颗粒蛋白前体作为早期新生儿败血症诊断的新型生物标志物。

Progranulin as a novel biomarker in diagnosis of early-onset neonatal sepsis.

机构信息

Department of Clinical Laboratory, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation base of Child development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, PR China; Chongqing Key Laboratory of Pediatrics. Chongqing, China.

出版信息

Cytokine. 2020 Apr;128:155000. doi: 10.1016/j.cyto.2020.155000. Epub 2020 Jan 23.

DOI:10.1016/j.cyto.2020.155000

PMID:31982701

Abstract

BACKGROUND

Infections are leading causes of morbidity and mortality in neonates and may also have severe long-term consequences. As early diagnosis of neonatal sepsis improves prognosis, identification of new or complementary biomarkers is of great importance. In this study, we have evaluated the diagnostic value of progranulin (PGRN) in early-onset neonatal sepsis (EOS) and compare its effectiveness with other commonly used biomarkers, such as procalcitonin (PCT) and C-reactive protein (CRP).

METHODS

A total of 121 infants with gestational age of >34 weeks admitted with suspected EOS were included in this study. Before initiating therapy, blood samples for whole blood count, CRP, PCT and PGRN were obtained from all neonates. Receiver-operating characteristic (ROC) curve and multivariate logistic regression analyses were performed.

RESULTS

Serum PGRN level of infected group was significantly higher than uninfected group (median 47.72 vs. 37.86 ng/ml, respectively; Mann-Whitney p < 0.0001). The ROC area under the curve (AUC) was 0.786 [95% confidence interval (CI) 0.706-0.867; p < 0.0001] for PGRN, 0.699 (95% CI 0.601-0.797; p = 0.0001) for age adjusted PCT, and 0.673 (95% CI 0.573-0.773; p = 0.0007) for CRP. With a cut-off value of 37.89 ng/ml, the diagnostic sensitivity and negative predictive value of PGRN were 94.34% and 91.7%, respectively. PGRN could significantly predict EOS independently of PCT (p < 0.0001), and the combined use of PGRN and PCT could significantly improve diagnostic performance for EOS (0.806; 95% CI 0.73-0.88; p < 0.0001), with a specificity of 89.06% and a positive predictive value of 81.10%.

CONCLUSIONS

PGRN may be used as a promising biomarker for the diagnosis of EOS, and the combined use of PGRN and PCT could improve the diagnosis of sepsis.

摘要

背景

感染是导致新生儿发病和死亡的主要原因，并且可能会导致严重的长期后果。由于早期诊断新生儿败血症可改善预后，因此寻找新的或补充的生物标志物非常重要。在这项研究中，我们评估了颗粒蛋白前体（PGRN）在早发性新生儿败血症（EOS）中的诊断价值，并将其与其他常用的生物标志物（如降钙素原（PCT）和 C 反应蛋白（CRP））进行了比较。

方法

本研究共纳入了 121 名胎龄>34 周的疑似 EOS 患儿。在开始治疗前，所有新生儿均采集全血细胞计数、CRP、PCT 和 PGRN 的血样。进行了受试者工作特征（ROC）曲线和多变量逻辑回归分析。

结果

感染组的血清 PGRN 水平明显高于未感染组（中位数分别为 47.72 和 37.86 ng/ml；Mann-Whitney p <0.0001）。PGRN 的 ROC 曲线下面积（AUC）为 0.786 [95%置信区间（CI）0.706-0.867；p <0.0001]，年龄校正的 PCT 为 0.699（95%CI 0.601-0.797；p = 0.0001），CRP 为 0.673（95%CI 0.573-0.773；p = 0.0007）。当截断值为 37.89 ng/ml 时，PGRN 的诊断敏感性和阴性预测值分别为 94.34%和 91.7%。PGRN 可独立于 PCT 显著预测 EOS（p <0.0001），PGRN 和 PCT 的联合使用可显著提高 EOS 的诊断效能（0.806；95%CI 0.73-0.88；p <0.0001），特异性为 89.06%，阳性预测值为 81.10%。