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目的探讨新生儿宫内细菌性感染中降钙素原的早期预警和诊疗价值。方法选取2013-2015年在湖南省妇幼保健院产科分娩、有宫内感染高危因素的新生儿,按感染结局分为败血症组、局部感染组,非感染疾病组和正常组,检测4组新生儿脐血PCT和CRP水平,比较4组新生儿在脐血炎症指标不同水平区间的分布频率,分析各指标对宫内感染诊断的敏感度和特异度。结果感染状态下降钙素原(PCT)、C反应蛋白(CRP)水平均增高,从各组在不同水平区间的分布来看,在PCT为0.05~0.5 ng/ml区间内,非感染疾病组分布频率最高(91.92%),局部感染组和败血症组分别为40.32%和30.91%。在新生儿科收治患儿中,PCT以0.5 ng/ml为临界值,诊断感染的敏感性和特异性分别为59.75%和93.94%;其中诊断败血症的敏感性为69.11%,特异性为60.70%;诊断局部感染的敏感性为67.74%,特异性为71.43%。PCT以2 ng/ml为临界值诊断败血症敏感性和特异性分别为40.00%和84.91%。CRP以2 mg/L为临界值,诊断感染的敏感性为42.32%,特异性为89.89%;其中诊断败血症的敏感性47.27%,特异性为69.82%;诊断局部感染的敏感性为40.86%,特异性为70.17%。结论 0.5 ng/ml脐血PCT诊断感染的敏感性和特异性相对CRP高,可作为宫内细菌感染早期预警和辅助诊断指标,特别是PCT 2.0 ng/ml以上时,诊断败血症特异性可达84.91%,对于感染程度的评估具有一定意义,可有效地指导临床抗生素的应用及评估疗效。
Objective To investigate the value of early warning and diagnosis of procalcitonin in neonatal intrauterine bacterial infection. Methods From 2013 to 2015, newborns with high risk of intrauterine infection in obstetric delivery at Hunan Provincial Maternal and Child Health Hospital were divided into sepsis group, local infection group, non-infected group and normal group according to the infection outcome. Four newborns The levels of PCT and CRP in umbilical cord blood were compared. The distribution frequency of cord blood inflammation in four groups of neonates was compared. The sensitivity and specificity of each index in diagnosis of intrauterine infection were analyzed. Results The levels of PCT and CRP in the infected group were all increased. According to the distribution of different levels in each group, in the range of 0.05-0.5 ng / ml, the distribution of non-infected disease group The frequency was the highest (91.92%). The rates of local infection and sepsis were 40.32% and 30.91% respectively. The sensitivity and specificity of PCT to diagnose the infection were 59.75% and 93.94%, respectively, in children admitted to neonatology. The sensitivity and specificity of PCT in diagnosis of sepsis were 69.11% and 60.70% respectively. The sensitivity of diagnosing local infection was 67.74% and the specificity was 71.43%. PCT sensitivity and specificity for the diagnosis of sepsis at the threshold of 2 ng / ml were 40.00% and 84.91%, respectively. The sensitivity of diagnosing sepsis was 42.32% and the specificity was 89.89%. The sensitivity and specificity of CRP in diagnosis of sepsis were 47.27% and 69.82% respectively. The sensitivity of diagnosis of local infection was 40.86% Specificity was 70.17%. Conclusions The sensitivity and specificity of 0.5 ng / ml umbilical cord blood cord blood in diagnosis of PCT are high and can be used as an early warning and auxiliary diagnostic indicator of intrauterine bacterial infection. Especially when PCT 2.0 ng / ml or above, the specificity of diagnosis of sepsis is 84.91 %, For the evaluation of the degree of infection has some significance, which can effectively guide the clinical application of antibiotics and evaluate the efficacy.