外周血T淋巴细胞亚群与PCT在新生儿败血症诊断及预后评估中的应用  

Peripheral blood T lymphocyte subsets and PCT in diagnosis of neonatal sepsis and assessment of prognosis

作　　者：刘倩 刘雪琴 员丽 原超 张卫星 LIU Qian;LIU Xue-qin;YUAN Li;YUAN Chao;ZHANG Wei-xing(Xinciang Central Hospital,Xin.riang,Henan 453000,China)

机构地区：[1]新乡市中心医院新生儿科(新乡医学院第四临床学院),河南新乡453000

出　　处：《中华医院感染学杂志》2021年第12期1786-1790,共5页Chinese Journal of Nosocomiology

基　　金：河南省医学科技攻关计划基金资助项目(2018020926)。

摘　　要：目的探究外周血T淋巴细胞亚群、降钙素原(PCT)及中性粒细胞(NEU)计数在新生儿败血症诊断及预后评估中的应用价值。方法回顾性分析新乡市中心医院78例新生儿败血症患儿(败血症组)及62例非败血症的一般感染患儿(一般感染组)的临床资料,并纳入同期入院的32例无感染新生儿作为对照组。比较三组外周血T淋巴细胞亚群(CD^(+)_(3)、CD^(+)_(4)、CD^(+)_(8))、NEU%、中性粒细胞CD64及PCT水平差异,使用受试者工作特征(ROC)曲线评估上述指标对新生儿败血症的诊断价值;并根据新生儿败血症患儿预后情况分为死亡患儿(预后不良)及存活患儿(预后良好),比较其外周血CD^(+)_(3)、CD^(+)_(4)、CD^(+)_(8)、NEU%、中性粒细胞CD64及PCT水平差异,利用ROC曲线评估上述指标对患儿不良预后的预测价值。结果败血症组、一般感染组及对照组外周血CD^(+)_(8),差异无统计学意义;败血症组及一般感染组外周血NEU,差异无统计学意义,但均高于对照组(P<0.05);三组外周血CD^(+)_(3)、CD^(+)_(4),均为败血症组<一般感染组<对照组(P<0.05);三组外周血中性粒细胞CD64及PCT比较,均为败血症组>一般感染组>对照组(P<0.05)。经ROC曲线分析,发现外周血CD^(+)_(3)、CD^(+)_(4)、NEU、CD64及PCT对新生儿败血症均具有较高诊断价值(P均<0.001),其Cut-off值分别为49.21%、30.70%、46.72%、4.48 ng/ml。78例新生儿败血症患儿预后死亡17例,存活61例,两组患儿外周血CD^(+)_(8)、NEU百分比,差异无统计学意义;预后不良患儿外周血CD^(+)_(3)、CD^(+)_(4)分别为(39.22±3.58)%、(23.31±2.09)%,低于预后良好患儿(P<0.001),而中性粒细胞CD64及PCT分别为(71.61±6.06)%、(9.49±0.98)ng/ml,高于预后良好组患儿(P<0.001)。经ROC曲线分析,发现外周血CD^(+)_(3)、CD^(+)_(4)、中性粒细胞CD64及PCT对新生儿败血症不良预后均具有较高预测价值(P均<0.001),其Cut-off值分别为43.08%、25.86%、62.29%、8.23 ng/ml。�OBJECTIVE To explore the application value of peripheral blood T lymphocyte subsets,procalcitonin(PCT)and neutrophil(NEU)count in the diagnosis and prognosis evaluation of neonatal sepsis.METHODS The clinical data of 78 neonatal sepsis patients(sepsis group)and 62 non-septicemia infants with general infection(general infection group)in Xinxiang Central Hospital were retrospectively analyzed,and another 32 uninfected neonates admitted during the same period were included as control group.The differences of peripheral blood T lymphocyte subsets(CD^(+)_(3),CD^(+)_(4),CD^(+)_(8)),NEU%,neutrophil CD64 and PCT levels were compared among the three group,and the receiver operating characteristic curve(ROC curve)was used to evaluate the diagnostic value of above indexes for the prognosis of neonatal sepsis.The children patients were divided into death group(poor prognosis)and survival group(good prognosis)according to the prognosis of neonatal sepsis,and the differences of peripheral blood CD^(+)_(3),CD^(+)_(4),CD^(+)_(8),NEU%,neutrophil CD64 and PCT levels were compared,and ROC curve was used to evaluate the predictive value of the above indexes for the poor prognosis of children patients.RESULTS There was no significant difference in peripheral blood CD^(+)_(8)level among sepsis group,general infection group and control group.There was no significant difference in the peripheral blood NEU between sepsis group and general infection group,but they were all significantly higher than that in control group(P<0.05).Comparing the three groups,peripheral blood CD^(+)_(3)and CD^(+)_(4)levels in the sepsis group were significantly lower than those in the general infection group,and significantly lower than the control group(P<0.05).Comparison among the three groups,the peripheral blood neutrophil CD64 and PCT in the sepsis group were significantly higher than those in the general infection group,and significantly higher than the control group(P<0.05).ROC curve analysis found that peripheral blood CD^(+)_(3),CD^(+)_(4),neutrophil

关 键 词：新生儿败血症 T淋巴细胞亚群 中性粒细胞 降钙素原 预后 

分 类 号：R722.13[医药卫生—儿科]