出生24 h内外周血炎性标志物在NEOS中的水平及NEOS病原菌分布

目的分析外周血炎性标志物在新生儿早发型败血症(NEOS)患儿出生24 h内的水平,并调查该院NEOS病原菌分布。方法回顾性分析该院2014年7月至2017年12月收治的451例新生儿,分为NEOS组(363例)和对照组(88例),比较两组一般资料,围生期影响因素,外周血炎性标志物超敏C反应蛋白(hs-CRP)、血清降钙素原(PCT)、白细胞计数(WBC)及中性粒细胞/淋巴细胞比值(NLR)水平,评估新生儿出生24 h内外周血炎性标志物对NEOS的诊断效能。结果两组的胎龄、体质量、低出生体质量患儿比例、住院时间、5 min Apgar评分比较,差异有统计学意义(P<0.05)。两组患儿母亲在孕次、产次、胎膜早破、产前发热、羊水异常方面比较,差异无统计学意义(P>0.05),而生产方式差异有统计学意义(P<0.05)。NEOS患儿病原菌培养出革兰阳性菌177例,以凝固酶阴性葡萄球菌为主;革兰阴性菌168例,以大肠埃希菌和肺炎克雷伯菌为主。血清PCT对NEOS具有较高的诊断效能。动态分析两组血清PCT变化趋势,NEOS组24~<48 h达到高峰,72 h后下降,而对照组在24 h内达到峰值。结论引起NEOS的革兰阳性菌以凝固酶阴性葡萄球菌为主,革兰阴性菌以大肠埃希菌和肺炎克雷伯菌为主。血清PCT水平在出生24 h内即可预测NEOS,动态监测血清PCT水平有助于早期诊断NEOS及监测疗效。

Levels of peripheral blood inflammatory markers within 24h after birth in neonatal early onset sepsis and pathogenic bacteria distribution

Objective To analyze the levels of peripheral blood inflammatory markers within 24 h after birth and to investigate the pathogenic bacteria distribution of neonatal early onset sepsis(NEOS)patients in this hospital.Methods A total of 451 neonates in this hospital from July 2014 to December 2017 were retrospectively analyzed and divided into the NEOS group(363 cases)and control group(88 cases).The differences in the general data,influencing factors during perinatal period and the levels of peripheral blood inflammatory markers hs-CRP,PCT,WBC count and neutrophil/lymphocyte ratio(NLR)were compared between the two groups.The diagnostic efficiency of peripheral blood inflammatory markers in NEOS was evaluated.Results The gestational age,body mass,proportion of neonates with low birth mass,hospitalization stay and Apgar scores at 5 min had statistically significant differences between the two groups(P<0.05).The gravidity,parity,premature rupture of membrane,prenatal fever and amniotic fluid abnormality had no statistical differences between the mothers of two groups(P>0.05).But the delivery mode had statistical difference between the mothers of two groups(P<0.05).In the pathogenic bacteria of NEOS,177 cases of Gram positive bacteria were cultured out,which was dominated by coagulase negative staphylococci(CNS),168 cases were Gram-negative bacterium,which was dominated by E.coli and Klebsiella pneumoniae.Serum PCT had higher diagnostic efficiency for NEOS.In dynamic analysis of serum PCT change trend in the two groups,PCT in the NEOS group reached the peak during 24-<48 h,then declined after 72 h,but which in the control group reached the peak within 24 h.Conclusion The Gram-positive bacteria causing NEOS are mainly CNS,the Gram-negative bacteria are dominated by E.coli and Klebsiella pneumoniae.Serum PCT level can predict NEOS within 24 h after birth.Dynamically monitoring serum PCT is conducive to early diagnosis of NEOS and monitoring of therapeutic effect.