用于早发型新生儿败血症早期检测的血清生物标志物：一项单中心前瞻性研究
Serum Biomarkers for the Early Detection of the Early-Onset Neonatal Sepsis: A Single-Center Prospective Study.
作者信息
Ahmed Ali Mahmoud, Mohammed Abdelrahman Tarek, Bastawy Samah, Attalla Hams Ahmed, Yousef Aly Abdelrahman, Abdelrazek MennatAllah Sayed, Fransawy Alkomos Mina, Ghareeb Ahmed
机构信息
Faculty of Medicine, Al-Azhar University, Cairo, Egypt (Messrs Ahmed and Tarek Mohammed); Departments of Clinical Pathology (Dr Bastawy) and Pediatrics and Neonatology (Drs Attalla and Yousef), Faculty of Medicine, Helwan University, Helwan, Cairo, Egypt; Faculty of Medicine, Misr University for Science & Technology, Giza, Egypt (Ms Abdelrazek); Internal Medicine Department, Saint Joseph University Medical Center, Paterson, NJ, USA (Mr. Fransawy Alkomos); and Neuromuscular Research Unit, Neurology and Neuropsychiatry Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt (Mr Ghareeb).
出版信息
Adv Neonatal Care. 2019 Oct;19(5):E26-E32. doi: 10.1097/ANC.0000000000000631.
BACKGROUND
Reducing the hazards of the early-onset neonatal sepsis (EONS) is a priority justifying the further investigation for potential biomarkers for its early diagnosis.
PURPOSE
We aimed to investigate the diagnostic value of presepsin, procalcitonin, lactoferrin, interleukin (IL)-6, and IL-8 for the early diagnosis of EONS.
METHODS
A prospective comparative study, including 30 cases with highly suspected EONS and 30 matched controls, was conducted. Besides the complete blood count and blood culture, C-reactive protein, procalcitonin, presepsin, IL-6, IL-8, and lactoferrin were measured at the admission and after 72 hours.
RESULTS
At the time of the admission, presepsin, procalcitonin, C-reactive protein, and IL-8 were significantly higher in the sepsis group. The levels of presepsin, procalcitonin, and IL-8 significantly decreased after 72 hours of the admission. Presepsin, procalcitonin, IL-8, and IL-6 showed a high diagnostic ability for sepsis at admission with area under the curve of 0.934, 0.798, 0.775, and 0.751, respectively. The cutoff values of presepsin, procalcitonin, IL-8, and IL-6 were 821 pg/mL, 2.3 ng/mL, 54 pg/mL, and 24 pg/mL, with a sensitivity of 88.9%, 72.2%, 83.3%, and 94.4% and specificity of 85.7%, 80.9%, 71.4%, and 52.4%, respectively. Lactoferrin had the lowest diagnostic ability with area under the curve of 0.558.
IMPLICATIONS FOR PRACTICE
Presepsin was the most accurate biomarker followed by procalcitonin, IL-8, and IL-6 regarding the early diagnosis and management of EONS. The combination between these biomarkers is highly recommended.
IMPLICATIONS FOR RESEARCH
Further studies are needed to investigate the diagnostic ability of the combination of these biomarkers.
背景
降低早发型新生儿败血症（EONS）的危害是一项优先任务，这证明有必要进一步研究其早期诊断的潜在生物标志物。
目的
我们旨在研究降钙素原、前降钙素、乳铁蛋白、白细胞介素（IL）-6和IL-8对EONS早期诊断的价值。
方法
进行了一项前瞻性对照研究，纳入30例高度怀疑患有EONS的病例和30例匹配的对照。除全血细胞计数和血培养外，在入院时和72小时后检测C反应蛋白、前降钙素、降钙素原、IL-6、IL-8和乳铁蛋白。
结果
入院时，败血症组的降钙素原、前降钙素、C反应蛋白和IL-8显著更高。入院72小时后，降钙素原、前降钙素和IL-8水平显著下降。降钙素原、前降钙素、IL-8和IL-6在入院时对败血症显示出较高的诊断能力，曲线下面积分别为0.934、0.798、0.775和0.751。降钙素原、前降钙素、IL-8和IL-6的临界值分别为821 pg/mL、2.3 ng/mL、54 pg/mL和24 pg/mL，敏感性分别为88.9%、72.2%、83.3%和94.4%，特异性分别为85.7%、80.9%、71.4%和52.4%。乳铁蛋白的诊断能力最低，曲线下面积为0.558。
对实践的启示
就EONS的早期诊断和管理而言，降钙素原是最准确的生物标志物，其次是前降钙素、IL-8和IL-6。强烈建议联合使用这些生物标志物。
对研究的启示
需要进一步研究来调查这些生物标志物联合使用的诊断能力。
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