血清降钙素原及超敏C-反应蛋白检测在新生儿感染诊断中的应用价值分析
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摘要
目的探讨血清降钙素原(Procalcitonin,PCT)及超敏C-反应蛋白(High-sensitivity C-reactive protein,hs-CRP)检测在新生儿感染诊断中的应用价值。方法根据血培养结果将2015年12月-2018年2月本院新生儿科入住的90例新生儿分为3组,非感染组44例,局部感染组23例,全身感染组23例。分析3组PCT、hs-CRP水平和单项检测与联合检测对诊断感染的价值,PCT、hs-CRP相关性,感染组治疗前、后PCT、hs-CRP水平。结果 PCT、hs-CRP水平全身感染组>局部感染组>非感染组,差异具有统计学意义(P<0.05);PCT、hs-CRP、PCT+hs-CRP的ROC曲线下面积分别为0.948、0.912、0.963,PCT+hs-CRP特异度、敏感度优于PCT、hs-CRP;PCT与hs-CRP呈正相关(r=0.784,P<0.01);局部感染组和全身感染组治疗后PCT、hs-CRP水平较治疗前均明显降低,差异具有统计学意义(P<0.05)。结论 PCT、hs-CRP在新生儿感染性疾病中均具有一定的诊断价值,能评估病情严重程度和治疗效果,指导临床合理使用抗生素,PCT和hs-CRP联合检测价值更高,可将两者作为早期诊断、鉴别新生儿感染的敏感性指标。
Objective To investigate the application value of serum procalcitonin(PCT) and high-sensitivity C-reactive protein(hs-CRP) detection in the diagnosis of neonatal infection. Methods A total of 90 newborns admitted into the neonatology department from December 2015 to February 2018 were selected and divided into non-infection group(44 cases), local infection group(23 cases) and general infection group(23 cases) according to the results of blood culture. The value of single or joint detections of PCT and hs-CRP levels in the diagnosis of infection and correlation of PCT and hs-CRP, PCT were analyzed, and hs-CRP levels of infection group before and after treatment were detected. Results The PCT and hs-CRP levels of general infection group were higher than those of local infection group and non-infection group, with the differences statistically significant(P<0.05); The area under the ROC curve of PCT, hs-CRP, PCT+hs-CRP were 0.948, 0.912 and 0.963, the specificity and sensitivity of PCT+hs-CRP were better than those of PCT, hs-CRP; PCT had positive correlation with hs-CRP(r=0.784, P<0.01); After treatment, the PCT and hs-CRP levels of local infection group and general infection group decreased compared with those before treatment, with the differences statistically significant(P<0.05). Conclusion PCT and hs-CRP have certain value in the diagnosis of neonatal infectious diseases, they can evaluate the disease′s severity and curative effects, guide reasonable use of antibiotics. The diagnostic value of PCT combined with hs-CRP is higher, which can be used as the sensitive indexes in early diagnosis and identification of neonatal infection.
Objective To investigate the application value of serum procalcitonin(PCT) and high-sensitivity C-reactive protein(hs-CRP) detection in the diagnosis of neonatal infection. Methods A total of 90 newborns admitted into the neonatology department from December 2015 to February 2018 were selected and divided into non-infection group(44 cases), local infection group(23 cases) and general infection group(23 cases) according to the results of blood culture. The value of single or joint detections of PCT and hs-CRP levels in the diagnosis of infection and correlation of PCT and hs-CRP, PCT were analyzed, and hs-CRP levels of infection group before and after treatment were detected. Results The PCT and hs-CRP levels of general infection group were higher than those of local infection group and non-infection group, with the differences statistically significant(P<0.05); The area under the ROC curve of PCT, hs-CRP, PCT+hs-CRP were 0.948, 0.912 and 0.963, the specificity and sensitivity of PCT+hs-CRP were better than those of PCT, hs-CRP; PCT had positive correlation with hs-CRP(r=0.784, P<0.01); After treatment, the PCT and hs-CRP levels of local infection group and general infection group decreased compared with those before treatment, with the differences statistically significant(P<0.05). Conclusion PCT and hs-CRP have certain value in the diagnosis of neonatal infectious diseases, they can evaluate the disease′s severity and curative effects, guide reasonable use of antibiotics. The diagnostic value of PCT combined with hs-CRP is higher, which can be used as the sensitive indexes in early diagnosis and identification of neonatal infection.
引文
[1] 成丽琴. 降钙素原检测在新生儿感染早期的临床应用[J]. 中日友好医院学报,2017,31(4):228-230.
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[6] 张绮翎,赵青,霍淑芬. 血清 PCT、hs-CRP水平及白细胞计数在新生儿感染中动态变化及其临床意义[J]. 国际检验医学杂志,2015,36(24):3537-3540.
[7] 吴延雷,汪晓英,方正,等. 降钙素原与 C-反应蛋白和白细胞计数在新生儿感染性疾病诊断应用[J]. 中华医院感染学杂志,2014,24(24):6063-6065.
[8] Tang LQ, Hu DP, Chen QY, et al. Elevated high-sensitivity C-reactive protein levels predict decreased survival for nasopharyngeal carcinoma patients in the intensity-modulated radiotherapy era[J]. PloS one, 2015, 10(4): e0122965.
[9] 冯广满,梁勇明. 新生儿感染早期诊断指标降钙素原与超敏C反应蛋白的临床价值[J]. 国际检验医学杂志,2016,37(19):2752-2754.
[10] Wu CW, Wu JY, Chen CK, et al. Does procalcitonin, C-reactive protein, or interleukin-6 test have a role in the diagnosis of severe infection in patients with febrile neutropenia A systematic review and meta-analysis[J]. Support Care Cancer, 2015, 23(10): 2863-2872.
[11] 国伟婷,张风华,李蓉. 超敏C反应蛋白联合降钙素原在新生儿重症感染的应用效果观察[J]. 中国医师杂志,2016,18(12):1855-1857.
[12] 杨爱平,张群威,叶君,等. PCT及CRP联合应用提高新生儿感染性肺炎的诊断灵敏度[J]. 中国卫生检验杂志,2015,25(5):694-696.
[13] 李素萍,汪倩,龚瑾,等. 血清降钙素原、超敏C反应蛋白和白细胞计数在新生儿感染性疾病早期诊断中的价值[J]. 中国妇幼保健,2017,32(17):4154-4157.
[14] 邱海南. 血清hs-CRP和PCT水平检测对新生儿败血症的早期诊断及疗效判断价值[J]. 热带医学杂志,2015,15(10):1353-1355.
[15] Mohsen AHA, Kamel BA. Predictive values for procalcitonin in the diagnosis of neonatal sepsis[J]. Electron Physician, 2015, 7(4): 1190-1195.
[16] 王卓,王学宽,陈强,等. 联合检测PCT、hs-CRP在新生儿脓毒症诊疗中的应用价值[J]. 中国微生态学杂志,2017,29(9):1049-1051.
[17] Zhu F, Jiang Z, Li WH, et al. Clinical significance of serum procalcitonin level monitoring on early diagnosis of severe pneumonia on children[J]. Eur Rev Med Pharmacol Sci, 2015, 19(22): 4300-4303.
[18] Westwood M, Ramaekers B, Whiting P, et al. Procalcitonin testing to guide antibiotic therapy for the treatment of sepsis in intensive care settings and for suspected bacterial infection in emergency department settings: a systematic review and cost-effectiveness analysis[J]. Health Technol Assess, 2015, 19(96): 1-236.
[19] 林艳,李微,黄颖璇,等. 血清PCT与hs-CRP对新生儿细菌感染性肺炎的诊断价值[J]. 海南医学,2017,28(10):1627-1628.
[20] 杨爱春. 新生儿感染诊断中降钙素原及超敏C-反应蛋白检测的临床意义[J]. 标记免疫分析与临床,2017,24(12):1393-1395.
[2] 殷静. 血清超敏C-反应蛋白、降钙素原、血小板参数在新生儿感染中的变化及临床意义[J]. 中国妇幼保健,2017,32(15):3539-3541.
[3] 傅国强,杜玉海,王新洲,等. 比较超敏C反应蛋白和降钙素原在新生儿肺部感染中的诊断价值[J]. 中国妇幼健康研究,2017,28(2):196-197.
[4] 邵肖梅. 实用新生儿学[M]. 4版. 北京:人民卫生出版社,2011:340-347.
[5] 周素芽,王丽娜,周琴,等. 血清降钙素原与超敏C-反应蛋白在新生儿感染性疾病中的表达及其临床评价[J]. 中华医院感染学杂志,2016,26(12):2837-2839.
[6] 张绮翎,赵青,霍淑芬. 血清 PCT、hs-CRP水平及白细胞计数在新生儿感染中动态变化及其临床意义[J]. 国际检验医学杂志,2015,36(24):3537-3540.
[7] 吴延雷,汪晓英,方正,等. 降钙素原与 C-反应蛋白和白细胞计数在新生儿感染性疾病诊断应用[J]. 中华医院感染学杂志,2014,24(24):6063-6065.
[8] Tang LQ, Hu DP, Chen QY, et al. Elevated high-sensitivity C-reactive protein levels predict decreased survival for nasopharyngeal carcinoma patients in the intensity-modulated radiotherapy era[J]. PloS one, 2015, 10(4): e0122965.
[9] 冯广满,梁勇明. 新生儿感染早期诊断指标降钙素原与超敏C反应蛋白的临床价值[J]. 国际检验医学杂志,2016,37(19):2752-2754.
[10] Wu CW, Wu JY, Chen CK, et al. Does procalcitonin, C-reactive protein, or interleukin-6 test have a role in the diagnosis of severe infection in patients with febrile neutropenia A systematic review and meta-analysis[J]. Support Care Cancer, 2015, 23(10): 2863-2872.
[11] 国伟婷,张风华,李蓉. 超敏C反应蛋白联合降钙素原在新生儿重症感染的应用效果观察[J]. 中国医师杂志,2016,18(12):1855-1857.
[12] 杨爱平,张群威,叶君,等. PCT及CRP联合应用提高新生儿感染性肺炎的诊断灵敏度[J]. 中国卫生检验杂志,2015,25(5):694-696.
[13] 李素萍,汪倩,龚瑾,等. 血清降钙素原、超敏C反应蛋白和白细胞计数在新生儿感染性疾病早期诊断中的价值[J]. 中国妇幼保健,2017,32(17):4154-4157.
[14] 邱海南. 血清hs-CRP和PCT水平检测对新生儿败血症的早期诊断及疗效判断价值[J]. 热带医学杂志,2015,15(10):1353-1355.
[15] Mohsen AHA, Kamel BA. Predictive values for procalcitonin in the diagnosis of neonatal sepsis[J]. Electron Physician, 2015, 7(4): 1190-1195.
[16] 王卓,王学宽,陈强,等. 联合检测PCT、hs-CRP在新生儿脓毒症诊疗中的应用价值[J]. 中国微生态学杂志,2017,29(9):1049-1051.
[17] Zhu F, Jiang Z, Li WH, et al. Clinical significance of serum procalcitonin level monitoring on early diagnosis of severe pneumonia on children[J]. Eur Rev Med Pharmacol Sci, 2015, 19(22): 4300-4303.
[18] Westwood M, Ramaekers B, Whiting P, et al. Procalcitonin testing to guide antibiotic therapy for the treatment of sepsis in intensive care settings and for suspected bacterial infection in emergency department settings: a systematic review and cost-effectiveness analysis[J]. Health Technol Assess, 2015, 19(96): 1-236.
[19] 林艳,李微,黄颖璇,等. 血清PCT与hs-CRP对新生儿细菌感染性肺炎的诊断价值[J]. 海南医学,2017,28(10):1627-1628.
[20] 杨爱春. 新生儿感染诊断中降钙素原及超敏C-反应蛋白检测的临床意义[J]. 标记免疫分析与临床,2017,24(12):1393-1395.