降钙素原、C反应蛋白及血清前白蛋白联合动态监测在足月新生儿败血症早期诊疗中的价值

Value of dynamic monitoring for procalcitonin, C-reactive protein and prealbumin in early diagnosis and prognosis of full-term

关键词:  降钙素原  C反应蛋白  血清前白蛋白  足月儿  新生儿败血症

Key words:  procalcitionin  C-reactive protein  prealbumin  term infant  neonatal septicemia

摘要:

目的　评估联合动态监测降钙素原（procalcitonin, PCT）、C反应蛋白（C-reactive protein, CRP）及血清前白蛋白（prealbumin, PA）在足月新生儿败血症早期诊疗中的应用价值。方法　选取2014年1月至2015年6月潍坊医学院附属医院新生儿科收住的足月儿164例，包括败血症组81例及非感染组（对照组）83例。分别连续监测两组患儿治疗前、治疗后1 d、3 d、7 d及出院前PCT、CRP及PA的含量变化并进行比较，分别绘制受试者工作特征（receiver operating characteristic，ROC）曲线以评估诊断效值。结果　 （1）败血症组治疗前PCT、CRP含量明显高于对照组，PA水平低于对照组，差异均有统计学意义（P＜0.05）；（2）与治疗前比较，治疗后1 d、3 d、7 d及出院前败血症组PCT及CRP含量持续下降，PA则逐渐升高，差异有统计学意义（P＜0.05）。治疗前及治疗后1 d、3 d、7 d时两组患儿间PCT、CRP和PA水平比较差异均有统计学意义（P＜0.05），而出院前三者的含量比较，差异无统计学意义（P＞0.05）；（3）ROC曲线分析示在单独应用时PA灵敏度及特异度最高，PCT次之；PCT联合CRP及PA的曲线下面积（area under the ROC curve，AUC）最大，灵敏度及特异度最佳。结论　动态、联合监测PCT、CRP及PA含量变化对足月儿败血症早期诊断有较高的敏感度及特异性，并能较好地提示预后。

Abstract:

Objective To investigate the clinical value of dynamic monitoring for PCT、CRP and PA in early diagnosis and prognosis of neonatal septicemia. Methods Totally, 164 case of term Infant form Affiliated Hospital of Weifang Medical University between January, 2014 and June, 2015 were selected as objects in the research，including 81 case of clinically confirmed neonatal septicemia patients (septicemia group) and 83 cases of non-infectious patients (control group). The levels of PCT, CRP and PA in both groups were measured before treatment and at one day、three day、seven day after treatment and before their hospital discharge. All of the test results were compared between the two groups, and the results of septicemia group were analyzed by receiver operating characteristic curve. Results （1）The levels of PCT and CRP in septicemia group were significantly higher than those in control group on admission, and PA distinctly declined; the results between the two groups exhibited significant differences.（2）In pace with improvement of the condition，the levels of PCT and CRP continuously decreased, and the levels of PA increased gradually, the test results at one day、three day、seven day after treatment and before hospital discharge exhibited statistical differences between the two groups. In addition, comparison of the levels of PCT、CRP、PA before treatment and at one day、three day、seven day after treatment between the two groups, revealed significant difference; however there were no statistical significances between the two groups before hospital discharge .（3）The area under the ROC curve of PA was maximal compared with PCT and CRP, also had the best sensibility and specificity, fellow by PCT. The area under the ROC curve of PCT combined CRP and PA was biggest of all, having the best sensibility and specificity. Conclusion Dynamic monitoring PCT、CRP and PA can be applied to early diagnosis of neonatal septicemia with high sensibility and specificity, and also valuable reflecting the prognosis of disease.