降钙素原、红细胞分布宽度对早产儿败血症病情及预后评估的价值  

Values of procalcitionin and red blood cell distribution width in evaluating severity and prognosis of septicemia in preterm infants

作　　者：赵育弘 张文雅 王涛[1] 赵倩[1] 王杨[1] Zhao Yuhong;Zhang Wenya;Wang Tao;Zhao Qian;Wang Yang(Department of Pediatrics,the First Affiliated Hospital of Anhui Medical University,Hefei 230022,China)

机构地区：[1]安徽医科大学第一附属医院儿科,合肥230022

出　　处：《中华围产医学杂志》2019年第9期641-647,共7页Chinese Journal of Perinatal Medicine

基　　金：安徽省科技厅2017年公益技术应用研究联动计划项目(1704f0804018);安徽省2016年卫生计生适宜技术推广项目(2016-RK01).

摘　　要：目的分析降钙素原、红细胞分布宽度(red blood cell distribution width, RDW)在败血症早产儿中的变化,探讨两者对早产儿败血症病情严重程度及预后评估的价值。方法回顾性分析2014年12月1日至2018年12月1日在安徽医科大学第一附属医院收治的96例确诊为败血症早产儿的病历资料,根据病情严重程度及参照新生儿休克评分,分为重症组(临床病情较重,合并休克,休克评分>6分,42例)和轻症组(临床病情较轻微,未合并休克或休克评分≤6分,54例);根据败血症患儿治疗3 d后是否死亡,分为病死组(10例)和存活组(86例)。分别于治疗前、治疗后第1及第3日采集外周静脉血检测降钙素原、RDW,比较两者在不同严重程度败血症早产儿中的动态变化。采用Mann-Whitney U检验、Wilcoxon符号秩和检验、Friedman检验以及受试者工作特征曲线对数据进行统计学分析。结果(1)治疗前、治疗后第1及第3日,重症组降钙素原均高于轻症组[分别为3.7(0.4~37.3)与1.4(0.2~5.0) ng/ml,43.1(18.7~83.0)与17.1(4.1~34.6) ng/ml,26.1(3.8~67.3)与4.8(0.3~32.9) ng/ml,Z值分别为-2.017、-3.350及-2.932,P值均<0.05];2组中治疗后第1日的降钙素原高于治疗前、治疗后第3日,且治疗后第3日均高于治疗前(P值均<0.05)。治疗后第1及第3日,重症组RDW均高于轻症组[分别为16.5%(16.2%~18.6%)与16.3%(15.5%~17.3%),16.1%(15.5%~19.4%)与15.7%(15.1%~16.5%),Z值分别为-1.992和-2.165,P值均<0.05];2组中治疗后第1日的RDW均高于治疗前、治疗后第3日,轻症组中治疗后第3日RDW低于治疗前,但重症组第3日高于治疗前(P值均<0.05)。(2)治疗后第1及第3日,病死组降钙素原、RDW均高于存活组[降钙素原:分别为162.0(62.9~187.2)与19.9(4.3~46.1) ng/ml,122.6(65.0~180.8)与6.2(0.5~32.9) ng/ml,Z值分别为-4.114和-4.594;RDW:分别为18.4%(16.9%~21.2%)与16.3%(15.7%~17.2%),21.8%(20.6%~22.2%)与15.8%(15.2%~16.5%),Z值分别为-3.307和-4.831;P值均<0.05]。2组中治疗后第1Objective To analyze the variations of procalcitionin (PCT) and red blood cell distribution width (RDW) in premature infants with septicemia and to investigate their values in evaluating the severity and prognosis of septicemia. Methods A retrospective study was conducted to analyze the medical records of 96 premature infants diagnosed with septicemia and admitted to the First Affiliated Hospital of Anhui Medical University from December 1, 2014 to December 1, 2018. According to the severity of the disease and neonatal shock score, there were 42 cases selected to the severe septicemia group (severe clinical condition with shock, shock score >6 points) and 54 in the mild septicemia group (mild clinical condition without shock or shock score ≤6 points). Moreover, after three days' treatment, they were divided into two groups: death group (n=10) and survival group (n=86, survived during hospitalization). Peripheral venous blood samples were collected before and on the first and third day after treatment to detect PCT and RDW. Dynamic changes of the two indexes were compared between different groups. Mann-Whitney U test, Wilcoxon rank sum test, Friedman test or receiver operating characteristic (ROC) curve was used for statistical analysis. Results (1) Before and on the first and third day after treatment, the severe septicemia group had a higher level of PCT than the mild group [3.7 (0.4-37.3) vs 1.4 (0.2-5.0) ng/ml, 43.1 (18.7-83.0) vs 17.1 (4.1-34.6) ng/ml, 26.1 (3.8-67.3) vs 4.8 (0.3-32.9) ng/ml;Z=-2.017,-3.350 and -2.932;all P<0.05]. In both groups, PCT level on the first day after treatment was the highest, and that on the third day after treatment was higher than that before treatment (all P<0.05). On the first and third day after treatment, RDW in the severe group was higher than that in the mild group [16.5%(16.2%-18.6%) vs 16.3%(15.5%-17.3%), 16.1%(15.5%-19.4%) vs 15.7%(15.1%-16.5%);Z=-1.992 and -2.165;both P<0.05]. In the severe and mild groups, RDW on the first day after treatment was higher than that b

关 键 词：新生儿脓毒症 降钙素 红细胞指数 婴儿 早产 预后 

分 类 号：R722.6[医药卫生—儿科]