白介素6早期诊断新生儿败血症的临床价值及新生儿早发型败血症危险因素临床分析

发布时间：2018-04-01 05:17

本文选题：IL-6　切入点：C反应蛋白　出处：《福建医科大学》2012年硕士论文

【摘要】：目的评价IL-6在早期诊断新生儿败血症及疾病转归中的应用价值。方法选择2011年5月至2011年12月入住我院新生儿科，入院日龄为出生至28天,发病时间小于24小时的新生儿120例，根据新生儿败血症诊断标准及病情严重程度进行分组：败血症危重组11例、败血症非危重组39例、对照组危重组14例、对照组非危重组56例。按预先设定时间段对研究对象采血以分别进行IL-6、超敏C反应蛋白（hs-CRP）、血常规及血培养检测，对数据进行统计学分析。结果当IL-6取切值146.8pg/ml时，其诊断新生儿败血症的灵敏度、特异度、阳性预测值、阴性预测值、曲线下面积分别为98%、94%、92.3%、98.5%、0.982，明显优于hs-CRP（70%、79%、71%、79%、0.725）；IL-6与新生儿危重症评分相关，病情越危重，评分越低，IL-6水平越高（r=-0.356，P=0.00）；入院24h后hs-CRP敏感性上升，与IL-6相比无明显差异，两者联合检测较单一指标诊断效能高；IL-6水平变化可及时反映患者病情变化。结论血清IL-6可作为新生儿败血症早期诊断的可靠指标，可为新生儿危重症评估提供一定参考。目的探讨新生儿早发型败血症发生的有关危险因素。方法采用历史性对照研究，按完全随机设计选择150例非败血症患儿作为对照组，，153例诊断早发型败血症患儿为病例组，对两组临床资料进行对照研究，应用logistic回归模型分析。结果配对资料单因素分析显示，胎儿宫内窘迫、羊水胎粪污染或发臭、母产前或产时发热、出生重度窒息、重度小于胎龄儿（SGA）或双胎、胎次、胎膜早破、绒毛膜羊膜炎、妊高症、母妊娠期糖尿病、产前胎心异常与新生儿发生早发型败血症有关联，其OR值分别为4.626、3.279、4.550、4.913、2.576、1.678、2.724、3.352、3.967、2.517、5.175，成组资料单因素分析显示胎龄及低出生体重亦为早发型新生儿败血症的危险因素，且存等级效益关系。Logistic回归分析显示羊水胎粪污染或发臭、胎儿宫内窘迫、胎膜早破、SGA/双胎、妊高症、糖尿病及早产为早发型新生儿败血症的独立危险因素，其OR值分别为3.488、3.193、3.053、2.552、4.636、2.856。新生儿败血症临床表现前几位分别为病理性黄疸、发热、呕吐、腹胀、反应差、白细胞异常、血小板减低、CRP升高及弥漫性血管内凝血(DIC)。结论新生儿早发型败血症的发生与围产期多种因素有关，有针对性地开展围产期保健，及时进行败血症危险评估及识别，是降低新生儿早发型败血症发生率的有效措施。
[Abstract]:Objective to evaluate the value of IL-6 in early diagnosis of neonatal septicemia and prognosis. Methods 120 neonates who were admitted to our hospital from May 2011 to December 2011, who were born to 28 days old and whose onset time was less than 24 hours, were selected. According to the diagnostic criteria and severity of neonatal septicemia, 11 cases of septicemia were regrouped, 39 cases of septicemia and 14 cases of control group. In the control group, 56 cases of non-critical recombination were collected for IL-6, hs-CRP, routine blood routine and blood culture, and the data were analyzed statistically. Results the sensitivity, specificity, positive predictive value, negative predictive value and area under the curve of IL-6 for neonatal septicemia were 98, 94, 92. 3 and 98. 05, respectively, which were significantly better than those of hs-CRP7079, 71-, 71and 72525IL-6, and the more serious the condition, the more serious the disease was. The lower the score of IL-6 was, the higher the level of IL-6 was. The sensitivity of hs-CRP increased 24 hours after admission, but there was no significant difference compared with IL-6. The higher the level of IL-6 was compared with the single index, the higher the level of IL-6 could reflect the change of patient's condition in time. Conclusion Serum IL-6 can be used as a reliable index for early diagnosis of neonatal septicemia and can provide some reference for neonatal critical assessment. Objective to investigate the risk factors of neonatal premature sepsis. Methods one hundred and fifty children with non-septicemia were selected as the control group by a historical control study. The clinical data of the two groups were analyzed by logistic regression model. Results univariate analysis of matched data showed that fetal distress, meconium contamination or stink in amniotic fluid, fever before and during birth, severe asphyxia at birth, severe SGA) or twins, fetal order, premature rupture of membranes, chorioamnionitis, Pregnancy induced hypertension (PIH), gestational diabetes mellitus (GDM) and abnormal fetal heart rate were associated with premature septicemia in newborns. Their OR values were 4.626 / 3.279 / 4.550 / 4.9132.576 / 1.6782.724 / 3.3523.967 / 2.517 / 5.175 respectively. Univariate analysis showed that gestational age and low birth weight were also the risk factors of premature neonatal septicemia. Logistic regression analysis showed that meconium contamination or stench in amniotic fluid, fetal distress, premature rupture of membranes, SGA / twins, pregnancy induced hypertension, diabetes and premature delivery were independent risk factors for premature neonatal septicemia. The OR values were 3.488 / 3.193 / 3.053 / 4.636 / 2.856 respectively. The first few clinical manifestations of neonatal septicemia were pathological jaundice, fever, vomiting, abdominal distention, poor reaction, abnormal white blood cell, increased CRP of thrombocytopenia and DICs of diffuse intravascular coagulation. Conclusion the occurrence of premature neonatal septicemia is related to many factors during perinatal period. It is an effective measure to reduce the incidence rate of neonatal premature sepsis by carrying out perinatal health care timely risk assessment and identification of sepsis.
【学位授予单位】：福建医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R722.1

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