120例新生儿感染实验室相关指标临床意义的研究

发布时间：2018-01-08 00:03

  本文关键词：120例新生儿感染实验室相关指标临床意义的研究　出处：《河北医科大学》2017年硕士论文　论文类型：学位论文

  更多相关文章： 新生儿感染 前白蛋白 C-反应蛋白 降钙素原 胆碱酯酶 外周血白细胞计数 诊断意义

【摘要】：目的:本实验通过回顾性分析120例感染新生儿和60例非感染新生儿血清前白蛋白、C-反应蛋白、降钙素原、胆碱酯酶水平及外周血白细胞计数,探讨以上各项早期检测指标在新生儿感染中的诊断意义、在早产儿与足月儿感染中是否存在差异,及其在诊断新生儿感染中的阳性率、敏感度、特异度、阳性预测值、阴性预测值及诊断符合率,以期阐明新生儿败血症早期单项检测指标与联合多项指标检测的差异及意义,为新生儿感染早期诊断提供临床依据。方法:本研究以2014年8月至2016年7月期间,河北医科大学第四医院儿科新生儿病区收治的,无严重心血管疾病、无窒息史、无溶血性疾病史、无遗传代谢性疾病及家族免疫性疾病史,发生不同程度感染的患儿120例作为实验组,其中男77例,女43例,早产儿42例,足月儿78例,胎龄在27+6~41+4周之间,出生体重942g~4400g,入院时间在0.20~380h之间。根据出院诊断结果分为败血症组60例和其他感染组60例,同期收治的60例非感染患儿作为对照组,其中男40例,女20例,早产儿28例,足月儿32例,胎龄在27+5~41+3周之间,出生体重945g~4398g,入院时间在0.18~384h。所有患儿均于入院24-48小时内,抗生素治疗前,在无菌操作下采取静脉血5ml,2ml离心分离血清,进行CRP、PCT、PA、ChE检测,CRP采用免疫散射比浊法,PCT为微粒子电化学发光法,PA采用免疫比浊法,ChE为丁酰硫代胆碱底物法。1ml送血常规检测,白细胞计数采用库尔特原理测定细胞体积大小。另2ml静脉血送检细菌培养,血样应用生物梅里埃公司儿科专用培养瓶培养5-7天,阳性者做药敏试验。抗感染治疗5-7天后,再次取患儿静脉血复查血常规、CRP、PCT、PA、ChE。所有数据应用统计学软件SPSS22.0进行分析处理,计量资料以均数±标准差((X|-)±S)表示,均进行正态性及方差齐性检验,多组数据比较采用单因素方差分析,若所得结果有统计学差异,则进一步应用LSD法行组间两两比较,两组比较采用配对t检验、独立样本t检验;计数资料采用χ2检验。检验水平α=0.05,P0.05视为差异有统计学意义。结果:1败血症组、其他感染组及非感染组间血清PA、CRP、PCT、ChE检测水平比较败血症组:PA、CRP、PCT、ChE水平分别为65.20±3.02mg/L、22.67±3.61mg/L、9.39±2.27ng/ml、4254.76±158.10U/L;其他感染组:PA、CRP、PCT、ChE水平分别为69.90±2.80mg/L、4.63±0.61mg/L、1.53±0.53ng/ml、5601.86±196.18U/L;非感染组:PA、CRP、PCT、ChE水平分别为83.43±3.02mg/L、2.14±0.28mg/L、0.44±0.10ng/ml、5796.85±204.47U/L。经单因素方差分析,三组比较,有显著性差异(FA=10.291,FB=27.955,FC=13.15,FD=20.09,P0.01)。组间两两比较采用LSD法,结果显示败血症组PA水平低于其他感染组与非感染组,均有显著性差异(P0.05),其他感染组PA水平与非感染组比较,无显著性差异(P0.05);败血症组和其他感染组CRP、PCT水平均高于非感染组,有显著性差异(P0.01),败血症组CRP、PCT水平和其他感染组比较,无显著性差异(P0.05);败血症组和其他感染组ChE水平均低于非感染组,有显著性差异(P0.01),败血症组ChE水平和其他感染组比较,无显著性差异(P0.05)。2败血症组治疗前后血清PA、CRP、PCT、ChE检测水平比较治疗前PA、CRP、PCT、ChE水平分别为65.20±3.02mg/L、22.67±3.61mg/L、9.39±2.27ng/ml、4254.76±158.10U/L,治疗5-7天后(恢复期)PA、CRP、PCT、ChE水平分别为94.14±3.64mg/L、3.35±0.63mg/L、0.57±0.40ng/ml、5450.52±143.31U/L,经配对t检验比较,败血症组治疗前后上述指标均有显著性差异(t A=-9.521,t B=6.109,t C=4.403,t D=-7.834,P0.01)。3败血症组早产儿与足月儿血清PA、CRP、PCT、ChE水平比较足月儿组PA、CRP、PCT、ChE水平分别为67.46±3.41mg/L、30.39±5.2mg/L、8.84±2.37ng/ml、4402.40±199.84U/L;早产儿组PA、CRP、PCT、ChE水平分别为61.57±5.69mg/L、10.25±2.90mg/L、10.28±4.61ng/ml、4017.27±256.10U/L。经独立样本t检验比较,早产儿组CRP水平较足月儿组低,存在显著性差异(P0.05);早产儿组PA、PCT、ChE水平分别与足月儿组PA、PCT、ChE水平比较,均无显著性差异(P0.05)。4败血症组、其他感染组及非感染组之间血清PA、CRP、PCT、ChE、白细胞计数阳性率水平比较败血症组血清PA、CRP、PCT、ChE、白细胞计数阳性率分别为91.67%、65%、73.33%、35%、38.33%;其他感染组血清PA、CRP、PCT、ChE、白细胞计数阳性率分别为91.67%、18.33%、31.67%、11.67%、8.33%;非感染组血清PA、CRP、PCT、ChE、白细胞计数阳性率分别为78.33%、1.67%、18.33%、5%、8.33%。经R×2列联表的χ2检验,三组比较,PA的χ2=6.381、CRP的χ2=63.694、PCT的χ2=40.801、ChE的χ2=20.888、WBC的χ2=24.045,均有显著性差异(P0.05)。败血症组血清PA、CRP、PCT、ChE、白细胞计数5项指标联合检测的总阳性率为96.67%,其他感染组血清PA、CRP、PCT、ChE、白细胞计数5项指标联合检测的总阳性率为95%。5对实验室指标进行诊断试验评价血清PA、CRP、PCT、ChE、WBC计数敏感度分别为70.06%、98.04%、85.14%、90.32%、84.84%;PA、CRP、PCT、ChE、WBC计数特异度分别为56.52%、45.73%、46.22%、38.26%、37.41%;PA、CRP、PCT、ChE、WBC计数阳性预测值分别为91.67%、41.67%、52.5%、23.33%、23.33%;PA、CRP、PCT、ChE、WBC计数阴性预测值分别为21.67%、98.33%、81.67%、95%、91.67%;PA、CRP、PCT、ChE、WBC计数诊断符合率分别为68.33%、60.56%、62.22%、47.22%、46.11%。提示PA、CRP、PCT、ChE、WBC计数为诊断新生儿感染的敏感指标,但ChE、WBC计数的特异度均偏低。6 ROC曲线显示诊断新生儿感染,PA、CRP、PCT曲线下面积分别为0.675、0.777、0.736,P值均为0.000,均0.01,有显著意义,最佳截取值分别为54.75mg/L、1.96mg/L、0.255ng/ml,此值时的敏感度分别为96.7%、75%、68.3%,特异度分别为30%、70%、66.7%。ChE曲线下面积为0.658,P值为0.0010.05,有显著意义,最佳临界值为4390.2U/L,此值时的敏感度为90%,特异度为36.7%。结论:1血清PA、CRP、PCT、ChE及WBC计数是新生儿感染早期用于诊断和判断疗效的敏感指标,CRP、PCT为敏感性、特异性均稳定的诊断指标,ChE及WBC计数单独检测时特异性低,PA的阴性预测值较低,需联合评价。2血清PA、PCT、ChE及WBC计数在诊断败血症时不受胎龄影响,CRP受胎龄影响。胎龄越低,CRP值越低。3三组患儿之间血清PA、CRP、PCT、ChE、白细胞计数阳性率存在差异,5项指标联合检测可显著提高新生儿感染诊断的阳性率。
[Abstract]:Objective: through the retrospective analysis of 120 cases of neonatal infection and 60 cases of non infectious neonatal serum albumin, C-reactive protein C-, procalcitonin, cholinesterase levels and leukocyte count in peripheral blood, explore the above indicators of early detection in diagnosis of neonatal infection, whether there are differences in preterm and full-term infants infection and, in the diagnosis of neonatal infection positive rate, sensitivity, specificity, positive predictive value, negative predictive value and diagnostic coincidence rate, in order to clarify the difference detection in early stage of sepsis indicators combined with the indexes of newborn and the significance, to provide clinical basis for early diagnosis of neonatal infection. Methods: in this study, from August 2014 to July 2016, the fourth hospital of Hebei Medical University pediatric neonatal ward admitted that no serious cardiovascular disease, no asphyxia, no hemolytic disease history, genetic Metabolic diseases and family history of autoimmune disease, different degrees of infection with 120 cases as experimental group, male 77 cases, female 43 cases, 42 cases of premature infants, 78 cases of full-term infants and gestational age between 27+6~41+4 weeks, birth weight 942g~4400g, hospitalization time between 0.20~380h. According to the discharge diagnosis results are divided into 60 cases of septicemia group and other infection group 60 cases, 60 cases of non infected children treated in the same period as the control group, there were 40 male and 20 female patients, 28 premature infants, 32 term infants, gestational age between 27+5~41+3 weeks, birth weight 945g~4398g, hospitalization time in 0.18~384h. patients were admitted to hospital within 24-48 hours antibiotics, before treatment, take blood 5ml in aseptic operation, 2ml centrifugal separation of serum, CRP, PCT, PA, ChE, CRP by immunoturbidimetry, PCT microparticle Electrochemiluminescence Method PA by immune turbidimetry, ChE for butyryl thiocholine substrate .1ml send blood test, white blood cell count determination of cell size by using Kurt principle. The other 2ml venous blood samples for bacterial culture, application of bioMerieux company dedicated pediatric flask culture for 5-7 days, positive drug sensitive test. Anti infection treatment after 5-7 days, again from children serum blood routine, CRP, PCT, PA ChE., all data using statistical software SPSS22.0 analysis, measurement data to mean + standard deviation ((X|-) + S) said that both the normality and homogeneity of variance, multiple sets of data compared with single factor analysis of variance, if the results are statistically significant, further application of the LSD method 22 groups, two groups were compared using paired t test, independent samples t test; count data using 2 test. The test level of =0.05 alpha, P0.05 as statistical significance. Results: 1 sepsis group, infection group and non sense Dye group serum PA, CRP, PCT, ChE detection level of sepsis group: PA, CRP, PCT, ChE levels were 65.20 + 3.02mg/L, 22.67 + 3.61mg/L, 9.39 + 2.27ng/ml, 4254.76 + 158.10U/L; other infection group: PA, CRP, PCT, ChE levels were 69.90 + 2.80mg/L, 4.63 + 0.61mg/L, 1.53 + 0.53ng/ml, 5601.86 + 196.18U/L; non infection group: PA, CRP, PCT, ChE levels were 83.43 + 3.02mg/L, 2.14 + 0.28mg/L, 0.44 + 0.10ng/ml, 5796.85 + 204.47U/L. by single factor analysis of variance, the comparison between the three groups, there was significant difference (FA=10.291, FB= 27.955, FC=13.15, FD=20.09, P0.01) between the 22 groups. Compared with LSD method, the results showed that PA levels in sepsis group was lower than that of other infected group and non infected group, there were significant differences (P0.05), compared with the other level of PA infected group and non infected group, no significant difference (P0.05); sepsis group and other infection group were higher than those of CRP, PCT level there was infection group. The difference (P0.01), sepsis group of CRP, PCT level and other infection group, no significant difference (P0.05); sepsis group and other infection group ChE levels were lower than those in the non infection group, there was significant difference (P0.01), compared the level of ChE and other septicemia group infection group, no significant difference (P0.05) serum PA,.2 before and after treatment of septicemia group CRP, PCT, ChE levels before treatment PA, CRP, PCT, ChE levels were 65.20 + 3.02mg/L, 22.67 + 3.61mg/L, 9.39 + 2.27ng/ml, 4254.76 + 158.10U/L, 5-7 days of treatment (recovery) of PA, CRP, PCT, ChE levels were 94.14 + 3.64mg/L, 3.35 + 0.63mg/L, 0.57 + 0.40ng/ml, 5450.52 + 143.31U/L, compared with the paired t test, there were significant differences in the indexes before and after treatment of sepsis group (t A=-9.521, t B=6.109, t C=4.403, t D=-7.834, P0.01.3) sepsis group of preterm and full-term infants serum PA, CRP, PCT, ChE level full-term infants 缁凱A,CRP,PCT,ChE姘村钩鍒嗗埆涓，

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