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目的探讨血清降钙素原(procalcitonin,PCT)和C反应蛋白(C-reactive protein,CRP)水平对鉴别新生儿血流感染菌种类型的临床应用价值。方法回顾性分析2015年7月-2016年6月于湖南省儿童医院新生儿科病房住院的血培养结果为单一细菌且同时检测血清PCT、CRP水平的病例168例,选择同期因外科疾病住院的非感染性疾病新生儿42例为对照组。比较PCT、CRP水平在真菌、革兰阳性(G~+)菌、革兰阴性(G~-)菌血流感染新生儿及对照组之间的差异,同时根据受试者工作曲线(ROC)判断PCT的诊断性能。结果 168例新生儿血流感染患者中真菌32例、G~+菌76例、G~-菌60例及对照组42例,四组PCT水平中位数分别为0.57、0.21、3.69和0.11 ng/ml,两两比较差异均有统计学意义(均P<0.05);四组CRP水平中位数分别为17.66、0.99、18.23和0.62 mg/L,两两比较发现真菌组与G~-菌组、G~+菌组与对照组比较差异无统计学意义外,余差异均有统计学意义(P<0.05)。根据ROC曲线,当PCT界值定为0.275 ng/ml时,PCT鉴别细菌感染性疾病与非感染性疾病的灵敏度、特异性分别为71.6%、83.3%;当界值定为0.505 ng/ml时,PCT鉴别真菌与G~+菌的灵敏度、特异性分别为75.0%、70.1%;当界值定为0.615 ng/ml时,PCT鉴别G~-菌与G~+菌的灵敏度、特异性分别为82.0%、75.8%;当界值定为1.665 ng/ml时,PCT鉴别G~-菌与真菌的灵敏度、特异性分别为70.0%、81.2%。结论 CRP作为鉴别新生儿血流感染的病原体菌种的应用价值有限;血清PCT水平对鉴别真菌与G~+菌、G~-菌与G~+菌及G~-菌与真菌所致的新生儿血流感染有一定的临床应用价值。
Objective To investigate the clinical value of serum levels of procalcitonin (PCT) and C-reactive protein (CRP) in the identification of neonatal bloodstream infection strains. Methods A retrospective analysis of 168 cases of blood cultures of single bacterium and simultaneous detection of serum PCT and CRP levels from July 2015 to June 2016 in neonatal ward of Hunan Provincial Children’s Hospital was performed. Infectious diseases in 42 newborns as a control group. The differences of PCT and CRP levels between fungal, Gram-positive (G ~ +) and Gram-negative (G ~) bacteria infected by bloodstream and control group were compared. According to the receiver operating characteristic curve Determine the diagnostic performance of PCT. Results Among the 168 cases of newborns with bloodstream infection, 32 were fungi, 76 were G ~ + bacteria, 60 were G ~ - bacteria and 42 were control group. The PCT median of the four groups were 0.57, 0.21, 3.69 and 0.11 ng / ml, any difference between the two groups was statistically significant (all P <0.05); the median CRP levels of the four groups were 17.66,0.99,18.23 and 0.62 mg / L, any pairwise comparison found fungal group and G ~ - bacteria There was no significant difference between G ~ + group and control group (P <0.05). According to the ROC curve, when the PCT cutoff value was set at 0.275 ng / ml, the sensitivity and specificity of PCT in distinguishing bacterial infectious diseases from non-infectious diseases were 71.6% and 83.3% respectively. When the cutoff value was 0.505 ng / ml , The sensitivity and specificity of PCT identification of fungi and G ~ + bacteria were 75.0% and 70.1% respectively. When the cutoff value was 0.615 ng / ml, the sensitivity and specificity of PCT identification of G ~ - Were 82.0% and 75.8%, respectively. The sensitivity and specificity of G - and Fungal fungi were 70.0% and 81.2% respectively when the cutoff value was 1.665 ng / ml. Conclusion The application of CRP as a pathogen to identify neonatal bloodstream infection is of limited value. The level of serum PCT can be used to identify the newborn caused by fungi and G ~ + bacteria, G ~ - bacteria and G ~ + bacteria and G ~ - bacteria and fungi Pediatric bloodstream infection has some clinical value.