血清高敏C-反应蛋白联合降钙素原对足月新生儿败血症并发化脓性脑膜炎的预测价值  

Predictive value of serum high-sensitivity C-reactive protein combined with procalcitonin for sepsis complicated with purulent meningitis in full-term neonates

作　　者：方瑞[1] 都鹏飞[1] FANG Rui;DU Pengfei(Department of Pediatrics,Second Affiliated Hospital of Anhui Medical University,Hefei,Anhui 230000,China)

机构地区：[1]安徽医科大学第二附属医院儿科

出　　处：《重庆医学》2019年第23期4020-4023,共4页Chongqing medicine

摘　　要：目的 探讨血清高敏C-反应蛋白(hs-CRP)联合降钙素原(PCT)对足月新生儿败血症并发化脓性脑膜炎的预测价值。方法 选取2014年1月1日至2018年12月31日于该院确诊为足月新生儿败血症患儿73例作为研究对象。采用回顾性分析方法,收集所有患儿的性别、胎龄、出生体质量等一般临床资料,以及血清hs-CRP及PCT。根据患儿是否并发化脓性脑膜炎,将其分为单纯败血症组和败血症并发化脓性脑膜炎组。通过二元Logistic回归分析方法构建回归方程,并对受试者工作特征(ROC)曲线进行分析。结果 血清hs-CRP在单纯败血症组及败血症并发化脓性脑膜炎组的中位表达水平分别为9.30、21.75mg/L,两组比较差异有统计学意义(P<0.01),PCT在单纯败血症组及败血症并发化脓性脑膜炎组的中位表达水平分别为1.01、8.87ng/mL,两组比较差异有统计学意义(P<0.01)。将血清hs-CRP及PCT作为自变量,以是否并发化脓性脑膜炎作为二分类因变量,建立二元Logistic回归方程,结果提示血清hs-CRP及PCT均是足月新生儿败血症并发化脓性脑膜炎的独立危险因素(OR=1.064,95%CI:1.001~1.131,P=0.045;OR=1.301,95%CI:1.094~1.547,P=0.003)。依据ROC曲线分析结果显示,血清hs-CRP、PCT及联合指标(hs-CRP+PCT)对足月新生儿败血症并发化脓性脑膜炎的ROC曲线下面积(AUC)分别为0.85(95%CI:0.753~0.955,P<0.01),0.87(95%CI:0.786~0.956,P<0.01),0.92(95%CI:0.83~0.97,P<0.01)。根据Yoden指数最大原则,血清hs-CRP及PCT预测新生儿败血症并发化脓性脑膜炎的最佳临界值分别为11.42mg/L、2.2ng/mL,其灵敏度分别为87.50%、91.67%,特异度分别为77.55%、71.43%。结论 联合监测足月新生儿败血症血清hs-CRP及PCT水平对于足月新生儿败血症并发化脓性脑膜炎具有一定的预测价值,值得在临床借鉴。Objective To explore the predictive value of serum high-sensitivity C-reactive protein(hs-CRP)combined with procalcitonin(PCT)for sepsis complicated with purulent meningitis in full-term neonates.Methods Seventy-three cases of full-term neonatal diagnosed with sepsis complicated with purulent meningitis in this Hospital from January 1,2014 to December 31,2018 were selected as the study subjects.General clinical data such as gender,gestational age,and birth weight,as well as serum hs-CRP and PCT,were collected by using retrospective analysis.According to whether the children were complicated with purulent meningitis,they were divided into the simple sepsis group and the sepsis complicated with purulent meningitis group.The regression equation was constructed by binary Logistic regression analysis methods,and the ROC curve was analyzed.Results The median expression levels of serum hs-CRP were 9.30 mg/L and 21.75 mg/L in the simple sepsis group and the sepsis complicated with purulent meningitis group,respectively,the median expression levels of PCT in the simple sepsis group and the sepsis complicated with purulent meningitis group were 1.01 ng/mL and 8.87 ng/mL,respectively,there were significant differences between the two groups of the two indicators(P<0.01).Logistic regression analysis showed that serum hs-CRP and PCT were independent risk factors for sepsis complicated with purulent meningitis in full-term neonates(OR=1.064,95%CI:1.001-1.131,P=0.045;OR=1.301,95%CI:1.094-1.547,P=0.003).The results of ROC curve analysis showed that the ROC-AUC of serum hs-CRP,PCT and combined indicators(hs-CRP+PCT)for septicemia complicated with purulent meningitis in full-term neonates were 0.85(95%CI:0.753-0.955,P<0.01),0.87(95%CI:0.786-0.956,P<0.01),0.92(95%CI:0.83-0.97,P<0.01),respectively.According to the maximum principle of Yoden index,the optimal threshold values of serum hs-CRP and PCT for predicting neonatal sepsis complicated with purulent meningitis were 11.42 mg/L and 2.20 ng/mL,respectively.The sensitivities were,9

关 键 词：高敏C反应蛋白质 降钙素 足月分娩 脓毒症 脑膜炎 

分 类 号：R722.1[医药卫生—儿科]