血清前降钙素在新生儿败血症诊疗中的应用价值

目的探讨血清前降钙素（PCT）在新生儿败血症诊疗中的应用价值。方法以112例新生儿败血症患儿为观察组，101例无感染征象的新生儿为对照组，入院时进行PCT、C反应蛋白（CRP）和血培养检查，其中观察组在治疗1周后复查PCT和CRP，并将结果进行分析。结果观察组入院时血PCT和CRP平均值分别为（7．58±4．81）ng／L、（22．26±4．67）mg／L，明显高于对照组的（0．17±1．44）ng／L、（6．38±4．61）mg／L，差异均有统计学意义（P〈0.01）。观察组治疗后PCT和CRP平均值分别为（0.24±1．89）ng／L、（4．07±1．08）mg／L，与治疗前相比，差异有统计学意义（P〈0.01）。观察组入院时PCT阳性率71.43％（80／112）与CRP的阳性率54．46％（61／112）、血培养阳性率27．68％（31／112）比较，差异有统计学意义（P〈0.05）。PCT检测对败血症的敏感度是71．43％（80／112），特异度是89．11％（90／101），CRP检测对败血症的敏感度为54．46％（61／112），特异度为73．27％（74／101）。结论PCT可作为新生儿败血症早期诊断有价值的指标。     

血清降钙素原和C反应蛋白在小儿感染性肺炎诊断中的应用

目的 探讨血清降钙素原（PCT）和C反应蛋白（CRP）在小儿感染性肺炎诊断中的临床意义.方法 选取290例小儿感染性肺炎患儿包括临床确诊细菌性肺炎85例,病毒性肺炎67例,单纯肺炎支原体肺炎82例,单纯肺炎衣原体肺炎56例,健康体检儿童50例,同时检测血清中的PCT和CRP的含量.结果 细菌感染组与病毒感染组、支原体感染组、衣原体感染组、正常对照组比较PCT和CRP明显升高,差异有统计学意义（P〈0.01）,病毒感染组、支原体感染组、衣原体感染组与正常对照组比较PCT和CRP仅轻度升高,差异无统计学意义（P〉0.05）.细菌感染组治疗前后比较PCT和CRP明显下降,差异有统计学意义（P〈0.01）.结论 PCT和CRP的检测有助于小儿感染性肺炎的鉴别诊断,动态监测其变化对细菌性肺炎的疗效判断有一定的临床价值.     

血清PCT、CRP对未足月胎膜早破并发绒毛膜羊膜炎的诊断意义

目的:探讨检测未足月胎膜早破(PPROM)孕妇血清降钙素原(PCT)及C-反应蛋白(CRP)浓度诊断绒毛膜羊膜炎的价值。方法:选取未足月胎膜早破患者55例,相同孕周健康孕妇40例,检测血清PCT、CRP。PPROM患者分娩后,对胎盘胎膜行病理学检查。结果:PPROM组孕妇血清中PCT、CRP阳性率高于对照组,差异有统计学意义(P<0.05);但PPROM组中有组织学绒毛膜羊膜炎与无绒毛膜羊膜炎的血清PCT、CRP无显著差异(P>0.05);PCT诊断绒毛膜羊膜炎的敏感性、特异性及阳性预测值、阴性预测值分别为60.00%、35.00%、61.76%、33.33%;CRP诊断绒毛膜羊膜炎的敏感性、特异性及阳性预测值、阴性预测值分别为57.14%、50.00%、66.67%、40.00%。结论:PPROM孕妇血清中PCT及CRP浓度升高,但其预测绒毛膜羊膜炎的价值尚需进一步研究。     

降钙素原对妊娠妇女宫内感染诊断的临床意义

目的：评价血清降钙素原（procalcitonin,PCT）对妊娠妇女宫内感染诊断的临床价值。方法：随机抽取到宫内感染的妊娠妇女及正常妊娠检查的妇女,主要观察细菌感染者及病毒感染者血清PCT的情况,并比较同期白细胞介素6（IL-6）、C-反应蛋白（CRP）、白细胞（WBC）计数、中性粒细胞百分率（N）的水平。结果：PCT对细菌感染的特异度（87.9%）、敏感度（92.4%）、准确度（83.5%）、阳性预测值（80.4%）、阴性预测值（91.7%）和阳性率（88.2%）均较高于其他项目,细菌感染组与病毒感染组比较差异有统计学意义（P＜0.05）。结论：血清PCT可作为妊娠妇女宫内感染的辅助诊断,也可作为鉴别细菌感染和病毒感染的依据,同时可有效地指导临床抗生素的应用及评估疗效。     

血清降钙素原对手足口病患儿病情变化和预后判断的价值

目的探讨监测血清降钙素原（PCT）水平对手足口病病情变化和预后判断的价值。方法将225例手足口病患儿按病情分组,Ⅲ期病危组15例,Ⅱ期重症组85例,Ⅰ期普通组125例,另选取同期体检健康儿童30例为正常对照组。对所有患儿动态监测血清PCT水平的变化,分析PCT与患儿病情程度及预后的关系。结果治疗前Ⅲ期患儿血清PCT水平最高,为（0．944-0．12）μg／L,明显高于Ⅱ期和Ⅰ期患儿,差异有统计学意义（P〈O．05）;治疗3、7d后,3组患儿PCT水平均明显下降,其中Ⅲ期患儿下降最为明显,差异有统计学意义（P〈O．01）;随访表明,Ⅰ期普通型患儿预后良好率最高为96％,后遗症率最低为0．8％,与其他两组比较差异有统计学意义（P〈O．017）。结论监测血清PCT有助于判断手足口病患儿病情变化、严重程度及预后,对伴有PCT短期内明显升高的患儿应密切观察和干预治疗,以免病情进一步恶化。     

血浆肾上腺髓质素前体在新生儿感染中的变化及其意义

目的 观察血浆肾上腺髓质素前体(pro-adrenomedullin,pro-ADM)浓度在新生儿感染中的变化,探讨其评估新生儿感染严重程度的价值. 方法 采用化学发光免疫检测定量法对我院2007年4月至12月间新生儿病房收治的356例新生儿(非感染160例,普通感染114例,重症感染82例)进行pro-ADM血浆水平测定,并同时检测降钙素原(procaleitonin,PCT)和C反应蛋白(C-reactive protein,CRP)水平.以受试者工作特征曲线计算曲线下面积得出pro-ADM诊断新生儿败血症的最佳临界值,以及敏感性和特异性,并与CRP的诊断效率相比较.组间差异比较采用方差分析和Wileoxon检验. 结果重症感染组pro-ADM为(2.079±1.195)nmol/L,较普通感染组和非感染组[1.025土0.421)nmol/L和(0.853±0.488)nmol/L]明显升高(P<0.01).感染是血浆pro-ADM水平变化的独立因素,且呈正相关(r=0.78,P<0.01).pro-ADM在新生儿败血症的诊断效率较CRP高,其敏感性为71.95%,特异性为87.23%.pro-ADM在新生儿重症感染危重组中水平[(2.498±1.140)nmol/L]较非危重组[(1.810±1.162)nmol/L]高,差异有统计学意义(t=2.63,P<0.05),而PCT水平在危重病例与非危重病例间差异无统计学意义. 结论 新生儿感染时pro-ADM水平升高,重症感染时尤为明显;pro-ADM对早期诊断新生儿重症感染及评估疾病严重程度具有潜在的临床应用价值.     

应用血清降钙素原诊断小儿感染性疾病的临床观察

目的 探讨小儿感染性疾病中血清降钙素原（PCT）、C反应蛋白（CRP）和全血白细胞（WBC）计数的变化及临床意义.方法 195例小儿感染性疾病患儿经实验室检测结果分为细菌感染组112例和病毒感染组83例,抽取同期健康体检50例儿童作为正常对照组.检测3组血清PCT和CRP的含量以及全血WBC计数.结果 细菌感染组与病毒感染组、正常对照组比较,PCT、CRP和WBC均明显升高,差异有统计学意义（P＜0.01）,病毒感染组与正常对照组比较,PCT、CRP和WBC仅轻度升高,差异无统计学意义（P＞0.05）.细菌感染组治疗前后比较PCT、CRP和WBC明显下降,差异有统计学意义（P＜0.01）.结论 小儿感染性疾病时,PCT、CRP和WBC的检测有助于疾病早期的鉴别诊断,动态检测其变化对疗效判断有一定的价值.     

降钙素原在早期诊断新生儿败血症中的价值

目的探讨降钙素原(PCT)在早期诊断新生儿败血症中的价值。方法选择30例新生儿败血症患儿为观察组,选择30例同期在同病区收治的非感染性疾病新生儿为对照组,两组患儿均检测PCT、C反应蛋白(CRP)、红细胞沉降率、白细胞计数,并对比结果。结果观察组PCT、CRP与对照组比较差异有统计学意义(P0.05),红细胞沉降率、白细胞计数与对照组比较差异无统计学意义(P0.05)。PCT诊断新生儿败血症的敏感度为76.7%,特异度为83.3%。CRP诊断新生儿败血症的敏感度为53.3%,特异度为73.3%。结论 PCT早期诊断新生儿败血症有很高的特异度和敏感度。     

动态监测PCT在新生儿全身炎症反应综合征中的意义

目的:探讨小儿全身炎症反应综合征(SIRS)患儿PCT水平及临床价值。方法:将2007年1月至2010年12月收住我院新生儿重症监护病房(NICU),符合新生儿SIRS诊断标准的61例足月新生儿作为观察对象。其中感染性SIRS 40例,原发病包括新生儿感染性肺炎、新生儿败血症、新生儿坏死性肠炎、化脓性脑膜炎。非感染SIRS 21例,包括新生儿呼吸窘迫综合症、中重度新生儿缺氧缺血性脑病、颅内出血。观察两组PCT、CRP、WBC水平及动态变化。结果:感染性新生儿SIRS组血清PCT水平高于非感染性SIRS组(P<0.05);脓毒症发展成多器官功能障碍综合症(MODS)时72h血清PCT水平进行性升高(P<0.001);在感染性SIRS脓毒症发展成MODS的患儿中,72小时的CRP、WBC无明显变化(P>0.05)。结论:PCT可作为小儿细菌感染和判断预后的重要参考指标,敏感性、特异性优于传统指标。     

降钙素原、超敏C反应蛋白及白细胞联合检测在新生儿败血症早期诊断中的应用价值

目的探讨降钙素原(PCT)、超敏C反应蛋白(hs-CRP)及白细胞(WBC)联合检测在新生儿败血症早期诊断中的应用。方法选取2013年1月至2016年1月确诊新生儿败血症患儿68例为观察组,同期健康新生儿68例为对照组,采用酶联荧光分析技术测定PCT,免疫比浊法测定hs-CRP,Sysmex800血液分析仪分析WBC。结果治疗前观察组PCT、hs-CRP及WBC值明显高于对照组,差异有统计学意义(P0.05),治疗后观察组PCT、hs-CRP及WBC值明显降低,与治疗前比较差异有统计学意义(P0.05);PCT、hs-CRP及WBC三项联合检测用于诊断的特异性、阳性预测值及阴性预测值均高于任意两项联合检测。结论 PCT、hs-CRP及WBC联合检测可用于新生儿败血症早期诊断,有助于提高诊断准确率。     

新生儿重症感染降钙素原检测的诊断价值

目的 探讨降钙素原(PCT)在新生儿重症感染时的诊断价值。方法 将自2002年3~12月于天津市儿童医院新生儿科住院的229例新生儿分别归入无感染对照组(116例)，全身感染组(39例)，局部感染组(51例)和病毒感染组(23例)。检测入院时血清PCT和C-反应蛋白(CRP),白细胞计数及分类。用SPSS 10.0 For Windows进行数据分析。结果 在全身感染时，血清PCT和CRP质量浓度升高均有显著性，但PCT显著性更高(P<0.001)。PCT≥2μg/L作为全身感染的诊断依据，其敏感度(0.804)和特异度(0.824)均优于CRP。结论 与CRP和白细胞计数相比,PCT是一个较好的新生儿全身细菌感染的诊断指标。 Abstract Objective The aim of this research is to evaluate the diagnostic value of PCT in neonates with severe bacterial infectious disease.Methods 229 neonates admitted to Neonatology Department,Tianjin Children’s Hospital since March to December 2002 were divided into 4 groups:non infection control(116),systemic bacterial infection (39),localized bacterial infection (51) and viral infection (23).Serum PCT and CRP were measured on admission;leucocyte count and differentiation was measured within 24 hours after admission.A serial measurement of PCT and CRP were taken during the course when necessary.Analyze data using SPSS 10.0 for Windows.Results Although both PCT and CRP significantly elevated in neonates with systemic bacterial infection,PCT revealed more sensitivity in systemic bacterial infection (P<0.001).The sensitivity and specificity of PCT to diagnose neonatal systemic bacterial infection using a cut off level 2 (μg/L) was 0.804 and 0.824,respectively.Conclusion PCT is a better diagnostic marker of neonatal systemic bacterial infection than CRP and leucocyte count. Key words Procalcitonin;Infection;C-reactive protein;Infant,neonate     

新生儿败血症早期诊断方法探讨

目的 通过比较不同指标在新生儿败血症诊断中的价值,探讨临床医生如何综合利用临床及实验室资料,进行新生儿败血症的早期快速诊断.方法 对2007年9月至2008年2月间所有入住新生儿病房的患儿,常规监测临床表现和实验室指标,详细记录患儿围产期情况、感染发生时间、临床表现及实验室指标.根据诊断分为败血症组(13例)、非败血症感染组(12例)和非感染对照组(12例).资料统计整理后,对各组数据应用灵敏度、特异度、误诊率、漏诊率、正确率、正确诊断指数(Youden指数)、阳性预测值、阴性预测值及ROC曲线等指标进行综合评价. 结果对于新生儿败血症的诊断:(1)临床表现中反应异常诊断价值最佳,正确诊断指数67.9%.(2)SIRS标准特异性高达95.8%,对诊断有重要参考价值.(3)常规实验室检查白细胞(WBC)、血小板(PLT)、血糖(GLU),其敏感性和特异性均不理想;I/T比有较高的特异性,但存在相当大的观察者差异.(4)C反应蛋白(CPR)、降钙素原(PCT)诊断新生儿败血症的ROC曲线下面积分别为0.734、0.878,最佳临界值分别为15 mg/L、0.81 ng/ml,P值分别为0.020、0.000,有统计学意义;正确诊断指数分别为45.5%、75.0%.结论 对临床表现的细心观察和重视,可有效发现感染败血症的患儿.对有临床表现异常的患儿,尽快完善SIRS标准评估,特异性高.常规实验室指标WBC、I/T、PLT,可作为对高危患儿经济简便的监测指标.CRP、PCT对新生儿败血症诊断有显著意义.     

Procalcitonin and C-reactive protein as a markers of neonatal sepsis

OBJECTIVES: Sensitive, reliable and early parameters of bacterial infection are extremely valuable in diagnosis of nosocomial infections in neonatal intensive care unit. In this study procalcitonin (PCT) and C-reactive protein (CRP) were evaluated for their diagnostic relevance in neonatal late onset sepsis. DESIGN: Clinical study MATERIALS AND METHODS: We analysed inflammatory parameters in 48 newborn infants admitted to the Intensive Care Unit of Institute of Paediatrics in Lodz who suffered from nosocomial sepsis. They were sampled for PCT and CRP levels at the time of the onset of signs and 24 hours later. CRP was determined by an nephelometric method and PCT was determined by an immunoluminometric assay. RESULTS: At the onset of Gram negative sepsis 14 from 17 contaminated newborns had significantly increased CRP levels and 15 of them had increased levels of PCT After 24 hours 100% of them had elevated PCT and CRP levels. At the onset of Gram positive sepsis only 18 from 31 neonates with positive blood culture had increased CRP levels and 28 of them had elevated concentrations of PCT. This difference was statistically significant. After 24 hours 26 of them had elevated CRP and 100% had increased PCT concentrations--this difference was not significant. CONCLUSION: Measurement of procalcitonin concentrations may be useful for early diagnosis of late onset sepsis in neonates.     

Pneumonia in term neonates: laboratory studies and duration of antibiotic therapy.

OBJECTIVES: To compare 2 days of antibiotic therapy (AT) to 4 days of AT in neonates with pneumonia and to assess the usefulness of neutrophil values (NV), C-reactive protein (CRP), and procalcitonin (PCT) in this population. DESIGN: The study population consisted of consecutive, eligible term neonates begun on AT for suspected pneumonia. Of 51 neonates, 26 qualified for randomization (14, 2-day group; 12, 4-day group). NV were obtained with the initial evaluation and 12 and 24 hours later. CRP and PCT were obtained 12 and 48 hours after the initial evaluation. RESULTS: None of the 12 neonates in the 4-day group developed recurrent respiratory symptoms. Three of the 14 neonates randomized to the 2-day group had recurrence of symptoms, resulting in study termination. NV, CRP, and PCT were similar in the 2- and 4-day groups. In the three neonates who developed respiratory symptoms, all absolute total neutrophil values and five out of nine absolute total immature neutrophil values were abnormal. However, all immature:total neutrophil values were normal, and CRP was strikingly elevated in only one neonate; only one of six PCT values was abnormal. In a secondary analysis of all 51 study neonates, CRP and PCT did not provide additional benefit over NV in differentiating neonates with pneumonia. CONCLUSIONS: Four days of AT appears to be adequate for selected term neonates with pneumonia; however, 2 days of AT appears to be inadequate for this population. Relative to NV, CRP and PCT appear to have a limited role.     

血清降钙素原、C反应蛋白、白细胞介素-6水平在小儿骨关节感染中的水平变化及临床意义

目的探讨血清降钙素原(PCT)、C反应蛋白(CRP)、白细胞介素-6(IL-6)在小儿骨关节感染中的水平变化及临床意义。方法选择2015年12月至2017年12月郑州大学附属儿童医院收治住院的骨关节感染患儿90例为观察组,同期选取健康体检儿童90例为对照组。所有小儿均检测血清PCT、CRP、IL-6水平。统计两组血清PCT、CRP、IL-6水平,不同类型骨关节感染患儿血清PCT、CRP、IL-6水平,急性感染期及恢复期患儿血清PCT、CRP、IL-6水平,不同病情程度患儿血清PCT、CRP、IL-6水平。结果观察组血清PCT、CRP、IL-6水平均高于对照组,差异有统计学意义(P<0.05)。化脓性关节炎患儿血清PCT、CRP、IL-6水平均高于急性骨髓炎及慢性骨髓炎患儿,差异有统计学意义(P<0.05)。骨关节感染患儿急性感染期血清PCT、CRP、IL-6水平均高于恢复期,差异有统计学意义(P<0.05)。重度感染患儿血清PCT、CRP、IL-6水平均高于轻度感染患儿,差异有统计学意义(P<0.05)。结论血清中PCT、CRP、IL-6水平对于临床评估骨关节感染患儿的病情有重要意义。     

血清可溶性髓样细胞触发受体-1在足月新生儿细菌感染中的表达及意义

目的 检测感染新生儿血清可溶性髓样细胞触发受体-1(soluble form of triggering receptors expressed on myeloid cell-1,sTREM-1)的水平,探讨sTREM-1在足月新生儿感染中的变化及其意义.方法 以上海交通大学附属儿童医院新生儿科85例足月新生儿为研究对象,根据感染情况分为重症感染组(27例),轻症感染组(28例)和非感染组(30例).感染组患儿在出现感染症状48 h内使用抗生素前采集静脉血1 ml;非感染组患儿在住院期间采集静脉血1 ml.重症感染组中合并器官功能障碍的患儿在出现感染症状的第3和7天再次采集静脉血各1 ml.采用酶联免疫吸附试验测定血清中sTREM-1水平,并采用方差分析进行组间比较.绘制受试者工作特性曲线确定sTREM-1的最佳界值,计算敏感性、特异性、阳性预测值、阴性预测值和约登指数.结果 (1)重症感染组sTREM-1水平为(91.2±47.3)pg/ml,高于轻症感染组[(68.8±30.4)pg/ml],轻症感染组又高于非感染组E(35.5±17.6)pg/ml],差异均有统计学意义(P均=0.000).(2)重症感染组中有17例存活,10例死亡;死亡患儿血清sTREM-1水平为(121.6±49.3)pg/ml,明显高于存活者[(73.1±34.9)pg/ml],差异有统计学意义(t=2.995,P=0.006).(3)重症感染组合并器官功能障碍的13例患儿中,存活者感染第1周内血清sTREM-1水平总体呈下降趋势,死亡患儿sTREM-1水平呈上升趋势,最佳界值为100.6 pg/ml.(4)将sTREM-1≥43.8 pg/ml作为阳性诊断标准,其曲线下面积为0.868,敏感性、特异性、阳性和阴性预测值及约登指数分别为85.5%、80.0%、0.887、0.750和0.655.结论 血清sTREM-1水平在新生儿感染时升高;重症感染患儿血清sTREM-1水平呈动态变化,其变化趋势可能与预后有关.

Abstract：

Objective To observe the changes of serum soluble form of triggering receptors expressed on myeloid cell-1 (sTREM-1) level in full-term newborns with infection and to investigate the relationship between serum sTREM-1 and neonatal bacterial infection.Methods Eighty-five full-term newborns admitted to the neonatal ward of Shanghai Children s Hospital of Shanghai Jiaotong University were selected into this study.According to the locations and severity of infection,patients were divided into 3 groups: severe infection group (n = 27),mild infection group (n = 28),non-infection group (n = 30).The samples of infection groups were collected before using antibiotics and within 48 h after infection symptom occurred; others were collected during hospitalization.For the neonates with organ dysfunction in the severe infection group,samples were also collected at the third and seventh day of infection.Serum sTREM-1 was measured by enzyme-linked immunosorbent assay.Analysis of variance was used to compare the difference between groups.Receiver operating characteristic (ROC) curve was used to calculate the sensitivity,specificity,positive and negative predictive value and Youden index.Results (1) Serum sTREM-1 level of severe infection group[(91.2±47.3) pg/ml] was significantly higher than that of mild infection group[(68.8 + 30.4) pg/ml] and non-infection group[(35.5±17.6) pg/ml],respectively (P＜0.05).(2) Serum sTREM-1 level of the survival newborns (n= 17) in the severe infection group was lower than that of dead ones[(73.1±34.9) pg/ml vs (121.6±49.3) pg/ml,t= - 2.995,P = 0.006].(3) For the survival patients,the serum sTREM-1 level decreased in the first week of infection,while that of dead patients increased,the cut-off value was 100.6 pg/ml.(4) Based on the ROC analysis,43.8 pg/ml was selected as the the cut-off value,area under the curve was 0.868,and sensitivity was 85.5%,specificity 80.0%,positive predictive value 0.887,negative predictive value 0.750,Youden index 0.655.Conclusions Serum sTREM-1 level increases in neonatal infection.The change of serum sTREM-1 level in patients with severe infection is correlated to the prognosis.     

Inborn bacterial infections during neonatal period

Considering the high mortality and serios morbilidy associatent with neonatal infections. A competent diagnostic marker also needs to have reasonably high specificity. Good evidence exists to support the use of CRP measurements in conjunction with other established diagnostic tests (such as a white blood cell (WBC) count with differential and blood culture) to establish or exclude the diagnosis of sepsis in full-term or near-term infants. Sepsis was suspected within the first 3 days after birth in. There were 20% early-onset and 53% late-onset episodes of proven sepsis. CRP had sensitivities of 39.4% and 64.6% for proven or probable sepsis and 35.0% and 61.5% for proven sepsis in early-onset and late-onset episodes, respectively. To compare the clinical informative value of and C-reactive protein (CRP) plasma concentrations in the detection of infection and sepsis and in the assessment of severity of sepsis. PCT is a better marker of sepsis than CRP. The course of PCT shows a closer correlation than that of CRP with the severity of infection and organ dysfunction. Diagnostic markers are useful indicators of neonatal bacterial infections C-reactive protein (CRP), procalcitonin (PCT) Intralevcin 6, 8 are early sensitive markers of infection.     

细菌16S rRNA基因检测在新生儿败血症早期诊断中的临床意义

目的 分析16S rRNA基因检测在早期诊断新生儿败血症中的临床意义.方法 收集临床常见的致病菌菌株37株并提取DNA,对106例临床拟诊为败血症的患儿于入院后24 h内采集血标本,提取DNA,在16S rRNA基因的保守区选择一对通用引物进行聚合酶链反应(polymerase chain reaction,PCR),并检验实验方法的灵敏性和特异性;106例临床拟诊为败血症的患儿同时查血培养、非特异性炎症指标及降钙素原(procalcitonin,PCT),并采用x2检验与同期住院的20例非败血症患儿进行比较.结果 所有细菌PCR均得到预期的约371 bp大小的扩增产物,与病毒及人基因组DNA无交叉反应,其扩增下限为10 CFU/ml的大肠埃希菌.106例拟诊败血症患儿血培养阳性15例,PCR阳性36例.PCR的敏感性、特异性及诊断指数分别为82.9%、96.9%和179.85,优于血培养及5项非特异指标至少2项异常的实验诊断方法;在围产儿中,PCR的特异性高于PCT.结论 PCR方法检测细菌16S rRNA基因能迅速判断临床标本中是否存在细菌,对于早期诊断新生儿败血症具有较高的敏感性及特异性,对于区分败血症与局部感染和非细菌性感染具有重要意义.     

Acute phase reactants in neonatal bacterial infection.

The C-reactive protein (CRP) level was evaluated in 142 infants requiring investigation for suspected infection. After excluding two neonates because of incomplete data, there remained 140 neonates, of whom 16 had septicemia. Fifteen of 16 had increased CRP levels. The CRP value was not elevated in any baby (n = 5) who had positive blood cultures for Staphylococcus epidermidis, all of whom had an uneventful clinical course. The CRP level was elevated in all six babies with meconium-aspiration syndrome, but was normal in five infants whose viral cultures were positive. Ninety-nine percent of uninfected babies had normal CRP values. Overall, CRP was a valuable test for diagnostic confirmation of bacterial infection. Elevated CRP level was always accompanied by at least one abnormality in the other tests performed. Although the study was not intended to predict clinical onset of bacterial disease, our results suggest that the CRP level, because of a high negative predictive value, may be useful in ruling out bacterial infection.