摘要目的 分析降钙素原、红细胞分布宽度(red blood cell distribution width, RDW)在败血症早产儿中的变化,探讨两者对早产儿败血症病情严重程度及预后评估的价值. 方法 回顾性分析2014年12月1日至2018年12月1日在安徽医科大学第一附属医院收治的96例确诊为败血症早产儿的病历资料,根据病情严重程度及参照新生儿休克评分,分为重症组(临床病情较重,合并休克,休克评分＞6分,42例)和轻症组(临床病情较轻微,未合并休克或休克评分≤6分, 54例);根据败血症患儿治疗3 d后是否死亡,分为病死组(10例)和存活组(86例).分别于治疗前、治疗后第1及第3日采集外周静脉血检测降钙素原、RDW,比较两者在不同严重程度败血症早产儿中的动态变化.采用Mann-Whitney U检验、Wilcoxon符号秩和检验、Friedman检验以及受试者工作特征曲线对数据进行统计学分析. 结果 (1)治疗前、治疗后第1及第3日,重症组降钙素原均高于轻症组[分别为3.7(0.4～37.3)与1.4(0.2～5.0) ng/ml,43.1(18.7～83.0)与17.1(4.1～34.6) ng/ml,26.1(3.8～67.3)与4.8(0.3～32.9) ng/ml,Z值分别为－2.017、－3.350及－2.932,P值均＜0.05];2组中治疗后第1日的降钙素原高于治疗前、治疗后第3日,且治疗后第3日均高于治疗前(P值均＜0.05).治疗后第1及第3日,重症组RDW均高于轻症组[ 分别为 16.5%(16.2%～18.6%)与 16.3%(15.5%～17.3%),16.1%(15.5%～19.4%)与 15.7% (15.1%～16.5%),Z值分别为－1.992和－2.165,P值均＜0.05];2组中治疗后第1日的RDW均高于治疗前、治疗后第3日,轻症组中治疗后第3日RDW低于治疗前,但重症组第3日高于治疗前(P值均＜0.05).(2)治疗后第1及第3日,病死组降钙素原、RDW均高于存活组[降钙素原:分别为162.0(62.9～187.2)与19.9(4.3～46.1) ng/ml,122.6(65.0～180.8)与6.2(0.5～32.9) ng/ml,Z值分别为－4.114和－4.594;RDW:分别为18.4%(16.9%～21.2%)与16.3% (15.7%～17.2%),21.8%(20.6%～22.2%)与 15.8%(15.2%～16.5%),Z 值分别为－ 3.307 和－4.831;P值均＜0.05].2组中治疗后第1日降钙素原均高于治疗前及治疗后第3日,而治疗后第3日均高于治疗前(P值均＜0.05);病死组中治疗后第1及第3日RDW均高于治疗前,且治疗后第3日高于第1日;而存活组中治疗后第1日RDW高于治疗前,但治疗后第3日低于治疗前及治疗后第1日(P值均＜0.05).(3)治疗前、治疗后第1及第3日降钙素原对早产儿重症败血症的预测界值分别为3.475、29.765及3.460 ng/ml,灵敏度和特异度分别为54.8%和75.9%、69.0%和72.2%、83.3%和46.3%;治疗后第1及第3日降钙素原对败血症早产儿发生死亡的预测界值分别为40.595、64.855 ng/ml,特异度分别为73.3%、87.2%,灵敏度均为100.0%.治疗后第1及第3日的RDW,对早产儿重症败血症的预测界值分别为15.650%和18.300%,灵敏度和特异度分别为95.2%和29.6%、33.3%和92.6%;对发生死亡的预测界值分别为16.650%和18.450%,灵敏度和特异度分别为100.0%和68.6%、100.0%和91.9%. 结论 动态监测降钙素原、RDW水平变化可有助于早产儿重症败血症的早期诊断,对早产儿败血症病情严重程度及预后评估具有一定价值.

abstractsObjective To analyze the variations of procalcitionin (PCT) and red blood cell distribution width (RDW) in premature infants with septicemia and to investigate their values in evaluating the severity and prognosis of septicemia. Methods A retrospective study was conducted to analyze the medical records of 96 premature infants diagnosed with septicemia and admitted to the First Affiliated Hospital of Anhui Medical University from December 1, 2014 to December 1, 2018. According to the severity of the disease and neonatal shock score, there were 42 cases selected to the severe septicemia group (severe clinical condition with shock, shock score >6 points) and 54 in the mild septicemia group (mild clinical condition without shock or shock score ≤6 points). Moreover, after three days' treatment, they were divided into two groups: death group (n=10) and survival group (n=86, survived during hospitalization). Peripheral venous blood samples were collected before and on the first and third day after treatment to detect PCT and RDW. Dynamic changes of the two indexes were compared between different groups. Mann-Whitney U test, Wilcoxon rank sum test, Friedman test or receiver operating characteristic (ROC) curve was used for statistical analysis. Results (1) Before and on the first and third day after treatment, the severe septicemia group had a higher level of PCT than the mild group [3.7 (0.4-37.3) vs 1.4 (0.2-5.0) ng/ml, 43.1 (18.7-83.0) vs 17.1 (4.1-34.6) ng/ml, 26.1 (3.8-67.3) vs 4.8 (0.3-32.9) ng/ml; Z= － 2.017, － 3.350 and － 2.932; all P<0.05]. In both groups, PCT level on the first day after treatment was the highest, and that on the third day after treatment was higher than that before treatment (all P<0.05). On the first and third day after treatment, RDW in the severe group was higher than that in the mild group [16.5% (16.2%-18.6%) vs 16.3% (15.5%-17.3%), 16.1% (15.5%-19.4%) vs 15.7% (15.1%-16.5%);Z= － 1.992 and － 2.165; both P<0.05]. In the severe and mild groups, RDW on the first day after treatment was higher than that before and on the third day after treatment; in the mild group, RDW on the third day after treatment was lower than that before treatment, while in the severe group, RDW on the third day after treatment was higher than that before treatment (all P<0.05). (2) On the first and third day after treatment, PCT and RDW in the death group were higher than those in the survival group [PCT: 162.0 (62.9-187.2) vs 19.9 (4.3-46.1) ng/ml, 122.6 (65.0-180.8) vs 6.2 (0.5-32.9) ng/ml; Z= － 4.114 and － 4.594; RDW: 18.4% (16.9%-21.2%) vs 16.3% (15.7%-17.2%), 21.8% (20.6%-22.2%) vs 15.8% (15.2%-16.5%); Z=－3.307 and －4.831;all P<0.05]. In both groups, PCT on the first day after treatment was higher than that before and on the third day after treatment, and the level on the third day after treatment was higher than that before treatment (all P<0.05). In the death group, RDW on the first and third day after treatment were higher than that before treatment, and RDW on the third day after treatment was higher than that on the first day; in the survival group, RDW on the first day after treatment was higher than that before treatment, but on the third day after treatment, it was lower than that before and on the first day after treatment (all P<0.05). (3) The cut-off values of PCT for predicting severe septicemia in premature infants before and on the first and third day after treatment were 3.475, 29.765 and 3.460 ng/ml, respectively, and the sensitivity and specificity were 54.8% and 75.9%, 69.0% and 72.2%, and 83.3% and 46.3%, respectively. The cut-off values of PCT for predicting the death of premature infants with septicemia on the first and third day after treatment were 40.595 and 64.855 ng/ml, respectively, with the specificity of 73.3% and 87.2% and sensitivity of both 100.0%. The predictive thresholds of RDW for severe septicemia on the first and third day after treatment were 15.650% and 18.300%, respectively, and the sensitivity and specificity were 95.2% and 29.6%, 33.3% and 92.6%, respectively. The predictive thresholds for death were 16.650% and 18.450%, and the sensitivity and specificity were 100.0% and 68.6%, 100.0% and 91.9%, respectively. Conclusions Dynamic monitoring of PCT and RDW levels may help with early diagnosis, determination of severity and prognosis prediction of severe septicemia in premature infants.