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目的探讨血清白蛋白水平(ALB)对新生儿败血症患儿预后判定的临床价值。方法将72例新生儿败血症患儿根据预后分为存活组(43例)和死亡组(29例)。在确诊为新生儿败血症时及确诊后的第1、5、10天检测2组血清ALB。于确诊为新生儿败血症时比较2组血清降钙素原(PCT)、超敏C反应蛋白(Hs-CRP)、白细胞计数(WBC)和新生儿危重病例评分(NCIS);分析血清ALB与PCT、Hs-CRP、WBC和NCIS评分相关性。新生儿败血症确诊时绘制72例患儿血清ALB值的受试者工作特征(ROC)曲线,分析其对死亡的预测效果。结果死亡组血清ALB在确诊新生儿败血症时及确诊后的第1、5、10天一直维持较低水平,存活组血清ALB上升,且死亡组低于存活组(P<0.01);确诊为新生儿败血症时死亡组血清PCT、Hs-CRP、WBC和NCIS评分高于存活组(P<0.01);经过相关分析表明确诊新生儿败血症时血清ALB与PCT、Hs-CRP和WBC呈负相关,与NCIS评分呈正相关(P<0.05);72例患儿在确诊新生儿败血症时血清ALB水平对死亡预测的ROC曲线下总面积为0.901,最佳阈值为20.93 g/L,灵敏度和特异性为89.52%和99.00%。结论血清ALB检测为新生儿败血症的早期诊断和预后评估提供快速的病原学诊断依据,可指导临床合理运用抗生素,改善预后。
Objective To investigate the clinical value of serum albumin (ALB) in prognosis of neonatal sepsis. Methods 72 neonates with sepsis were divided into survival group (43 cases) and death group (29 cases) according to the prognosis. Two groups of serum ALB were detected on the 1st, 5th and 10th day after the diagnosis of neonatal sepsis. Serum procalcitonin (PCT), high-sensitivity C-reactive protein (Hs-CRP), white blood cell count (WBC) and neonatal critical illness score (NCIS) were compared at the time of diagnosis of neonatal sepsis; , Hs-CRP, WBC and NCIS scores. The neonatal sepsis was diagnosed at 72 patients with serum ALB values of the receiver operating characteristic (ROC) curve analysis of its prediction of mortality. Results Serum ALB in the death group remained at a low level on the 1st, 5th and 10th days after the diagnosis of neonatal sepsis and the serum ALB level in the surviving group was lower than that in the surviving group (P <0.01) The levels of serum PCT, Hs-CRP, WBC and NCIS in death group were higher than those in survival group (P <0.01). Correlation analysis showed that the serum ALB was negatively correlated with PCT, Hs-CRP and WBC in neonates with sepsis, NCIS score was positively correlated (P <0.05). The total area under the ROC curve of prediction of serum ALB level in 72 children with neonatal sepsis was 0.901, the best threshold was 20.93 g / L, the sensitivity and specificity were 89.52 % And 99.00%. Conclusion The serum ALB test provides a rapid etiological diagnosis basis for the early diagnosis and prognosis evaluation of neonatal septicemia, which can guide clinical rational use of antibiotics and improve the prognosis.