新生儿脐动脉血血清淀粉样蛋白A、C-反应蛋白水平变化及临床意义
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摘要
目的探讨新生儿脐动脉血血清淀粉样蛋白A (SAA)、C-反应蛋白(CRP)水平变化并分析其临床意义,为临床早期有效诊断危重症新生儿提供参考依据。方法选取2015年2月-2017年2月在医院产科分娩的新生儿195例为研究对象,根据新生儿危重病例评分法将其分为正常对照组135例、非危重组22例、危重组23例及极危重组15例。所有新生儿断脐后采取脐动脉血,采用酶联免疫吸附法检测脐动脉血血清SAA与CRP水平,制作研究对象工作特性(ROC)曲线,计算SAA与CRP诊断危重症的敏感度与特异性。结果正常对照组、非危重组、危重组及极危重组新生儿的脐动脉血血清SAA、CRP水平均呈逐渐上升趋势,组间差异均有统计学意义(P<0. 05)。经Pearson相关性分析可得:新生儿脐动脉血血清SAA及CRP水平与危重症程度均呈正相关关系(P<0. 01)。新生儿脐动脉血血清SAA及CRP水平诊断危重症ROC曲线下面积分别为0. 941及0. 904。分别以新生儿脐动脉血血清SAA>1. 78 mg/L、CRP>24. 58 mg/L为最佳切入点,新生儿脐动脉血血清SAA、CRP水平诊断危重症的敏感度分别为84. 01%、72. 12%,特异性分别为96. 72%、90. 58%,约登指数分别为0. 802、0. 782。结论新生儿脐动脉血血清SAA、CRP水平均能有效反映危重症病情严重程度,且血清SAA及CRP水平在诊断危重症新生儿中均有较高的敏感度与特异性,可作为临床上诊断危重症新生儿的指标。
Objective To explore the changes of serum amyloid A( SAA) and C-reactive protein( CRP) levels in umbilical artery blood of neonates,analyze the clinical significance,and provide a reference basis for clinical early and effective diagnosis of critical diseases in neonates. Methods A total of 195 neonates born in Department of Obstetrics in People's Hospital of Wuhan University from February2015 to February 2017 were selected as study object,then they were divded into normal control group( 135 neonates),non-critical disease group( 22 neonates),critical disease group( 23 neonates),and very critical disease group( 15 neonates) according to neonatal critical ill score. Umbilical artery blood samples were obtained after omphalotomy in the four groups. ELISA was used to detect the levels of serum SAA and CRP in umbilical artery blood. ROC was drawn to calculate sensitivities and specificities of SAA and CRP in diagnosis of critical diseases. Results The levels of serum SAA and CRP in umbilical artery blood of neonates in normal control group,non-critical disease group,critical disease group,and very critical disease group increased gradually( P<0. 05). Pearson correlation analysis showed that the levels of serum SAA and CRP in umbilical artery blood of neonates were positively correlated with the severity of critical diseases( P<0. 01). The areas under ROC curve of serum SAA and CRP in umbilical artery blood of neonates in diagnosis of critical diseases were 0. 941 and 0. 904,respectively. Taking serum SAA>1. 78 mg/L and CRP>24. 58 mg/L as the optimal incisiveness,the sensitivities of serum SAA and CRP in diagnosis of critical diseases were 84. 01% and 72. 12%,respectively,the specificities were 96. 72% and 90. 58%,respectively,Youden indexes were 0. 802 and 0. 782,respectively. Conclusion The levels of serum SAA and CRP in umbilical artery blood of neonates can effectively reflect the severity of critical diseases. The sensitivities and specificities of serum levels of SAA and CRP in diagnosis of critical diseases are high. SAA and CRP can be used as clinical indicators for clinical diagnosis of critical diseases in neonates.
Objective To explore the changes of serum amyloid A( SAA) and C-reactive protein( CRP) levels in umbilical artery blood of neonates,analyze the clinical significance,and provide a reference basis for clinical early and effective diagnosis of critical diseases in neonates. Methods A total of 195 neonates born in Department of Obstetrics in People's Hospital of Wuhan University from February2015 to February 2017 were selected as study object,then they were divded into normal control group( 135 neonates),non-critical disease group( 22 neonates),critical disease group( 23 neonates),and very critical disease group( 15 neonates) according to neonatal critical ill score. Umbilical artery blood samples were obtained after omphalotomy in the four groups. ELISA was used to detect the levels of serum SAA and CRP in umbilical artery blood. ROC was drawn to calculate sensitivities and specificities of SAA and CRP in diagnosis of critical diseases. Results The levels of serum SAA and CRP in umbilical artery blood of neonates in normal control group,non-critical disease group,critical disease group,and very critical disease group increased gradually( P<0. 05). Pearson correlation analysis showed that the levels of serum SAA and CRP in umbilical artery blood of neonates were positively correlated with the severity of critical diseases( P<0. 01). The areas under ROC curve of serum SAA and CRP in umbilical artery blood of neonates in diagnosis of critical diseases were 0. 941 and 0. 904,respectively. Taking serum SAA>1. 78 mg/L and CRP>24. 58 mg/L as the optimal incisiveness,the sensitivities of serum SAA and CRP in diagnosis of critical diseases were 84. 01% and 72. 12%,respectively,the specificities were 96. 72% and 90. 58%,respectively,Youden indexes were 0. 802 and 0. 782,respectively. Conclusion The levels of serum SAA and CRP in umbilical artery blood of neonates can effectively reflect the severity of critical diseases. The sensitivities and specificities of serum levels of SAA and CRP in diagnosis of critical diseases are high. SAA and CRP can be used as clinical indicators for clinical diagnosis of critical diseases in neonates.
引文
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[18]沈伟虹,岳朝艳,孙振东,等.血清淀粉样蛋白A与C反应蛋白联合检测在新生儿细菌感染诊断中的应用[J].检验医学,2016,31(3):173-175.
[19]杨长仪,张宝泉,陈涵强,等.胎膜早破新生儿脐血白细胞介素6和C反应蛋白水平与早发型新生儿败血症的关系[J].中华新生儿科杂志(中英文),2017,32(2):110-114.
[20]Bochniarz M,Zdzisińska B,Wawron W,et al.Milk and serum IL-4,IL-6,IL-10,and amyloid A concentrations in cows with subclinical mastitis caused by coagulase-negative staphylococci[J].J Dairy Sci,2017,100(12):9674-9680.
[2]朱荣平,李晓英,顾春燕,等.动脉血乳酸变化对重度窒息新生儿预后的评估[J].中国小儿急救医学,2015,22(11):780-782.
[3]Rogier R,Evans-Marin H,Manasson J,et al.Alteration of the intestinal microbiome characterizes preclinical inflammatory arthritis in mice and its modulation attenuates established arthritis[J].Sci Rep,2017,7(1):15613.
[4]杨慧敏.新生儿感染性休克与新生儿疾病危重病例评分及多脏器功能损害间的关系研究[J].临床研究,2015,23(6):85-86.
[5]李斌,蔡群,徐美玉,等.儿童早期预警评分与新生儿危重病例评分在新生儿败血症病情评估的应用[J].江苏医药,2015,41(2):178-180.
[6]Shabuj KH,Hossain J,Moni SC,et al.C-reactive protein(CRP)as a single biomarker for diagnosis of neonatal sepsis:a comprehensive meta-analysis[J].Mymensingh Med J,2017,26(2):364-371.
[7]吴健容,谷强.新生儿危重病例评分和第三代小儿死亡危险评分预测危重新生儿死亡风险比较[J].中国儿童保健杂志,2014,22(4):368-370.
[8]董传莉,徐家丽.动脉血乳酸对新生儿窒息病情严重程度及预后的评估价值[J].蚌埠医学院学报,2016,41(5):589-591.
[9]王战胜,刘雨露,施雪颖,等.不同评分系统预测危重新生儿死亡风险的应用[J].中国新生儿科杂志,2016,31(3):189-192.
[10]陈翠瑶,黄为民,钱新华,等.新生儿危重病例评分与新生儿急性生理学评分围产期补充Ⅱ的应用比较[J].中国当代儿科杂志,2017,19(3):342-345.
[11]何柳,夏斌,虎春元,等.新生儿危重病例评分法的临床应用[J].中华妇幼临床医学杂志(电子版),2017,13(2):162-168.
[12]陈波,张惠荣,段为浩,等.两种危重评分对新生儿呼吸窘迫综合征患儿死亡风险的预测价值[J].中国现代医学杂志,2017,27(3):97-100.
[13]陆文峰,张洁,方成志,等.新生儿败血症发病情况及早期诊断指标分析[J].中国妇幼健康研究,2017,28(8):908-910.
[14]Barbierato M,Borri M,Facci L,et al.Expression and differential responsiveness of central nervous system glial cell populations to the acute phase protein serum amyloid A[J].Sci Rep,7(1):12158.
[15]杨秀霖,王程毅,郑启安,等.重症肺炎合并脓毒症患儿炎症因子及凝血指标与危重症评分相关性分析[J].中国循证儿科杂志,2013,8(4):300-303.
[16]陈茜娜,蔡小核,陈清,等.脐血PCT、CRP水平对具有感染高危因素晚期早产儿早发感染的诊断价值[J].浙江医学,2017,39(6):478-479.
[17]Gür A,Oguzturk H,K9se A,et al.Prognostic value of procalcitonin,CRP,serum amyloid A,lactate and IL-6 markers in liver transplant patients admitted to ED with suspected infection[J].In Vivo,2017,31(6):1179-1185.
[18]沈伟虹,岳朝艳,孙振东,等.血清淀粉样蛋白A与C反应蛋白联合检测在新生儿细菌感染诊断中的应用[J].检验医学,2016,31(3):173-175.
[19]杨长仪,张宝泉,陈涵强,等.胎膜早破新生儿脐血白细胞介素6和C反应蛋白水平与早发型新生儿败血症的关系[J].中华新生儿科杂志(中英文),2017,32(2):110-114.
[20]Bochniarz M,Zdzisińska B,Wawron W,et al.Milk and serum IL-4,IL-6,IL-10,and amyloid A concentrations in cows with subclinical mastitis caused by coagulase-negative staphylococci[J].J Dairy Sci,2017,100(12):9674-9680.