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目的探讨降钙素原(PCT)在诊断新生儿败血症中的价值。方法选择日龄0-28d新生儿分为三组:A组188例,日龄0-3d,非感染性新生儿,依据入院时龄分为六个亚组;B1组30例,日龄4-28d,诊断新生儿败血症;B2组30例,日龄4-28d,非感染性新生儿。采血以分别进行PCT、C反应蛋白(CRP)、血培养及血常规检测。结果 A组的非感染性新生儿在出生后24-36h血清PCT浓度达到高峰(1.27-2.94μg/L),48h后逐渐降至正常范围(0.24-0.41μg/L)。以PCT≥0.68μg/L作为新生儿败血症的诊断指标,其灵敏度、特异度、阳性预测值、阴性预测值、准确性、约登指数分别为90.0%、93.3%、93.1%、90.3%、91.7%、83.3%,优于CRP≥7.5mg/L的80.0%、86.7%、85.7%、81.3%、83.3%、66.7%。结论新生儿PCT浓度在出生后0-3d存在生理性高峰。PCT≥0.68μg/L对于诊断新生儿败血症具有较高的灵敏度和特异度。
Objective To investigate the value of procalcitonin (PCT) in the diagnosis of neonatal sepsis. Methods Neonates 0-28 days old were divided into three groups: group A 188 cases, day 0-3d, noninfectious newborns, according to age at admission were divided into six subgroups; B1 group 30 cases, day 4 -28d, diagnosis of neonatal sepsis; B2 group of 30 cases, 4-28 days of age, non-infectious neonates. Blood was collected for PCT, C-reactive protein (CRP), blood culture and blood tests. Results In non-infectious neonatal group A, the serum PCT concentration peaked at 24-36 h after birth (1.27-2.94 μg / L) and gradually decreased to the normal range (0.24-0.41 μg / L) after 48 h. The sensitivity, specificity, positive predictive value, negative predictive value, accuracy and Youden index of PCT≥0.68μg / L were 90.0%, 93.3%, 93.1%, 90.3% and 91.7 %, 83.3%, better than 80.0%, 86.7%, 85.7%, 81.3%, 83.3%, 66.7% of CRP≥7.5mg / L. Conclusions The neonatal PCT concentration has a physiological peak at 0-3d after birth. PCT ≥ 0.68μg / L for the diagnosis of neonatal sepsis with high sensitivity and specificity.