探讨铁蛋白（SF）在新生儿早发型败血症诊断中的临床意义。

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。

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%。

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。

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

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.

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.

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.