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目的评价降钙素原(PCT)、CRP、WBC总数及杆状核细胞对早期新生儿感染诊断的价值。方法选择本院产科出生且小于3 d的因血WBC、杆状核细胞和CRP增高诊断为新生儿感染的63例新生儿为研究对象。所有患儿入院后(抗生素使用前)立即取血做血常规、血培养及CRP、PCT检查,根据PCT结果将患儿分为PCT增高组(PCT≥2μg.L-1)和PCT正常组(PCT<2μg.L-1),治疗后复查上述指标。结果 63例患儿血培养均阴性,入院时血WBC(29.45±9.61)×109L-1,中性粒细胞为0.783 6±0.078 6,杆状核细胞为0.077 0±0.037 7,血小板为(241.44±9.30)×109L-1。PCT增高组28例,PCT中位数为7.07(2.02,53.57)μg.L-1,PCT正常组35例,PCT中位数为0.45(0.05,1.83)μg.L-1。2组胎龄、体质量、胎心异常史、羊水污染史、胎膜早破史、母亲发热史、母亲血象增高史、入院时血WBC及杆状核均无统计学差异,PCT增高组中5例CRP增高,PCT正常组CRP均正常。2组治疗前后各感染指标比较除血小板外差异均无统计学意义,PCT增高组治疗前后血小板均高于PCT正常组(Pa<0.01)。Spearman相关分析显示PCT与WBC总数及中性粒细胞杆状核细胞、血小板、CRP均无相关性(Pa>0.05)。结论早期新生儿轻症感染以血WBC增高及杆状核增高为主,可伴或不伴CRP增高,PCT大多正常,因此PCT对诊断早期新生儿轻症感染的意义不大。
Objective To evaluate the value of procalcitonin (PCT), total CRP and WBC and the diagnosis of early neonatal infection by the nucleated cells. Methods Sixty-three newborns diagnosed as neonatal infection with blood WBC, erythrocytes and CRP increased less than 3 days after birth in our hospital. All children were admitted to hospital immediately after antibiotics, blood was taken for blood routine examination, blood culture and CRP, PCT examination. According to the PCT results, the patients were divided into PCT increased group (PCT≥2μg.L-1) and PCT normal group PCT <2μg.L-1), after treatment, review the above indicators. Results The blood culture of 63 children were all negative. The blood WBC (29.45 ± 9.61) × 109L-1, neutrophil 0.783 6 ± 0.078 6, tubercle cell 0.077 0 ± 0.037 7 and platelet 241.44 ± 9.30) × 109L-1. PCT increased in 28 cases, median PCT was 7.07 (2.02,53.57) μg.L-1, PCT normal group 35 cases, PCT median 0.45 (0.05,1.83) μg.L-1.2 gestational age , Body weight, history of abnormal fetal heart rate, history of amniotic fluid contamination, history of premature rupture of membranes, history of fever in mother and history of maternal blood increased. There was no significant difference in blood WBC and rod nucleus at admission, and CRP increased in 5 cases , Normal PCT CRP were normal. Before and after treatment, the indexes of infection except platelet were no significant difference between the two groups before and after treatment. The platelets of PCT increased group before and after treatment were higher than that of PCT normal group (Pa <0.01). Spearman correlation analysis showed no correlation between PCT, WBC count, neutrophil myeloid cells, platelets and CRP (Pa> 0.05). Conclusions Early neonatal mild infection is mainly caused by the increase of blood WBC and rod-shaped nucleus, with or without increased CRP, PCT is mostly normal, so PCT has little significance in the diagnosis of mild neonatal infection.