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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) ›› 2020, Vol. 14 ›› Issue (03) : 224 -228. doi: 10.3877/cma.j.issn.1674-1358.2020.03.008

所属专题： 文献；

论著

铁蛋白在新生儿早发型败血症诊断中的临床意义
孟林1, 白萌萌2, 李文1,†(), 张红波3, 桑艳峰1, 唐静1, 张冬梅1, 付田丽1   
  1. 1. 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. 430000　武汉市，湖北省妇幼保健院
    3. 510282　广州市，南方医科大学珠江医院神经外科
  • 收稿日期:2019-07-24 出版日期:2020-06-15
  • 通信作者: 李文
  • 基金资助:
    中国博士后科学基金资助面上项目(No. 2018M1640802); 承德市科学技术研究及发展项目(No. 201706A026)

Clinical significance of serum ferritin in diagnosis of early-onset sepsis in neonates

Lin Meng1, Mengmeng Bai2, Wen Li1,†(), Hongbo Zhang3, Yanfeng Sang1, Jing Tang1, Dongmei Zhang1, Tianli Fu1   

  1. 1. Department of Pediatric Surgery, Affiliated Hospital of Chengde Medical University, Chengde 067000, China
    2. Maternal and Child Health Hospital of Hubei Province, Wuhan 430000, China
    3. Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China
  • Received:2019-07-24 Published:2020-06-15
  • Corresponding author: Wen Li
  • About author:
    Corresponding author: Li Wen, Email:
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孟林, 白萌萌, 李文, 张红波, 桑艳峰, 唐静, 张冬梅, 付田丽. 铁蛋白在新生儿早发型败血症诊断中的临床意义[J]. 中华实验和临床感染病杂志(电子版), 2020, 14(03): 224-228.

Lin Meng, Mengmeng Bai, Wen Li, Hongbo Zhang, Yanfeng Sang, Jing Tang, Dongmei Zhang, Tianli Fu. Clinical significance of serum ferritin in diagnosis of early-onset sepsis in neonates[J]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2020, 14(03): 224-228.

目的

探讨铁蛋白（SF）在新生儿早发型败血症诊断中的临床意义。

方法

选取2017年8月至2019年8月承德市中心医院新生儿重症监护室（NICU）收治的新生儿早发型败血症109例，根据SF水平分为铁蛋白正常组54例（SF < 200 ng/ml）和铁蛋白升高组55例（SF ≥ 200 ng/ml），比较两组新生儿一般资料（性别、发病日龄、孕母年龄、是否胎心异常或窒息、孕母晚期是否贫血、足月/早产、分娩方式、是否胎膜早破），炎性指标C-反应蛋白（CRP）和降钙素原（PCT）水平，采用多因素Logistic回归分析早发型败血症中铁蛋白升高的危险因素，绘制CRP和PCT预测铁蛋白水平的ROC曲线，比较两组新生儿的炎性指标变化及其预测价值。

结果

两组新生儿性别、胎心异常或窒息、孕母晚期有无贫血、发病日龄、孕母年龄等差异均无统计学意义（P均> 0.05）；而分娩方式（χ2 = 13.799、P < 0.001）、足月/早产（χ2 = 10.717、P = 0.001）以及胎膜早破（χ2 = 10.639、P = 0.001）等差异均有统计学意义。铁蛋白正常组新生儿CRP[（5.43 ± 4.75）mg/L]和PCT[（5.85 ± 3.56）ng/ml]水平低于铁蛋白升高组[CRP：（13.79 ± 4.36）mg/L、PCT：（13.58 ± 7.42）ng/ml]，差异均有统计学意义（t = 2.890、P = 0.006，t = 2.158、P = 0.034）。多因素Logistic回归分析显示，顺产（OR = 5.16、P = 0.032）、胎膜早破（OR = 0.195、P = 0.038）以及足月（OR = 4.104、P = 0.041）均为早发型败血症患儿铁蛋白升高的独立危险因素。CRP和PCT预测铁蛋白升高的ROC曲线显示：CRP最佳诊断分界点> 10.4 mg/L，敏感性和特异性分别为56.0%和87.6%，PCT最佳诊断分界点> 5.54 ng/ml，敏感性和特异性分别为73.5%和62.6%。

结论

顺产、胎膜早破和足月均为早发型败血症患儿铁蛋白升高的独立危险因素；铁蛋白升高可作为炎性指标辅助诊断早发型败血症。

关键词: 新生儿, 早发型败血症, 铁蛋白, 炎性蛋白
Objective

To investigate the clinical significance of ferritin (SF) in the diagnosis of neonatal early-onset sepsis.

Methods

Total of 109 cases of neonatal early-onset sepsis in neonatal intensive care unit (NICU) of Chengde Central Hospital were selected from August 2017 to August 2019, among whom, 54 cases (SF < 200 ng/ml) as SF normal group and 55 cases (SF ≥ 200 ng/ml) as SF elevated group. The general conditions (sex, onset day, gestational age, fetal heart abnormality or asphyxia, anemia in late pregnancy, full-term/preterm delivery, mode of delivery, premature rupture of membranes), inflammatory indicators levels such as C-reactive protein (CRP) and procalcitonin (PCT) were compared. Multivariate Logistic regression analysis was used to analyze the risk factors of elevated SF in early-onset sepsis. The changes of inflammatory indexes and their predictive value in the groups of newborns were compared by the ROC curves of CRP and PCT to predict ferritin level.

Results

There were no significant differences in sex, abnormal fetal heart or asphyxia, anemia in late pregnancy, age of onset and age of pregnant mother between the two groups (all P > 0.05). But the delivery mode (χ2 = 13.799, P < 0.001), full-term/preterm delivery (χ2 = 10.717, P = 0.001) and premature rupture of membranes (χ2 = 10.639, P = 0.001) were significantly different between the two groups. The levels of CRP [(5.43 ± 4.75) mg/L] and PCT [(5.85 ± 3.56) ng/ml] of neonates in SF normal group were significantly lower than those of SF elevated group [CRP: (13.79 ± 4.36) mg/L, PCT: (13.58 ± 7.42) ng/ml], with significant differences (t = 2.890, P = 0.006; t = 2.158, P = 0.034). Multivariate Logistic regression analysis showed that spontaneous delivery (OR = 5.16, P = 0.032), premature rupture of membranes (OR = 0.195, P = 0.038) and full-term (OR = 4.104, P = 0.041) were all independent risk factors for elevated SF in children with early-onset sepsis. The ROC curve of CRP and PCT to predict the increase of ferritin showed that: the best diagnostic cut-off point of CRP was > 10.4 mg/L, the sensitivity and specificity were 56.0% and 87.6%, respectively. The best diagnostic cut-off point of PCT was > 5.54 ng/ml, the sensitivity and specificity were 73.5% and 62.6%, respectively.

Conclusions

Early delivery, premature rupture of membranes and full-term were all independent risk factors for elevated SF in children with early-onset sepsis. Elevated SF could be used as an inflammatory marker to assist the diagnosis of early-onset sepsis.

Key words: Neonatal, Early onset sepsis, Serum ferritin, Inflammatory protein
表1 不同铁蛋白水平EOS患儿的一般资料
组别 例数 男/女（例） 足月/早产（例） 发病日龄（ ± s，h） 孕母年龄（ ± s，岁）
铁蛋白正常组 54 27/27 28/26 6.4 ± 5.6 29.0 ± 4.5
铁蛋白升高组 55 28/27 44/11 7.0 ± 4.5 28.4 ± 5.1
统计量 ? χ2 = 0.012 χ2 = 10.717 t = 0.298 t =－0.478
P值 ? 0.914 0.001 0.766 0.635
组别 例数 顺产/剖宫产（例） 胎膜早破（是/否，例） 胎心异常或窒息（无/有，例） 孕母晚期贫血（有/无，例）
铁蛋白正常组 54 19/35 34/20 30/24 40/14
铁蛋白升高组 55 36/19 28/27 37/18 42/13
统计量 ? χ2 = 13.799 χ2 = 10.631 χ2 = 1.636 χ2 = 0.036
P值 ? < 0.001 0.001 0.201 0.849
表2 EOS患儿铁蛋白升高的多因素Logistic回归分析
影响因素 β值 Wald值 P值 OR值 95%CI值
分娩方式 ? ? ? ? ?
? 顺产（36例） －1.654 4.673 0.032 5.16 1.154～22.112
? 剖宫产（19例） Ref
胎膜早破 ? ? ? ? ?
? 是（28例） －1.655 4.316 0.038 0.195 0.043～0.910
? 否（27例） Ref
早产 ? ? ? ? ?
? 否（11例） 1.415 3.259 0.041 4.104 1.158～18.110
? 是（44例） Ref
图1 CRP和PCT对铁蛋白水平升高预测的ROC曲线
表4 CRP和PCT对铁蛋白水平升高预测的ROC曲线参数
指标 曲线下面积 诊断最佳点 敏感性（%） 特异性（%）
CRP 0.697 > 10.4 mg/L 56.0 87.6
PCT 0.679 > 5.54 ng/ml 73.5 62.6
[1]
Shao J, Lou J, Rao R. Maternal serum ferritin concentration is positively associated with newborn iron stores in women with low ferritin status in late pregnancy[J]. J Nutr,2012,142(11):2004-2009.
[2]
Baier C, Pirr S, Ziesing S, et al. Prospective surveillance of bacterial colonization and primary sepsis: findings of a tertiary neonatal intensive and intermediate care unit[J]. J Hosp Infect,2019,7(3):325- 333.
[3]
中华医学会儿科学分会新生儿学组, 中国医师协会新生儿科医师分会感染专业委员会. 新生儿败血症诊断及治疗专家共识(2019年版)[J]. 中华儿科杂志,2019,57(4):252-257.
[4]
黄奕娟. 铁蛋白对军团菌肺炎诊断分析[J]. 中华医院感染学杂志,2014,6(24):1555-1557.
[5]
Meza J, Perry D, James S, et al. Ferritin and iron in pediatric infections in the emergency department: A pilot study[J]. J Pediat Inf Dis-Ger,2015,9(4):177-182.
[6]
Darveau M, Denault AY, Blais N, et al. Bench-to-bedside review: iron metabolism in critically ill patients [J]. Crit Care,2004,8(5):356-362.
[7]
曹芳芹, 刘黎明. 国内外住院新生儿疾病病种构成分析[J]. 中国妇幼健康研究,2015,3(26):664-665.
[8]
Wang XL, Wang J, Yuan L, et al. Trend and causes of neonatal mortality in a level III children’s hospital in Shanghai: a 15-year retrospective study [J]. World J Pediatr,2018,14(1):44-51.
[9]
Fleischmann-Struzek C, Goldfarb DM, Schlattmann P, et al. The global burden of paediatric and neonatal sepsis: a systematic review[J]. Lancet Respir Med,2018,6(3):223-230.
[10]
李长振, 饶菁菁, 黄水国, 等. 军团菌肺炎患儿铁蛋白水平变化及意义[J]. 广东医学2012,33(11):1571.
[11]
乔培修. 脓毒症儿童血清降钙素原,铁蛋白水平变化及相关分析[J]. 实用临床医药杂志,2014,11(18):70-72.
[12]
Suchdev PS, Williams AM, Mei Z, et al. Assessment of iron status in settings of inflammation: challenges and potential approaches[J]. Am J Clin Nutr,2017,106(Suppl 6):1626S-1633S.
[13]
Garcia PC, Longhi F, Branco RG, et al. Ferritin levels in children with severe sepsis and septic shock[J]. Acta paediatr,2007,96(12):1829- 1831.
[14]
Liu S, Hou Y, Cui H. Clinical values of the early detection of serum procalcitonin, C-reactive protein and white blood cells for neonates with infectious diseases[J]. Pak J Med Sci,2016,32(6):1326-1329.
[15]
许蔓, 春廖扬, 任广立, 等. 不同日龄降钙素原与C反应蛋白对新生儿早发型败血症的诊断价值[J]. 实用医学杂志,2017,22(33):3816-3818.
[16]
Walker O, Kenny CB, Goel N. Neonatal sepsis[J]. Paediatrics and Child Health,2019,29(6):263-268.
[17]
Eschborn S, Weitkamp JH. Procalcitonin versus C-reactive protein: review of kinetics and performance for diagnosis of neonatal sepsis[J]. J Perinatol,2019,39(7):893-903.
[18]
Kato S, Lindholm B, Yuzawa Y, et al. High ferritin level and malnutrition predict high risk of infection-related hospitalization in incident dialysis patients: A Japanese prospective cohort study[J]. Blood Purification,2016,42(1):56-63.
[19]
Pammi M, Haque KN. Pentoxifylline for treatment of sepsis and necrotizing enterocolitis in neonates[J]. Cochrane Database Syst Rev,2015,3:CD004205.
[20]
李裕昌. 早产与足月新生儿血清铁水平的比较及其与体质量的关系[J]. 广东医学院学报,2016,3(34):324-325.
[21]
Kell DB, Pretorius E. Serum ferritin is an important inflammatory disease marker, as it is mainly a leakage product from damaged cells[J]. Metallomics,2014,6(4):748-773.
[22]
Benzing J, Wellmann S, Achini F, et al. Plasma copeptin in preterm infants: a highly sensitive marker of fetal and neonatal stress[J]. J Clin Endocrinol Metab,2011,96(6):E982-E985.
[23]
Al-Lawama M, AlZaatreh A, Elrajabi R, et al. Prolonged rupture of membranes, neonatal outcomes and management guidelines[J]. J Clin Med Res,2019,11(5):360-366.
[24]
Abdel-Malek K, El-Halwagi MA, Hammad BE, et al. Role of maternal serum ferritin in prediction of preterm labour[J]. J Obstet Gynaecol,2018,38(2):222-225.
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