39(0.02~2.31),差异有统计学意义(P<0.05)。对于早产儿败血症诊断,△PCTd-1-0诊断价值显著高于△CRPd-1-0(P<0.05);△PCTd-1-0Cut-off值为1.49时,AUC为0.91,诊断特异性为0.96,敏感性为0.73。△CRPd-1-0Cut-off值为15.40时,AUC为0.69,对早产儿败血症诊断特异性和敏感性分别为0.86和0.69。92%的败血症早产儿(23例)PCT在治疗第3天恢复至正常水平。结论△PCT和△CRP检测可作为临床早期诊断新生儿细菌感染的重要指标。△PCT对新生儿败血症的诊治价值更高,其变化值越大,疾病的危险度越高。Objective To investigate the diagnostic value of serum procalcitonin（PCT）and C reactive protein（CRP）gradient in the diagnosis and treatment of sepsis in premature infants.Methods Twenty-five preterm infants admitted to our hospital from June 2016 to June 2017 were enrolled and clinically diagnosed as sepsis.The results were compared with those of 30 non-sepsis preterm infants treated in our hospital during the same period.Set the initial blood culture time d0,analysis of d-1,d0,d1,d2 and d3 PCT,CRP and WBC test values and differences in changes.Results In the observation group PCT,CRP and WBC in d-1 began to rise,d0 reached the highest value,then gradually decreased;PCT,CRP and WBC the mean were 12.09 ng/mL,48.13 mg/L,4.63×109 g/L.The control group did not find a significant change in the trend;The observation group △PCTd-1-0 was 10.87（0.16,57.13）,it was significantly higher than the control group△PCTd-1-00.39（0.02,2.31）,differences were statistically significant（P〈0.05）.Diagnosis of sepsis in preterm infants,the value of△PCTd-1-0 diagnosis was significantly higher than that of△CRPd-1-0,（P〈0.05）;the △PCTd-1-0 cut-off value was 1.49,AUC was 0.91,specificity was 0.96,the sensitivity was 0.73.When the △CRPd-1-0 cut-off value was 15.40,AUC was 0.69,diagnostic specificity and sensitivity of the diagnosis of sepsis in preterm infants were 0.86 and 0.69.And 92%patients（23 patients）in control group with PCT recovered to normal levels within third days of treatment.Conclusion △PCT and △CRP detection can be used as an important indicator of early diagnosis of neonatal bacterial infection.The△PCT diagnosis and treatment of neonatal septicemia are more important value,the more data changes,the greater the risk.

关 键 词：降钙素原 C反应蛋白 早产儿 败血症 

分 类 号：R446.1[医药卫生—诊断学]