几种感染指标在儿童细菌性脓毒症的诊断价值

目的 分析白细胞计数(WBC)、中性粒细胞/淋巴细胞比率(NLCR)、C-反应蛋白(CRP)、降钙素原(PCT)等指标在儿童细菌性脓毒症早期诊断的临床价值。方法 选取53例诊断为细菌性脓毒症住院患者作为研究组,另选取50例同期门诊体检健康儿童作为对照组,分别检测WBC、NLCR、CRP、PCT水平并比较差异;同时采用受试者工作特征(ROC)曲线评价各项指标诊断儿童细菌性脓毒症的准确性。结果 53例儿童细菌性脓毒症患者血培养均阳性,以革兰阳性球菌为主(60.4%)。革兰阳性球菌感染组、革兰阴性杆菌感染组WBC、NLCR、CRP、PCT水平均显著高于对照组,差异均有统计学意义(均P<0.05);经ROC曲线分析提示CRP及联合应用WBC与NLCR对于诊断细菌性脓毒症有较高的准确性,AUC为0.90(0.84~0.97)、0.91(0.84~0.97);联合应用WBC、NLCR、CRP与PCT 4种指标有更高的准确性,AUC为0.97(0.94~1.00);而WBC、NLCR、PCT有一定的准确性,AUC分别为0.85(0.77~0.93)、0.89(0.82~0.96)、0.88(0.80~0.96)。结论WBC、NLCR、CRP、PCT等4种感染诊断指标对于早期诊断儿童细菌性脓毒症均有价值,联合应用4种指标有更高的准确性。

Diagnostic value of several infection indexes in children with bacterial sepsis

Objective To evaluate the roles of several indicators,including white blood cell(WBC),neutrophil lymphocyte count ratio(NLCR),C-reactive protein(CRP)and procalcitonin(PCT)in early diagnosis of bacterial sepsis in children.Methods 53 in-patients who diagnosed as bacterial sepsis were selected as study objects and 50 outpatient healthy children as controls.WBC,NLCR,CRP and PCT were determined.Receiver operating charateristic(ROC)curve was used to evaluate several indicators in the diagnosis of bacterial sepsis in children.Results The blood cultures of 53 in-patients were positive,and Gram-positive cocci were the most common(60.4%).The levels of WBC,NLCR,CRP and PCT in Gram-positive cocci infection group and Gram-negative bacilli infection group were significantly higher than those in non-infected group,and the differences were statistically significant(P<0.05).ROC curve analysis showed that CRP and the combination of WBC and NLCR had high accuracy in the diagnosis of bacterial sepsis in children,the areas under curves(AUC)were 0.90(0.84-0.97),0.91(0.84-0.97).The combination of WBC,NLCR,CRP and PCT had higher accuracy,and AUC was 0.97(0.94-1.00).WBC,NLCR and PCT had certain accuracy,and AUC were 0.85(0.77-0.93),0.89(0.82-0.96),0.88(0.80-0.96).Conclusion WBC,NLCR,CRP and PCT play roles in the early diagnosis of bacterial sepsis in children and the combination of WBC,NLCR,CRP and PCT had higher accuracy.