白细胞介素-6、降钙素原、C-反应蛋白对足月新生儿社区获得性败血症晚发型的早期诊断价值
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摘要
目的分析白细胞介素-6 (IL-6)、降钙素原(PCT)、C-反应蛋白(CRP)在足月新生儿社区获得性败血症晚发型与正常足月儿间的水平差异,并评估其作为早期诊断指标的临床应用价值。方法以某院2016年6月-2017年6月收治的48例足月新生儿社区获得性败血症晚发型确诊病例为观察组,同时选取同期住院的54例非感染足月晚期新生儿为对照组。对比分析两组新生儿IL-6、PCT及CRP水平差异,并绘制ROC曲线评价其作为早期诊断指标的价值。结果观察组新生儿血清IL-6、PCT、CRP水平均高于对照组,差异均有统计学意义(均P<0. 05)。IL-6作为单项指标的曲线下面积为0. 875,最佳截断值为22. 79 pg/ml,灵敏度和特异度分别为85. 41%和74. 12%; PCT作为单项指标的曲线下面积为0. 778,最佳截断值为1. 11 ng/ml,灵敏度和特异度分别为70. 79%和79. 61%; CRP作为单项指标的曲线下面积为0. 809,最佳截断值为5. 84 mg/L,灵敏度和特异度分别为66. 73%和92. 64%。各指标联合:曲线下面积IL-6+PCT为0. 886,IL-6+CRP为0. 914,PCT+CRP为0. 855,三者联合为0. 916;灵敏度和特异度IL-6+PCT分别为83. 31%和81. 52%; IL-6+CRP分别为93. 78%和74. 12%; PCT+CRP分别为77. 12%和88. 94%。三者联合分别为91. 68%和81. 52%。结论新生儿社区获得性败血症晚发型患儿的IL-6、PCT、CRP水平均高于正常足月儿,三者均可作为早期诊断的敏感指标,联合检测可以提高诊断的准确率和灵敏度。
Objective To analyze the differences of interleukin-6( IL-6),procalcitonin( PCT),and C-reactive protein( CRP) levels between full-term neonates with community-acquired late-onset neonatal septicemia and normal full-term neonates,evaluate the clinical application value as early diagnostic indicators. Methods From June 2016 to June 2017,48 full-term neonates with community-acquired late-onset neonatal septicemia treated in a hospital were selected as observation group,and 54 full-term late neonates without infection were selected from the hospital during the same period. The differences of IL-6,PCT,and CRP levels between the two groups were compared and analyzed. The value of IL-6,PCT,and CRP as early diagnostic indicators was evaluated by ROC curve. Results The levels of serum IL-6,PCT,and CRP in observation group were statistically significantly higher than that in control group( P<0. 05). The area under ROC of IL-6 was 0. 875,the optimal cutoff value was 22. 79 pg/ml,the sensitivity and specificity were 85. 41% and 74. 12%,respectively. The area under ROC of PCT was 0. 778,the optimal cutoff value was 1. 11 ng/ml,the sensitivity and specificity were 70. 79% and 79. 61%,respectively. The area under ROC of CRP was 0. 809,the optimal cutoff value was 5. 84 mg/L,the sensitivity and specificity were 66. 73%and 92. 64% respectively. Combined detection of three indicators: the areas under ROC of IL-6+PCT,IL-6+CRP,PCT+CRP,L-6+PCT+CRP were 0. 886,0. 914,0. 855,and 0. 916,respectively; the sensitivities and specificities of IL-6+PCT,IL-6+CRP,PCT+CRP,L-6+PCT + CRP were 83. 31% and 81. 52%, 93. 78% and 74. 12%, 77. 12% and 88. 94%, 91. 68% and 81. 52%, respectively.Conclusion The levels of IL-6,PCT,and CRP in full-term neonates with community-acquired late-onset neonatal septicemia are higher than those in normal full-term neonates,IL-6,PCT,and CRP can be used as sensitive indicators of early diagnosis of community-acquired late-onset neonatal septicemia,combined detection can improve accuracy and sensitivity of diagnosis.
Objective To analyze the differences of interleukin-6( IL-6),procalcitonin( PCT),and C-reactive protein( CRP) levels between full-term neonates with community-acquired late-onset neonatal septicemia and normal full-term neonates,evaluate the clinical application value as early diagnostic indicators. Methods From June 2016 to June 2017,48 full-term neonates with community-acquired late-onset neonatal septicemia treated in a hospital were selected as observation group,and 54 full-term late neonates without infection were selected from the hospital during the same period. The differences of IL-6,PCT,and CRP levels between the two groups were compared and analyzed. The value of IL-6,PCT,and CRP as early diagnostic indicators was evaluated by ROC curve. Results The levels of serum IL-6,PCT,and CRP in observation group were statistically significantly higher than that in control group( P<0. 05). The area under ROC of IL-6 was 0. 875,the optimal cutoff value was 22. 79 pg/ml,the sensitivity and specificity were 85. 41% and 74. 12%,respectively. The area under ROC of PCT was 0. 778,the optimal cutoff value was 1. 11 ng/ml,the sensitivity and specificity were 70. 79% and 79. 61%,respectively. The area under ROC of CRP was 0. 809,the optimal cutoff value was 5. 84 mg/L,the sensitivity and specificity were 66. 73%and 92. 64% respectively. Combined detection of three indicators: the areas under ROC of IL-6+PCT,IL-6+CRP,PCT+CRP,L-6+PCT+CRP were 0. 886,0. 914,0. 855,and 0. 916,respectively; the sensitivities and specificities of IL-6+PCT,IL-6+CRP,PCT+CRP,L-6+PCT + CRP were 83. 31% and 81. 52%, 93. 78% and 74. 12%, 77. 12% and 88. 94%, 91. 68% and 81. 52%, respectively.Conclusion The levels of IL-6,PCT,and CRP in full-term neonates with community-acquired late-onset neonatal septicemia are higher than those in normal full-term neonates,IL-6,PCT,and CRP can be used as sensitive indicators of early diagnosis of community-acquired late-onset neonatal septicemia,combined detection can improve accuracy and sensitivity of diagnosis.
引文
[1]邵肖梅,叶鸿瑁,邱小汕.实用新生儿学[M].第4版,北京:人民卫生出版社,2011:340-347.
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[7]丘惠娴,吴伟晴,黄循斌.s TREM-1、TREM-1、CRP对新生儿败血症早期诊断及疗效判断的价值研究[J].中国妇幼保健,2016,31(14):2881-2883.
[8]解晶,喻长法,戴卫峰.白细胞介素-6、降钙素原和C-反应蛋白联合检测在新生儿败血症早期诊断中的价值[J].中华医院感染学杂志,2010,20(22):3628-3629.
[9]Irwin AD,Carrol ED.Procalcitonin[J].Arch Dis Child Educ Pract Ed,2011,96(6):228-233.
[10]Li H,Luo YF,Blackwell TS,et al.Meta-analysis and systematic review of procalcitonin-guided therapy in respiratory tract infections[J].Antimicrob Agents Chemother,2011,55(12):5900-5906.
[11]Cousin F,Ortega-Deballon P,Bourredjem A,et al.Diagnostic accuracy of procalcitonin and C-reactive protein for the early diagnosis of intra-abdominal Infection after elective colorectal surgery:a Meta analysis[J].Ann Surg,2016,264(2):252-256.
[12]赵凤霞,刘光辉,张健.IL-6和IL-8在诊断新生儿败血症中的价值研究[J].中国当代儿科杂志,2015,17(22):1311-1315.
[13]Hotoura E,Giapros V,Kostola A,et al.Tracking changes of lymphocyte subsets and pre-inflammatory mediators in full-term neohates with suspected or documented infection[J].Scand J Immunol,2011,73(3):250-255.
[14]黄丽娇,庄晖,刘丽明.联合检测PCT、IL-6和CRP水平在预测未足月胎膜早破患者并发绒毛膜羊膜炎及新生儿败血症的临床价值研究[J].中国妇幼保健,2016,31(17):3471-3474.
[15]陆忠星,顾月琴.新生儿败血症的辅助实验室检查[J].中华全科医学,2016,14(3):474-477.
[2]Oza S,Lawn JE,Hogan DR,et al.Neonatal cause-of-death estimates for the early and late neonatal periods for 194 countries:2000-2013[J].Bull World Health Organ,2015,93(1):19-28.
[3]叶应妩,王毓三.全国临床检验操作规程[M].第3版,南京:东南大学出版社,2006:715-920.
[4]余加林,吴仕孝.新生儿败血症诊疗方案[J].中华儿科杂志,2003,41(12):897-899.
[5]Polin RA,Committee on Fetus and Newborn.Management of neonates with suspected or proven early-onset bacterial sepsis[J].Pediatrics,2012,129(5):1006-1015.
[6]陈潇,富建华.新生儿败血症诊治的研究进展[J].中华新生儿科杂志,2017,32(3):236-239.
[7]丘惠娴,吴伟晴,黄循斌.s TREM-1、TREM-1、CRP对新生儿败血症早期诊断及疗效判断的价值研究[J].中国妇幼保健,2016,31(14):2881-2883.
[8]解晶,喻长法,戴卫峰.白细胞介素-6、降钙素原和C-反应蛋白联合检测在新生儿败血症早期诊断中的价值[J].中华医院感染学杂志,2010,20(22):3628-3629.
[9]Irwin AD,Carrol ED.Procalcitonin[J].Arch Dis Child Educ Pract Ed,2011,96(6):228-233.
[10]Li H,Luo YF,Blackwell TS,et al.Meta-analysis and systematic review of procalcitonin-guided therapy in respiratory tract infections[J].Antimicrob Agents Chemother,2011,55(12):5900-5906.
[11]Cousin F,Ortega-Deballon P,Bourredjem A,et al.Diagnostic accuracy of procalcitonin and C-reactive protein for the early diagnosis of intra-abdominal Infection after elective colorectal surgery:a Meta analysis[J].Ann Surg,2016,264(2):252-256.
[12]赵凤霞,刘光辉,张健.IL-6和IL-8在诊断新生儿败血症中的价值研究[J].中国当代儿科杂志,2015,17(22):1311-1315.
[13]Hotoura E,Giapros V,Kostola A,et al.Tracking changes of lymphocyte subsets and pre-inflammatory mediators in full-term neohates with suspected or documented infection[J].Scand J Immunol,2011,73(3):250-255.
[14]黄丽娇,庄晖,刘丽明.联合检测PCT、IL-6和CRP水平在预测未足月胎膜早破患者并发绒毛膜羊膜炎及新生儿败血症的临床价值研究[J].中国妇幼保健,2016,31(17):3471-3474.
[15]陆忠星,顾月琴.新生儿败血症的辅助实验室检查[J].中华全科医学,2016,14(3):474-477.