摘要
目的了解组织因子途径抑制物（TFPI）、前降钙素（PCT）在新生儿败血症诊断中的价值。方法通过检测48例败血症新生儿及30例健康新生儿血TFPI、PCT、C-反应蛋白（CRP）浓度，比较各炎症指标对诊断败血症的灵敏度、特异度、阳性预测值、阴性预测值和约登指数，评价它们对该病的早期诊断价值。结果（1）以TFPI≥30μg／L、CRP≥8mg／L、PCT〉12ng／ml为阳性标准，三指标对诊断败血症的灵敏度分别为86．92％、89．83％、87．50％，差异无显著性（P〉0．05），其中PCT的特异度96．67％、阳性预测值97．50％、阴性预测值83．32％、约登指数0．84；（2）在败血症组中，20例血培养阳性患儿的TFPI值为（35．5±4．5）μg/L，28例血培养阴性患儿的耵甲I值为（34．3±3．2）μg/L，差异无显著性（P〉0．05）；但是相对于正常对照组（26．9±5．24）μg/L，败血症组的TFPI值明显升高（P〈0．05）。结论TFPI≥30μg/L对诊断新生儿败血症是一个具有较高灵敏度（86．92％）、中度特异度（59．3％）的指标；TFPI对新生儿败血症早期诊断有一定的价值，但均不及PCT及CRP，所有检测指标中PCT特异度、阳性预测值、阴性预测值、约登指数均最高。
Objective Neonatal septicemia is a critical disease in neonatal period. The early signs of septicemia in the newborn are generally nonspecific. Blood culture and the other clinical diagnostic measures are not sufficiently sensitive. The present study aimed at evaluating potential use of tissue factor pathway inhibitor （ TFPI ）, procalcitonin （PCT） and C-reactive protein （ CRP ） in diagnosis of neonatal septicemia. Methods Fourty-eight newborn infants with septicemia enrolled the study. Twenty of the 48 cases had positive blood culture. The control group included 30 healthy newborns. Fasting blood samples were taken for bacterial cultures and TFPI、CRP、PCT determination. The sensitivity,specificity,positive and negative predictive values,Youden＇s index for TFPI,PCT and CRP were calculated. These values were compared with each other. Results （ 1 ） There were significant differences among the three groups in the contents of TFPI, CRP and PCT （ P 〈 0. 05 ）. These markers were considered positive if TFPI ≥ 30 μg/L , CRP ≥ 8 mg/L, PCT ≥ 2ng/ml. Among these indices, PCT had the highest specificity （96. 67%）, positive predictive value （97. 50% ）,negative predictive value （83.32%）, and Youden＇s index （0. 84）. （2） In the whole group of newborns with septicemia,the TFPI was （35.5 ±4. 5） μg/L in the 20 newborns who had positive blood culture, and the TFPI was （ 34. 3 ± 3.2 ） μg/L in those who had negative blood culture. There was no significant difference between them （ P 〉 0. 05 ）, but comparing with the normal control group （ 26. 9 ± 5.24 ） μg/L, the TFPI level in newborns with septicemia was significantly increased. Conclusion The level of TFPI is related with neonatal septicemia. TFPI concentration（ TFPI ≥30 μg/L） may be used as a diagnostic tool with high sensitivity（86. 92% ） and moderate specificity（59. 3% ） in neonates suspected of infection. Among these indices ,PCT has the highest specificity ,positive predictive ,negative predictive values and Youden＇s index.
出处
《中国小儿急救医学》
CAS
2009年第2期125-127,130,共4页
Chinese Pediatric Emergency Medicine
