降钙素原在新生儿早发型败血症中的诊断价值

Diagnostic value of procalcitonin in neonatal early-onset sepsis

摘要:

目的 探讨生后3 d内降钙素原（PCT）在新生儿早发型败血症（EOS）中的诊断价值，拟定不同胎龄段新生儿生后不同时龄段PCT诊断EOS的阈值。方法 纳入确诊败血症109例、临床诊断败血症215例、非败血症367例新生儿为研究对象，通过ROC曲线分析不同胎龄段、时龄段新生儿PCT水平诊断EOS的最佳阈值，比较PCT与血培养的诊断价值。结果 确诊组中胎龄<34周患儿PCT水平明显高于胎龄≥ 34周患儿（P < 0.05）。胎龄≥ 34周患儿在不同时龄段<12 h、12~<24 h、24~<36 h、36~<48 h、48~<60 h、60~72 h，PCT诊断EOS的最佳阈值分别为1.588、4.960、5.583、1.710、3.570、3.574 ng/mL，灵敏度分别为0.688、0.737、0.727、0.732、0.488、0.333，特异度分别为0.851、0.883、0.865、0.755、0.930、0.900。生后36 h内PCT的曲线下面积较血培养大（P < 0.05）。结论 晚期早产儿（胎龄≥ 34周）及足月儿在PCT诊断EOS时可采用共同的标准，但早期早产儿（胎龄<34周）需单独考虑。PCT诊断不同时龄段EOS患儿有不同的最佳诊断阈值，生后36 h内PCT在EOS中的诊断价值比血培养高。

Abstract:

Objective To study the value of procalcitonin (PCT) within 3 days after birth in the diagnosis of neonatal early-onset sepsis (EOS), as well as the thresholds of PCT in the diagnosis of EOS in neonates with different gestational ages and different ages. Methods A total of 109 neonates with a confirmed diagnosis of sepsis, 215 neonates with clinically diagnosed sepsis, and 367 neonates without sepsis were enrolled. Receiver operating characteristic (ROC) curves were plotted to determine the optimal cut-off values of PCT in the diagnosis of EOS in neonates with different gestational ages and different ages. The diagnostic value of PCT and blood culture was compared. Results In the confirmed diagnosis group, the neonates with a gestational age of <34 weeks had a significantly higher level of PCT than those with a gestational age of ≥34 weeks (P < 0.05). For the neonates with a gestational age of ≥34 weeks, the optimal cut-off values of PCT in the diagnosis of EOS were 1.588 ng/mL (sensitivity 0.688, specificity 0.851) at age of <12 hours, 4.960 ng/ mL (sensitivity 0.737, specificity 0.883) at age of 12-<24 hours, 5.583 ng/mL (sensitivity 0.727, specificity 0.865) at age of 24 - <36 hours, 1.710 ng/mL (sensitivity 0.732, specificity 0.755) at age of 36- <48 hours, 3.570 ng/mL (sensitivity 0.488, specificity 0.930) at age of 48-<60 hours, and 3.574 ng/mL (sensitivity 0.333, specificity 0.900) at age of 60-72 hours. PCT had a larger area under the ROC curve in the diagnosis of EOS than blood culture within 36 hours after birth (P < 0.05). Conclusions The same criteria can be used for late preterm infants (with a gestational age of ≥34 weeks) and full-term infants, while early preterm infants (with a gestational age of <34 weeks) should be considered separately. PCT has different optimal cut-off values in the diagnosis of EOS in neonates with different ages, with a higher value than blood culture in the diagnosis of EOS within 36 hours after birth.