SAA及NGAL对早产儿脓毒症的预测价值
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摘要
目的探讨血清淀粉样蛋白A(SAA)、人中性粒细胞明胶酶相关脂质运载蛋白(NGAL)在早产儿脓毒症中的预测价值。方法选取2014年1月至2015年1月入住该院新生儿重症监护室,日龄>7d,怀疑感染的68例早产儿作为研究对象,分为全身炎症反应综合征(SIRS)组、脓毒症组和严重脓毒症组,分别为16、31、21例;无感染早产儿19例纳入对照组;比较不同发病时间点、不同疾病严重程度患儿的SAA、NGAL、C反应蛋白(CRP)水平,同时采用受试者工作特征曲线比较上述指标的预测价值。结果发病当天,严重脓毒症组与SIRS组、对照组SAA、NGAL、CRP水平比较,差异有统计学意义(P<0.05);严重脓毒症组与脓毒症组SAA、NGAL水平比较,差异有统计学意义(P<0.05);脓毒症组与SIRS组CRP水平比较,差异有统计学意义(P<0.05)。发病4d及治疗结束时SAA、NGAL在严重脓毒症组中升高,与SIRS组、脓毒症组比较,差异有统计学意义(P<0.05);而CRP在发病4d及治疗结束时,严重脓毒症组及脓毒症组较SIRS组升高明显,差异有统计学意义(P<0.05);CRP在发病4d时严重脓毒症组及脓毒症组比较,差异无统计学意义(P>0.05);治疗结束时严重脓毒症组及脓毒症CRP水平差异有统计学意义(P<0.05)。发病当天,SAA、NGAL、CRP水平曲线下面积分别为0.97、0.89及0.85。结论 SAA及NGAL在早产儿脓毒症中有预测作用,随病情好转,该2项指标均下降,可用于指导临床治疗。
Objective To determine the value of serum amyloid A(SAA)and human neutrophil gelatinaseassociated lipocalin(NGAL)in predication of neonatal sepsis.Methods A total of 87 infants were enrolled in this prospective study.The infants were divided into four groups including systemic inflammatory response syndrome(SIRS)group(16 cases),sepsis group(31 cases),severe sepsis group(21 cases),other 19 infants without sepsis in control group.SAA,NGAL and c-reactive protein(CRP)were compared at different time point and different disease severe degree.The receiver operating characteristic curve were drawn to evaluate the values of the three parameters in the forecast of neonatal sepsis.Results On the day of onset,the differences on SAA,NGAL and CRP levels between the severe sepsis group and those in the SIRS group and those in the control group were significant(P<0.05).SAA and NGAL levels in severe sepsis group and sepsis group were significantly different(P<0.05).CRP level in sepsis group and SIRS group was statistically significant(P<0.05).SAA and NGAL increased in severe sepsis group after onset 4 days and at the end of treatment,and the differences were statistically significant compared with that in SIRS group and sepsis group(P<0.05).However,CRP was significantly higher in the severe sepsis group and the sepsis group than in the SIRS group after the onset 4 days and at the end of treatment,and the differences were statistically significant(P<0.05).There was no significant difference in CRP between the severe sepsis group and the sepsis group after onset 4 days(P>0.05).At the end of treatment,CRP levels in severe sepsis group and sepsis group were significantly different(P<0.05).The area under the curve for SAA,NGAL and CRP at 0 hwere 0.97,0.89 and 0.85 respectively.Conclusion SAA is useful at the onset of inflammation for rapid prognosis of neonatal sepsis and could be safely and accurately used in combination with other sepsis markers such as NGAL and CRP in diagnosis and follow-up of neonatal sepsis in preterm infants.
Objective To determine the value of serum amyloid A(SAA)and human neutrophil gelatinaseassociated lipocalin(NGAL)in predication of neonatal sepsis.Methods A total of 87 infants were enrolled in this prospective study.The infants were divided into four groups including systemic inflammatory response syndrome(SIRS)group(16 cases),sepsis group(31 cases),severe sepsis group(21 cases),other 19 infants without sepsis in control group.SAA,NGAL and c-reactive protein(CRP)were compared at different time point and different disease severe degree.The receiver operating characteristic curve were drawn to evaluate the values of the three parameters in the forecast of neonatal sepsis.Results On the day of onset,the differences on SAA,NGAL and CRP levels between the severe sepsis group and those in the SIRS group and those in the control group were significant(P<0.05).SAA and NGAL levels in severe sepsis group and sepsis group were significantly different(P<0.05).CRP level in sepsis group and SIRS group was statistically significant(P<0.05).SAA and NGAL increased in severe sepsis group after onset 4 days and at the end of treatment,and the differences were statistically significant compared with that in SIRS group and sepsis group(P<0.05).However,CRP was significantly higher in the severe sepsis group and the sepsis group than in the SIRS group after the onset 4 days and at the end of treatment,and the differences were statistically significant(P<0.05).There was no significant difference in CRP between the severe sepsis group and the sepsis group after onset 4 days(P>0.05).At the end of treatment,CRP levels in severe sepsis group and sepsis group were significantly different(P<0.05).The area under the curve for SAA,NGAL and CRP at 0 hwere 0.97,0.89 and 0.85 respectively.Conclusion SAA is useful at the onset of inflammation for rapid prognosis of neonatal sepsis and could be safely and accurately used in combination with other sepsis markers such as NGAL and CRP in diagnosis and follow-up of neonatal sepsis in preterm infants.
引文
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[12]LANNERGARD A,VIBERG A,CARS O,et al.The time course of body temperature,serum amyloid A protein,C-reactive protein and interleukin-6in patients with bacterial infection during the initial 3days of antibiotic therapy[J].Scand J Infect Dis,2009,41(9):663-671.
[13]KOUTSOKERA A,KIROPOULOS T S,NIKOULIS DJ,et al.Clinical,functional and biochemical changes during recovery from COPD exacerbations[J].Respir Med,2009,103(6):919-926.
[14]HUTTUNEN T,TEPPO A M,LUPISAN S,et al.Correlation between the severity of infectious diseases in children and the ratio of serum amyloid A protein and C-reactive protein[J].Scand J Infect Dis,2003,35(8):488-490.
[15]ELVIRA P,SHERI L N,KENNETH A M,et al.Urinary Neutrophil Gelatinase-Associated lipocalin is a promising biomarker for late onset culture-positive sepsis in very low birth weight infants[J].Pediatr Res,2010,67(6):636-640.
[16]贾芙蓉,张宇,王超,等.人中性粒细胞载脂蛋白在急性细菌与病毒感染鉴别诊断中的临床意义[J].中国生物制品学杂志,2012,25(1):87-90.
[17]刘炳旭,魏殿军,李真玉.中性粒细胞明胶酶相关脂质运载蛋白在脓毒血症中的表达及意义[J].山东医药,2012,52(33):60-61.
[18]杨惠聪,林洁,吴阿阳.中性粒细胞明胶酶相关脂质运载蛋白检测在新生儿败血症中的应用[J].实用医技杂志,2016,23(11):1180-1182.
[2]CAMACHO-GONZALEZ A,SPEARMAN P W,STOLLB J.Neonatal infectious diseases evaluation of neonatal sepsis[J].Pediatr Clin North Am,2013,60(2):367-389.
[3]MUKHOPADHYAY S,PUOPOLO K M.Clinical and microbiologic characteristics of early-onset sepsis among very low birth weight infants:opportunities for antibiotic stewardship[J].Pediatr Infect Dis J,2017,36(5):477-481.
[4]ZEA-VERA A,OCHOA T J.Challenges in the diagnosis and management of neonatal sepsis[J].J Trop Pediatr,2015,61(1):1-13.
[5]LAI M Y,TSAI M H,LEE C W,et al.Characteristics of neonates with culture-proven bloodstream infection who have low levels of C-reactive protein(≤10 mg/L)[J].BMC Infect Dis,2015,15:320-328.
[6]AYDEMIR C,AYDEMIR H,KOKTURK F,et al.The cut-off levels of procalcitonin and C-reactive protein and the kinetics of mean platelet volume in preterm neonates with sepsis[J].Pediatr,2018,18(1):253-264.
[7]PARRAVICINI E,NEMEROFSKY S L,MICHELSONK A,et al.Urinary neutrophil Gelatinase-Associated lipocalin is a promising biomarker for late onset CulturePositive sepsis in very low birth weight infants[J].Pediatr Res,2010,67(6):636-640.
[8]费凤英,衣萍,林见敏.血清淀粉样蛋白A与C反应蛋白联合检测的临床应用价值[J].检验医学,2014,29(10):1031-1033.
[9]CETINKAYA M,OZKAN H,KKSAL N,et al.Comparison of serum amyloid A concentrations with those of C-reactive protein and procalcitonin in diagnosis and follow-up of neonatal sepsis in premature infants[J].J Perinatol,2009,29(3):225-231.
[10]YUAN H N,HUANG J,LV B K,et al.Diagnosis value of the serum amyloid a test in neonatal sepsis:a Meta-A-nalysis[J].Biomed Res Int,2013,2013:520294.
[11]LANNERGARD A,LARSSON A,FRIMAN G,et al.Human serum amyloid A(SAA)and high sensitive C-reactive protein(hsCRP)in preterm newborn infants with nosocomial infections[J].Acta Paediatr,2008,97(8):1061-1065.
[12]LANNERGARD A,VIBERG A,CARS O,et al.The time course of body temperature,serum amyloid A protein,C-reactive protein and interleukin-6in patients with bacterial infection during the initial 3days of antibiotic therapy[J].Scand J Infect Dis,2009,41(9):663-671.
[13]KOUTSOKERA A,KIROPOULOS T S,NIKOULIS DJ,et al.Clinical,functional and biochemical changes during recovery from COPD exacerbations[J].Respir Med,2009,103(6):919-926.
[14]HUTTUNEN T,TEPPO A M,LUPISAN S,et al.Correlation between the severity of infectious diseases in children and the ratio of serum amyloid A protein and C-reactive protein[J].Scand J Infect Dis,2003,35(8):488-490.
[15]ELVIRA P,SHERI L N,KENNETH A M,et al.Urinary Neutrophil Gelatinase-Associated lipocalin is a promising biomarker for late onset culture-positive sepsis in very low birth weight infants[J].Pediatr Res,2010,67(6):636-640.
[16]贾芙蓉,张宇,王超,等.人中性粒细胞载脂蛋白在急性细菌与病毒感染鉴别诊断中的临床意义[J].中国生物制品学杂志,2012,25(1):87-90.
[17]刘炳旭,魏殿军,李真玉.中性粒细胞明胶酶相关脂质运载蛋白在脓毒血症中的表达及意义[J].山东医药,2012,52(33):60-61.
[18]杨惠聪,林洁,吴阿阳.中性粒细胞明胶酶相关脂质运载蛋白检测在新生儿败血症中的应用[J].实用医技杂志,2016,23(11):1180-1182.