目的: 探讨降钙素原（procalcitonin,PCT）、C反应蛋白（C-reactive protein,CRP）、中性粒细胞与淋巴细胞比率（neutrophil to lymphocyte ratio,NLR）、平均血小板体积（mean platelet volume,MPV）联合检测对早产儿败血症的诊断价值。方法: 回顾纳入2021年1月—2024年1月汕头大学医学院第二附属医院接受治疗的早产儿95例。根据是否发生败血症分为败血症组（59例）和对照组（36例）,比较两组早产儿一般资料及24 h内PCT、CRP、NLR、MPV差异,采用Logistic回归分析早产儿发生败血症的影响因素,绘制各指标诊断早产儿发生败血症的受试者工作特征（receiver operating characteristic,ROC）曲线。结果: 败血症组与对照组患者产房气管插管率、胎龄、剖宫产率、出生体质量、性别构成的比较,差异均无统计学意义;败血症组胎膜早破和绒毛膜羊膜炎发生率均高于对照组;败血症组PCT水平、CRP水平、NLR水平和MPV水平均高于对照组;多因素回归分析显示：胎膜早破（OR=1.707,95%CI：1.063~2.744）、绒毛膜羊膜炎（OR=1.742,95%CI：1.076~2.821）、PCT水平高（OR=1.864,95%CI：1.167~2.979）、CRP水平高（OR=1.718,95%CI：1.067~2.766）、NLR水平高（OR=1.818,95%CI：1.161~2849）和MPV水平高（OR=1.850,95%CI：1.052~3.253）均是早产儿发生败血症的危险因素;ROC曲线显示：PCT、CRP、NLR、MPV四项指标联合检测对早产儿发生败血症的诊断效能最高,敏感度为86.4%（95% CI：0.745~0.936）,特异度为91.7%（95% CI：0.764~0.978）,曲线下面积为0.955（95% CI：0.920~0.990）。结论: 早产儿败血症早期内即可出现PCT、CRP、NLR、MPV异常升高,四者联合检测可提高早产儿败血症的诊断效能。
Abstract
Objective To investigate the diagnostic value of combined detection of procalcitonin (PCT), C-reactive protein (CRP), neutrophil to lymphocyte ratio (NLR) and mean platelet volume (MPV) in sepsis of premature infants. Methods 95 premature infants who were treated in the Second Affiliated Hospital of Shantou University Medical College from January 2021 to January 2024 were retrospectively included. According to the occurrence of sepsis, they were divided into sepsis group (59 cases) and control group (36 cases). The general data of premature infants and the differences of PCT, CRP, NLR and MPV within 24 hours were compared between the two groups. Logistic regression was used to analyze the influencing factors of sepsis in premature infants, and the receiver operating characteristic (ROC) curve of each index in the diagnosis of sepsis in premature infants was drawn. Results There was no significant difference in tracheal intubation rate, gestational age, cesarean section rate, birth weight and gender composition between the sepsis group and the control group. The incidence of premature rupture of membranes and chorioamnionitis in the sepsis group was higher than that in the control group. The levels of PCT, CRP, NLR and MPV in sepsis group were higher than those in control group. Multivariate regression analysis showed that premature rupture of membranes (OR=1.707, 95 % CI: 1.063-2.744), chorioamnionitis (OR=1.742, 95 % CI: 1.076-2.821), high PCT level (OR=1.864, 95 % CI: 1.167-2.979), high CRP level (OR=1.718, 95 % CI: 1.067-2.766), high NLR level (OR=1.818, 95 % CI: 1.161-2849) and high MPV level (OR=1.850, 95 % CI: 1.052-3.253) were risk factors for sepsis in premature infants. ROC curve showed that the combined detection of PCT, CRP, NLR and MPV had the highest diagnostic efficiency for sepsis in premature infants. The sensitivity was 86.4 % (95 % CI: 0.745-0.936), the specificity was 91.7 % (95 % CI: 0.764-0.978), the area under the curve was 0.955(95 % CI: 0.920-0.990). Conclusion The abnormal increase of PCT, CRP, NLR and MPV in the early stage of sepsis in premature infants is related, and the combined detection of these markers can improve the diagnostic efficiency of sepsis in premature infants.
关键词
降钙素原 /
C反应蛋白 /
平均血小板体积 /
早产儿 /
败血症
Key words
procalcitonin /
C-reactive protein /
mean platelet volume /
premature infants /
sepsis
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基金
汕头市科技计划医疗卫生类别项目“超声引导下经皮置管闭式引流在新生儿气胸中的临床应用价值研究”（210624106490827）;广东省医学科学技术研究基金项目“核受体FXR介导的p53功能在儿童神经母细胞瘤的研究”（A2023431）
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