尿甲壳质酶蛋白-40对新生儿急性尿路感染的早期诊断价值及与其他指标相关性分析

目的探讨尿甲壳质酶蛋白40(YKL-40)对新生儿急性尿路感染(UTI)的早期诊断价值,并分析其与其他临床指标的相关性。方法选择2015年1月至2018年6月在本院就诊的疑似急性UTI患儿88例作为研究对象,取清洁中段尿10mL,放入带塞无菌试管中并在1h内送检.经细菌培养后进行成分分析。根据细菌培养结果将患儿分为对照组(细菌培养阴性49例)和观察组(细菌培养阳性39例),对比两组患者各临床指标。结果两组的血肌酐(Scr)和肾小球滤过率估计值(eGFR)比较.差异均无统计学意义(P>0.05),观察组的血沉(ESR)及C反应蛋白(CRP)明显高于对照组(P<0.05)。观察组患儿的尿YKL-40/尿肌酐(Cr)水平明显高于对照组患儿(P<0.05),对照组中脓尿阳性与阴性者YKL40/Cr水平比较,差异无统计学意义(P>0.05)。观察组中脓尿、血尿、蛋白尿、亚硝酸盐、肾积水及膀胱输尿管反流检查结果阳性与阴性者YKL40/Cr水平比较,差异均无统计学意义(P>0.05)。受试者操作特征(ROC)曲线分析结果显示尿YKL 40/Cr对UTI诊断截断值为123.25 pg/mg,曲线下面积(AUC)为.0.793,P=0.023,灵敏度为82.05%,特异度为90.04%。相关性分析结果显示YKL40/Cr与性别、体重指数(BMI)、ESR.eGFR、血尿、蛋白尿、肾积水及膀胱输尿管反流均不具有显著相关性(P>0.05),与出生天数、发烧持续时间呈显著负相关(r<0,P<0.05).与白细胞计数、CRP.脓.尿及亚硝酸盐阳性显著正相关(r>0,P<0.05)。结论尿YKL-40对新生儿急性UTI早期诊断具有较高的诊断价值,其水平与出生天数、发烧持续时间呈显著负相关,与白细胞计数、CRP、脓尿及亚硝酸盐阳性显著正相关。

Early diagnosis value of urinary chitin enzyme protein-40 in newborn with acute urinary tract infection and its correlation with other clinical indicators

Objective To investigate the value of urinary YKL-40 in the early diagnosis of ar cute urinary tract infection in newborn and its correlation with other clinical indicators.Methods Eighty-eight children with suspeeted acute urinary tract infection(UTI)who were admitted to our hos-pital from January 2015 to June 2018 were enrolled in the study.10 mL of clean mid-stage urine was taken and placed in a sterile test tube.The test was carried out in 1 hour,and the components were analyzed after bacterial culture.According to the results of bacterial culture,the children were divided into the control group(negative bacterial culure,n=49)and the observation group(positive bacterial culure,n=39),and the two groups were compared.Results There were no significant differences in Ser and eGFR between the two groups(P>0.05).The ESR and CRP in the observation group were significantly higher than those in the control group(P<0.05).The level of urinary YKL-40/Cr in the observation group was significantly higher than that in the control group(P<0.05).There was no signifcant diference in the level of YKL-40/Cr between the positive and negative pus in the control group(P>0.05).There were no significant diferences in the levels of YKL-40/Cr between the posi-tive and negative patients with pyuria,hematuria,proteinuria,nitrite,hydronephrosis and vesi-coureteral reflux in the observation group(P>0.05).The results of ROC curve analysis showed that the diagnostic cutoff value of urine YKL-40/Cr for UTI was 123.25 pg/mg,AUC was 0.793,P=0.023,sensitivity was 82.05%,and specificity was 9004%.Correlation analysis showed that YKL-40/Cr was not signifcanly associated with gender,BMI index,ESR,eGFR,hematuria,proteinuria,hydronephrosis,photon deficiency in DMSA,and vesicoureleral reflux(P>0.05).There was a sig-nificant negative correlation between bith days and duration of fever(r<0,P<0.05),and a signifi-cant positive correlation with W BC count,CRP,pyuria and nitrite positive(r>0,P<0.05).Con-clusions Urine YKL40 has a high diagnostic value for early diagnosis of acute urinary tract infection in newborn.The level is negatively correlated with age and duration of fever,and positively correlated with W BC count,CRP,pyuria and nitrite positive.