新生儿败血症早期实验室诊断指标的价值评价

Values of C-reactive protein, percentage of neutrophils and mean platelet volume in early diagnosis of neonatal sepsis

摘要:

目的 探讨C反应蛋白(CRP)、中性粒细胞百分比及平均血小板体积(MPV)在新生儿败血症中的临床诊断价值。方法 将2010年1月至2014年5月确诊为败血症的315例新生儿分为血培养阳性组(n=207)和临床诊断组(n=108), 另选取同期住院的132例非感染性疾病新生儿为对照组。检测各组CRP水平、中性粒细胞百分比及MPV变化, 并通过绘制受试者工作特征曲线(ROC曲线)分析CRP、中性粒细胞百分比和MPV对新生儿败血症的诊断价值。结果 血培养阳性组和临床诊断组患儿的CRP水平、中性粒细胞百分比及MPV均高于对照组(P<0.05)。CRP的最佳诊断截点为8.5 mg/L时, 敏感度为74.6%, 特异度为92.0%; 中性粒细胞百分比的最佳诊断截点为0.53时, 敏感度为64.4%, 特异度为83.3%; MPV的最佳诊断截点为11.4 fL时, 敏感度为40.5%, 特异度为88.4%。结论 CRP在诊断新生儿败血症的价值较中性粒细胞百分比和MPV高; 监测中性粒细胞百分比及MPV对新生儿败血症的早期诊断具有一定的临床应用价值。

Abstract:

Objective To study the clinical values of C-reactive protein (CRP), the percentage of neutrophils, and mean platelet volume (MPV) in the diagnosis of neonatal sepsis. Methods A total of 315 neonates who were confirmed to have sepsis between January 2010 and May 2014 were divided into two groups: proven sepsis (with a positive blood culture; n=207) and clinical sepsis (with a clinical diagnosis; n=108). Within the same period, 132 hospitalized neonates with noninfectious diseases were enrolled as the control group. Serum CRP level, percentage of neutrophils, and MPV were measured. The receiver operating characteristic (ROC) curves were drawn to evaluate the values of the three parameters in the diagnosis of neonatal sepsis. Results Serum CRP level, percentage of neutrophils, and MPV were significantly higher in the two sepsis groups than in the control group (P<0.05). The optimal cut-off point of CRP for the diagnosis of sepsis was 8.5 mg/L, with the sensitivity and specificity of 74.6% and 92.0%, respectively. The optimal cut-off point of the percentage of neutrophils for the diagnosis of sepsis was 0.53, with the sensitivity and specificity of 64.4% and 83.3%, respectively. The optimal cut-off point of MPV for the diagnosis of sepsis was 11.4 fL, with the sensitivity and specificity of 40.5% and 88.4%, respectively. Conclusions The diagnostic accuracy of CRP for neonatal sepsis is superior to those of the percentage of neutrophils and MPV. The measurements of the percentage of neutrophils and MPV hold promise for the early diagnosis of neonatal sepsis.