降钙素原与C反应蛋白作为胎膜早破早产胎儿感染的早期指标比较

Procalcitonin versus CRP as an early indicator of fetal infection in preterm premature rupture of membranes.

作者信息

Canpolat Fuat Emre, Yiğit Sule, Korkmaz Ayşe, Yurdakök Murat, Tekinalp Gülsevin

机构信息

Neonatology Unit, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey.

出版信息

Turk J Pediatr. 2011 Mar-Apr;53(2):180-6.

PMID:21853656

Abstract

The aim of this study was to examine the diagnostic sensitivity and specificity of C-reactive protein (CRP) and procalcitonin (PCT) in neonates who were born after preterm premature rupture of membranes (PPROM) and compare these with interleukin-6 (IL-6). The study involved 74 preterm neonates who were born after PPROM. IL-6, CRP, complete blood count and leukocyte ratios, and PCT levels were measured in the 1st day of life, and CRP, PCT, and blood counts were repeated on the 3rd day of life. Seventy-four infants with PPROM were divided into two groups according to the development of sepsis and infection (Group 1: sepsis, n = 32; Group 2: no sepsis, n = 42). There were no significant differences between these groups with respect to gestational age, birthweight and duration of membrane rupture. There were significant differences between the two groups in the 1st day CRP (Group 1: 0.85 -/+ 1.36 mg/dl, Group 2: 0.23 +/- 0.25 mg/dl; p = 0.016), 1st day PCT (Group 1: 7.2 +/- 7.6 ng/ml, Group 2, 1.6 +/- 4.0 ng/ml; p < 0.001), and 3rd day PCT (Group 1: 9.01 +/-11.5 ng/ml, Group 2: 1.34 +/- 1.35 ng/ml; p = 0.001) and IL-6 (Group 1: 80.7 +/- 67.2 pg/ml, Group 2: 3.4 +/- 3.5 ng/ml; p < 0.001) levels. CRP levels were not significantly different between Group 1 (1.2 +/- 1.7 mg/dl) and Group 2 (0.58 +/- 1.1 mg/dl) on the 3rd day of life (p=0.059). CRP levels on the 1st day of life had a cut-off value of 0.72 mg/dl with a sensitivity and specificity of 56% and 58%, respectively. CRP levels on the 3rd day had a cut-off level of 0.78 mg/dl with 60% sensitivity and 63% specificity. PCT levels had a cut-off level of 1.74 ng/ml with 76% sensitivity and 85% specificity on the 1st day of life, and of 1.8 with 89% sensitivity and 86% specificity on the 3rd day of life. Statistical analysis revealed that the cut-off value of 7.6 pg/ml for IL-6 had a 93% sensitivity and 96.7% specificity. Interleukin (IL)-6 is the most reliable marker for the detection of early-onset sepsis in preterm neonates with PPROM. Early PCT levels seemed to be more sensitive than early CRP in this population.

摘要

本研究旨在检测胎膜早破（PPROM）后出生的新生儿中C反应蛋白（CRP）和降钙素原（PCT）的诊断敏感性和特异性，并将其与白细胞介素-6（IL-6）进行比较。该研究纳入了74例PPROM后出生的早产儿。在出生第1天测量IL-6、CRP、全血细胞计数及白细胞分类计数和PCT水平，并在出生第3天重复测量CRP、PCT和血细胞计数。74例PPROM患儿根据败血症和感染的发生情况分为两组（第1组：败血症，n = 32；第2组：无败血症，n = 42）。两组在胎龄、出生体重和胎膜破裂持续时间方面无显著差异。两组在出生第1天的CRP（第1组：0.85±1.36mg/dl，第2组：0.23±0.25mg/dl；p = 0.016）、出生第1天的PCT（第1组：7.2±7.6ng/ml，第2组：1.6±4.0ng/ml；p<0.001）、出生第3天的PCT（第1组：9.01±11.5ng/ml，第2组：1.34±1.35ng/ml；p = 0.001）和IL-6（第1组：80.7±67.2pg/ml，第2组：3.4±3.5ng/ml；p<0.001）水平存在显著差异。出生第3天，第1组（1.2±1.7mg/dl）和第2组（0.58±1.1mg/dl）的CRP水平无显著差异（p = 0.059）。出生第1天CRP水平的临界值为0.72mg/dl，敏感性和特异性分别为56%和58%。出生第3天CRP水平的临界值为0.78mg/dl，敏感性为60%，特异性为63%。出生第1天PCT水平的临界值为1.74ng/ml，敏感性为76%，特异性为85%；出生第3天PCT水平的临界值为1.8，敏感性为89%，特异性为86%。统计分析显示，IL-6的临界值为7.6pg/ml时，敏感性为93%，特异性为96.7%。白细胞介素（IL）-6是检测PPROM早产儿早发性败血症最可靠的标志物。在这一人群中，早期PCT水平似乎比早期CRP更敏感。