降钙素原和超敏 C 反应蛋白联合检测对新生儿败血症的诊断价值

目的探讨血清降钙素原(PCT)和超敏C反应蛋白(hs-CRP)联合检测对新生儿败血症的诊断价值。方法选择95例新生儿败血症患者(败血症组)、53例新生儿局部感染患者(局部感染组)和40例新生儿健康对照者(对照组),检测3组血清PCT和hs-CRP水平,并进行比较,血清PCT水平检测采用电化学发光法,血清hs-CRP水平检测采用速率散射比浊法。结果败血症组患者血清PCT和hs-CRP水平显著高于局部感染组和对照组(P<0.01);局部感染组患者血清PCT和hs-CRP水平显著高于对照组(P<0.05)。以2.0μg.L-1作为PCT诊断新生儿败血症的最佳截断点,得出其灵敏度、特异度、阳性预测值、阴性预测值、诊断准确度分别为87.4%、69.9%、74.7%、84.4%、78.7%;以10.0 mg.L-1作为hs-CRP诊断新生儿败血症的最佳截断点,得出其灵敏度、特异度、阳性预测值、阴性预测值、诊断准确度分别为83.2%、63.4%、69.9%、78.7%、73.4%;采用序列试验联合检测PCT与hs-CRP,得出其灵敏度、特异度、阳性预测值、阴性预测值、诊断准确度分别为81.1%、83.9%、83.7%、81.3%、82.4%。单独检测血清PCT或hs-CRP水平诊断新生儿败血症的特异度较低,联合检测血清PCT和hs-CRP水平诊断新生儿败血症的特异度较高。结论联合检测血清PCT和hs-CRP水平有助于新生儿败血症的诊断与鉴别诊断。

Value of procalcitonin and hypersensitive C-reactive protein in diagnosis of neonatal septicemia

Objective To explore the value of procalcitonin(PCT)and hypersensitive C-reactive protein(hs-CRP)in the diagnosis of neonatal septicemia.Methods Ninety-five neonatus with septicemia(septicemia group),fifty-three neonatus with local infection(local infection group)and forty health neonatus(control group)were chosen in this study.The levels of serum PCT and hs-CRP were detected and compared in the three groups.The PCT level was detected by electrochemiluminescence method,and the hs-CRP level was detected by rate nephelometry.Results The levels of serum PCT and hs-CRP in septicemia group were significantly higher than those in local infection group and control group(P<0.01),and the levels of serum PCT and hs-CRP in local infection group were significantly higher than those in control group(P<0.05).The best cut-off point of PCT in the diagnosis of neonatal septicemia was 2.0 μg·L-1,based on this,the sensitivity,specificity,positive predictive value,negative predictive value and the diagnostic accuracy was 87.4%,69.9%,74.7%,84.4% and 78.7%,respectively.The best cut-off point of hs-CRP in the diagnosis of neonatal septicemia was 10.0 mg·L-1,the sensitivity,specificity,positive predictive value,negative predictive value and the diagnostic accuracy was 83.2%,63.4%,69.9%,78.7% and 73.4%,respectively.The levels of PCT and hs-CRP were detected by sequence test,the sensitivity,specificity,positive predictive value,negative predictive value and the diagnostic accuracy was 81.1%,83.9%,83.7%,81.3% and 82.4%,respectively.The specificity of separate detection of PCT or hs-CRP level in the diagnosis of neonatal septicemia was low,but the specificity of combined detection of PCT and hs-CRP levels in the diagnosis of neonatal septicemia was high.Conclusion The combined detection of PCT and hs-CRP levels is helpful in the diagnosis and differential diagnosis of neonatal septicemia.