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中华实验和临床感染病杂志(电子版)

中华实验和临床感染病杂志(电子版) ›› 2018, Vol. 12 ›› Issue (03) : 272 -277. doi: 10.3877/cma.j.issn.1674-1358.2018.03.014

所属专题： 经典病例； 文献；

临床论著

新生儿感染性疾病127例临床研究
白萌萌1, 孟林2, 李文2,†(), 崔玉婕2, 张冬梅2, 桑艳峰2, 刘咏梅2, 唐静2   
  1. 1. 067000　承德市；承德医学院2016级研究生；067000　承德市，承德市中心医院儿科（承德医学院第二临床学院）
    2. 067000　承德市，承德市中心医院儿科（承德医学院第二临床学院）
  • 收稿日期:2017-02-27 出版日期:2018-06-15
  • 通信作者: 李文
  • 基金资助:
    承德市科学技术研究及发展项目(No. 201706A026)

Clinical study on 127 cases with suspected early-onset sepsis

Mengmeng Bai1, Lin Meng2, Wen Li2,†(), Yujie Cui2, Dongmei Zhang2, Yanfeng Sang2, Yongmei Liu2, Jing Tang2   

  1. 1. Chengde Medical University, Chengde 067000, China
    2. Chengde Central Hospital (Second Clinical College of Chengde Medical College), Chengde 067000, China
  • Received:2017-02-27 Published:2018-06-15
  • Corresponding author: Wen Li
  • About author:
    Corresponding author: Li Wen, Email:
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引用本文：

白萌萌, 孟林, 李文, 崔玉婕, 张冬梅, 桑艳峰, 刘咏梅, 唐静. 新生儿感染性疾病127例临床研究[J/OL]. 中华实验和临床感染病杂志(电子版), 2018, 12(03): 272-277.

Mengmeng Bai, Lin Meng, Wen Li, Yujie Cui, Dongmei Zhang, Yanfeng Sang, Yongmei Liu, Jing Tang. Clinical study on 127 cases with suspected early-onset sepsis[J/OL]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2018, 12(03): 272-277.

目的

探讨新生儿感染性疾病实验室非特异性指标相关因素的诊断价值。

方法

选取2016年7月至2017年7月承德市中心医院NICU收治的127例出生0~3 d的感染性疾病患儿为感染组，103例0~3 d非感染性疾病新生儿为对照组，比较两组新生儿的临床症状、围产期因素以及实验室指标等。

结果

与对照组新生儿相比，感染组患儿喂养困难（15.7%）、呼吸困难（30.7%）、呻吟（31.5%）、皮肤黄染（18.1%）和窒息（5%）等初始症状差异均有统计学意义（χ2 = 4.136、24.574、33.282、38.039，P均< 0.001）。围产期因素中两组新生儿母亲孕晚期有感染病史和胎膜早破> 18 h两个因素差异有统计学意义（χ2 = 10.536、10.717，P均= 0.001）。实验室指标结果显示，两组新生儿C-反应蛋白（CRP）、白细胞计数以及中性粒细胞百分比差异均有统计学意义（t = 2.740、P = 0.008，t = 6.378、P < 0.001，t = 4.860、P < 0.001）。感染组患儿ROC曲线分析显示：CRP、白细胞计数、中性粒细胞百分比最佳截断点分别为8.0 mg/dl、12.65 × 109/L和63.15%，敏感性分别为24.3%、62.2%和68.9%，特异性分别为99.0%、81.2%和84.4%，曲线下面积（AUC）分别为0.544、0.707和0.769；CRP、白细胞计数和中性粒细胞百分比三者联合敏感性为83.8%，特异性为75.0%，曲线下面积（AUC）为0.860，显著高于单项指标。

结论

新生儿感染性疾病的发生与多种围产期因素密切相关，以呼吸系统症状为始发临床表现多见。CRP、白细胞计数和中性粒细胞百分比联合诊断可以提高诊断价值。围产期因素、临床表现和实验室指标相结合，有利于早期识别新生儿感染性疾病。

关键词: 新生儿, 感染, C-反应蛋白, 白细胞, 中性粒细胞, 诊断
Objective

To investigate the diagnostic value of related nonspecific indexes in the laboratory factors for neonatal infectious diseases.

Methods

From July 2016 to July 2017, a total of 127 cases with infectious diseases in NICU of Chengde Central Hospital were selected as infection group, while 103 cases of non-infection newborns (0-3 day) were taken as the control group. Perinatal factors, laboratory indicators and other clinical factors were compared between the two groups.

Results

Compared with the control group, initial symptoms such as feeding difficulties (15.7%), breathing difficulties (30.7%), groans (31.5%), yellow skin stains (18.1%) and suffocation (5%) were significantly different in the infection group (χ2 = 4.136, 24.574, 33.282, 38.039; all P < 0.001). There were significant differences of perinatal factors between the two groups of newborns with a history of infection in the late stages of pregnancy and premature rupture of the fetal membrane > 18 h (χ2 = 10.536, 10.717; both P = 0.001). The results of laboratory indicators showed that the C-reactive protein (CRP), count of white blood cell (WBC) and percentage of neutrophils between newborns in the two groups were all significantly different (t = 2.740, P = 0.008; t = 6.378, P < 0.001; t = 4.860, P < 0.001). The ROC curve analysis of infection group showed that the best cut-off points for CRP, count of WBC and neutrophils were 8.0 mg/dl, 12.65 × 109/L and 63.15%, respectively; the sensitivity were 24.3%, 62.2% and 68.9%, respectively; the specificity were 99.0%, 81.2% and 84.4%, respectively; and the area under the curve (AUC) were 0.544, 0.707 and 0.769, respectively. The combined sensitivity of CRP, count of WBC and neutrophils was 83.8%, the specificity was 75.0%, and the AUC was 0.860, which was significantly higher than the individual index.

Conclusions

The incidence of neonatal infectious diseases is closely related to many perinatal factors, and mainly showed the clinical manifestations of respiratory symptoms. The combined diagnosis of leukocyte count and neutrophil percentage could improve the diagnostic value. The combination of perinatal factors, clinical manifestations and laboratory indexes are beneficial to the early identification of neonatal infectious diseases.

Key words: Newborn, Infective, C- reactive protein, Leukocyte, Neutrophil, Diagnosis
表1 两组新生儿的一般资料
组别 例数 男[例（%）] 剖宫产[例（%）] 胎龄（ ± s，周） 日龄（ ± s，d） 出生体重（ ± s，kg）
感染组 127 77（71.5） 70（66.3） 37.22 ± 3.18 1.23 ± 1.23 3.02 ± 0.86
对照组 103 53（58.5） 50（53.7） 37.84 ± 2.16 1.47 ± 1.31 3.09 ± 0.66
统计量 χ2 = 2.153 χ2 = 0.985 t =－1.751 t =－1.421 t =－0.673
P值 0.142 0.321 0.081 0.159 0.502
表2 两组患儿的临床表现[例（%）]
组别 例数 窒息 喂养困难 呼吸困难 呻吟 皮肤黄染 低血糖 体温异常 抽搐 呕吐腹胀
感染组 127 7（3.9） 20（12.1） 39（24.3） 40（23.2） 23（45.3） 5（5.5） 2（1.1） 3（1.7） 3（1.7）
对照组 103 0（3.1） 2（9.9） 5（19.7） 2（18.8） 59（36.7） 5（4.5） 0（0.9） 0（1.3） 0（1.3）
χ2值 4.136 12.532 24.574 33.282 38.039 0.000 — 0.972 0.972
P值 0.042 < 0.001 < 0.001 < 0.001 < 0.001 0.989 0.503 0.116 0.324
表3 两组患儿的围产期因素[例（%）]
组别 例数 孕晚期感染 羊水早破≥ 18 h 羊水粪染 胎心减慢
感染组 127 20（11.6） 19（11.0） 12（12.7） 11（11.0）
对照组 103 3（10.3） 2（9.0） 7（8.5） 9（9.0）
χ2值 10.536 10.717 0.528 0.000
P值 0.001 0.001 0.476 0.984
表4 两组患儿的实验室非特异性指标（ ± s）
组别 例数 CRP（mg/L） 白细胞计数（× 109/L） 中性粒细胞百分比（%） 血小板计数（× 1012/L）
感染组 127 9.80 ± 23.23 15.07 ± 6.56 60.99 ± 16.60 250.78 ± 71.67
对照组 103 2.30 ± 2.01 11.01 ± 2.57 52.07 ± 10.96 249.85 ± 61.67
t值 2.740 6.378 4.860 0.103
P值 0.008 0.000 0.000 0.918
图1 感染组患儿单指标和多指标联合检测诊断新生儿早发型败血症的ROC曲线
表5 单指标和多指标联合检测诊断新生儿早发型败血症的参数
检测指标 最佳截断点 AUC 约登指数 敏感性（%） 特异性（%）
CRP 8.0 mg/L 0.544 0.233 24.3 99.0
WBC 12.65 × 109/L 0.707 0.434 62.2 81.2
中性粒细胞百分比 63.15% 0.769 0.587 68.9 84.4
三项指标联合 — 0.860 0.588 83.8 75.0
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