本文關(guān)鍵詞：120例新生兒感染實(shí)驗(yàn)室相關(guān)指標(biāo)臨床意義的研究　出處：《河北醫(yī)科大學(xué)》2017年碩士論文　論文類(lèi)型：學(xué)位論文

  更多相關(guān)文章： 新生兒感染 前白蛋白 C-反應(yīng)蛋白 降鈣素原 膽堿酯酶 外周血白細(xì)胞計(jì)數(shù) 診斷意義

【摘要】：目的:本實(shí)驗(yàn)通過(guò)回顧性分析120例感染新生兒和60例非感染新生兒血清前白蛋白、C-反應(yīng)蛋白、降鈣素原、膽堿酯酶水平及外周血白細(xì)胞計(jì)數(shù),探討以上各項(xiàng)早期檢測(cè)指標(biāo)在新生兒感染中的診斷意義、在早產(chǎn)兒與足月兒感染中是否存在差異,及其在診斷新生兒感染中的陽(yáng)性率、敏感度、特異度、陽(yáng)性預(yù)測(cè)值、陰性預(yù)測(cè)值及診斷符合率,以期闡明新生兒敗血癥早期單項(xiàng)檢測(cè)指標(biāo)與聯(lián)合多項(xiàng)指標(biāo)檢測(cè)的差異及意義,為新生兒感染早期診斷提供臨床依據(jù)。方法:本研究以2014年8月至2016年7月期間,河北醫(yī)科大學(xué)第四醫(yī)院兒科新生兒病區(qū)收治的,無(wú)嚴(yán)重心血管疾病、無(wú)窒息史、無(wú)溶血性疾病史、無(wú)遺傳代謝性疾病及家族免疫性疾病史,發(fā)生不同程度感染的患兒120例作為實(shí)驗(yàn)組,其中男77例,女43例,早產(chǎn)兒42例,足月兒78例,胎齡在27+6~41+4周之間,出生體重942g~4400g,入院時(shí)間在0.20~380h之間。根據(jù)出院診斷結(jié)果分為敗血癥組60例和其他感染組60例,同期收治的60例非感染患兒作為對(duì)照組,其中男40例,女20例,早產(chǎn)兒28例,足月兒32例,胎齡在27+5~41+3周之間,出生體重945g~4398g,入院時(shí)間在0.18~384h。所有患兒均于入院24-48小時(shí)內(nèi),抗生素治療前,在無(wú)菌操作下采取靜脈血5ml,2ml離心分離血清,進(jìn)行CRP、PCT、PA、ChE檢測(cè),CRP采用免疫散射比濁法,PCT為微粒子電化學(xué)發(fā)光法,PA采用免疫比濁法,ChE為丁酰硫代膽堿底物法。1ml送血常規(guī)檢測(cè),白細(xì)胞計(jì)數(shù)采用庫(kù)爾特原理測(cè)定細(xì)胞體積大小。另2ml靜脈血送檢細(xì)菌培養(yǎng),血樣應(yīng)用生物梅里埃公司兒科專(zhuān)用培養(yǎng)瓶培養(yǎng)5-7天,陽(yáng)性者做藥敏試驗(yàn)�？垢腥局委�5-7天后,再次取患兒靜脈血復(fù)查血常規(guī)、CRP、PCT、PA、ChE。所有數(shù)據(jù)應(yīng)用統(tǒng)計(jì)學(xué)軟件SPSS22.0進(jìn)行分析處理,計(jì)量資料以均數(shù)±標(biāo)準(zhǔn)差((X|-)±S)表示,均進(jìn)行正態(tài)性及方差齊性檢驗(yàn),多組數(shù)據(jù)比較采用單因素方差分析,若所得結(jié)果有統(tǒng)計(jì)學(xué)差異,則進(jìn)一步應(yīng)用LSD法行組間兩兩比較,兩組比較采用配對(duì)t檢驗(yàn)、獨(dú)立樣本t檢驗(yàn);計(jì)數(shù)資料采用χ2檢驗(yàn)。檢驗(yàn)水平α=0.05,P0.05視為差異有統(tǒng)計(jì)學(xué)意義。結(jié)果:1敗血癥組、其他感染組及非感染組間血清PA、CRP、PCT、ChE檢測(cè)水平比較敗血癥組:PA、CRP、PCT、ChE水平分別為65.20±3.02mg/L、22.67±3.61mg/L、9.39±2.27ng/ml、4254.76±158.10U/L;其他感染組:PA、CRP、PCT、ChE水平分別為69.90±2.80mg/L、4.63±0.61mg/L、1.53±0.53ng/ml、5601.86±196.18U/L;非感染組:PA、CRP、PCT、ChE水平分別為83.43±3.02mg/L、2.14±0.28mg/L、0.44±0.10ng/ml、5796.85±204.47U/L。經(jīng)單因素方差分析,三組比較,有顯著性差異(FA=10.291,FB=27.955,FC=13.15,FD=20.09,P0.01)。組間兩兩比較采用LSD法,結(jié)果顯示敗血癥組PA水平低于其他感染組與非感染組,均有顯著性差異(P0.05),其他感染組PA水平與非感染組比較,無(wú)顯著性差異(P0.05);敗血癥組和其他感染組CRP、PCT水平均高于非感染組,有顯著性差異(P0.01),敗血癥組CRP、PCT水平和其他感染組比較,無(wú)顯著性差異(P0.05);敗血癥組和其他感染組ChE水平均低于非感染組,有顯著性差異(P0.01),敗血癥組ChE水平和其他感染組比較,無(wú)顯著性差異(P0.05)。2敗血癥組治療前后血清PA、CRP、PCT、ChE檢測(cè)水平比較治療前PA、CRP、PCT、ChE水平分別為65.20±3.02mg/L、22.67±3.61mg/L、9.39±2.27ng/ml、4254.76±158.10U/L,治療5-7天后(恢復(fù)期)PA、CRP、PCT、ChE水平分別為94.14±3.64mg/L、3.35±0.63mg/L、0.57±0.40ng/ml、5450.52±143.31U/L,經(jīng)配對(duì)t檢驗(yàn)比較,敗血癥組治療前后上述指標(biāo)均有顯著性差異(t A=-9.521,t B=6.109,t C=4.403,t D=-7.834,P0.01)。3敗血癥組早產(chǎn)兒與足月兒血清PA、CRP、PCT、ChE水平比較足月兒組PA、CRP、PCT、ChE水平分別為67.46±3.41mg/L、30.39±5.2mg/L、8.84±2.37ng/ml、4402.40±199.84U/L;早產(chǎn)兒組PA、CRP、PCT、ChE水平分別為61.57±5.69mg/L、10.25±2.90mg/L、10.28±4.61ng/ml、4017.27±256.10U/L。經(jīng)獨(dú)立樣本t檢驗(yàn)比較,早產(chǎn)兒組CRP水平較足月兒組低,存在顯著性差異(P0.05);早產(chǎn)兒組PA、PCT、ChE水平分別與足月兒組PA、PCT、ChE水平比較,均無(wú)顯著性差異(P0.05)。4敗血癥組、其他感染組及非感染組之間血清PA、CRP、PCT、ChE、白細(xì)胞計(jì)數(shù)陽(yáng)性率水平比較敗血癥組血清PA、CRP、PCT、ChE、白細(xì)胞計(jì)數(shù)陽(yáng)性率分別為91.67%、65%、73.33%、35%、38.33%;其他感染組血清PA、CRP、PCT、ChE、白細(xì)胞計(jì)數(shù)陽(yáng)性率分別為91.67%、18.33%、31.67%、11.67%、8.33%;非感染組血清PA、CRP、PCT、ChE、白細(xì)胞計(jì)數(shù)陽(yáng)性率分別為78.33%、1.67%、18.33%、5%、8.33%。經(jīng)R×2列聯(lián)表的χ2檢驗(yàn),三組比較,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,均有顯著性差異(P0.05)。敗血癥組血清PA、CRP、PCT、ChE、白細(xì)胞計(jì)數(shù)5項(xiàng)指標(biāo)聯(lián)合檢測(cè)的總陽(yáng)性率為96.67%,其他感染組血清PA、CRP、PCT、ChE、白細(xì)胞計(jì)數(shù)5項(xiàng)指標(biāo)聯(lián)合檢測(cè)的總陽(yáng)性率為95%。5對(duì)實(shí)驗(yàn)室指標(biāo)進(jìn)行診斷試驗(yàn)評(píng)價(jià)血清PA、CRP、PCT、ChE、WBC計(jì)數(shù)敏感度分別為70.06%、98.04%、85.14%、90.32%、84.84%;PA、CRP、PCT、ChE、WBC計(jì)數(shù)特異度分別為56.52%、45.73%、46.22%、38.26%、37.41%;PA、CRP、PCT、ChE、WBC計(jì)數(shù)陽(yáng)性預(yù)測(cè)值分別為91.67%、41.67%、52.5%、23.33%、23.33%;PA、CRP、PCT、ChE、WBC計(jì)數(shù)陰性預(yù)測(cè)值分別為21.67%、98.33%、81.67%、95%、91.67%;PA、CRP、PCT、ChE、WBC計(jì)數(shù)診斷符合率分別為68.33%、60.56%、62.22%、47.22%、46.11%。提示PA、CRP、PCT、ChE、WBC計(jì)數(shù)為診斷新生兒感染的敏感指標(biāo),但ChE、WBC計(jì)數(shù)的特異度均偏低。6 ROC曲線(xiàn)顯示診斷新生兒感染,PA、CRP、PCT曲線(xiàn)下面積分別為0.675、0.777、0.736,P值均為0.000,均0.01,有顯著意義,最佳截取值分別為54.75mg/L、1.96mg/L、0.255ng/ml,此值時(shí)的敏感度分別為96.7%、75%、68.3%,特異度分別為30%、70%、66.7%。ChE曲線(xiàn)下面積為0.658,P值為0.0010.05,有顯著意義,最佳臨界值為4390.2U/L,此值時(shí)的敏感度為90%,特異度為36.7%。結(jié)論:1血清PA、CRP、PCT、ChE及WBC計(jì)數(shù)是新生兒感染早期用于診斷和判斷療效的敏感指標(biāo),CRP、PCT為敏感性、特異性均穩(wěn)定的診斷指標(biāo),ChE及WBC計(jì)數(shù)單獨(dú)檢測(cè)時(shí)特異性低,PA的陰性預(yù)測(cè)值較低,需聯(lián)合評(píng)價(jià)。2血清PA、PCT、ChE及WBC計(jì)數(shù)在診斷敗血癥時(shí)不受胎齡影響,CRP受胎齡影響。胎齡越低,CRP值越低。3三組患兒之間血清PA、CRP、PCT、ChE、白細(xì)胞計(jì)數(shù)陽(yáng)性率存在差異,5項(xiàng)指標(biāo)聯(lián)合檢測(cè)可顯著提高新生兒感染診斷的陽(yáng)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 緇凱A,CRP,PCT,ChE姘村鉤鍒嗗埆涓，

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