周炜 俞君 曾雪琪 季翠红

[摘要] 目的 探讨白介素-6（IL-6）和降钙素原（PCT）在预测低体重新生儿细菌感染性疾病中的价值，为预防和及时治疗新生儿感染提供依据。 方法 选取2015年3月—2017年3月上海市奉贤区中心医院儿科69例低出生体重新生儿为低出生体重新生儿组，选取同期产房分娩的正常新生儿30名为正常组。根据临床症状将低出生体重新生儿组分为疑似细菌感染亚组（17例）、败血症亚组（6例）及无感染亚组（46例）。检测正常组及低出生体重新生儿组入院后4 h内（入院后）白细胞（WBC）、中性粒细胞（Neu）、C反应蛋白（CRP）、PCT和IL-6水平;检测不同亚组间入院后WBC、Neu、CRP、PCT和IL-6水平及治愈后4 h内（治愈后）PCT和IL-6水平。ROC曲线检测低出生体重新生儿败血症的预测价值。 结果 低出生体重新生儿组入院后PCT水平高于正常组，IL-6水平低于正常组，差异均有统计学意义（均P < 0.05），两组WBC、Neu、CRP水平比较，差异无统计学意义（P > 0.05）。入院后，三亚组间PCT和IL-6水平比较，差异均有统计学意义（均P < 0.05）;但三亚组间WBC、Neu、CRP水平比较，差异无统计学意义（P > 0.05）。治愈后，三亚组间PCT和IL-6水平比较，差异无统计学意义（P > 0.05）。ROC曲线显示，PCT和IL-6预测低出生体重新生儿败血症的最佳临界值分别为2.15 ng/L和12.34 pg/mL时，敏感度均为83.3%，特异性分别为81.0%和71.4%;联合检测敏感度为87.3%，特异性为83.3%。 结论 PCT和IL-6检测及二者联合检测对低出生体重新生儿败血症预测均有一定准确性，其中联合检测价值最优。

[关键词] 白介素-6;降钙素原;低出生体重;新生儿;败血症

[中图分类号] R725.1          [文獻标识码] A          [文章编号] 1673-7210（2020）07（c）-0109-04

The value of interleukin-6 and procalcitonin to predict bacterial infection in low birth weight neonates

ZHOU Wei   YU Jun   ZENG Xueqi   JI Cuihong

Department of Pediatrics， South Hospital of Shanghai Sixth People′s Hospital  Fengxian District Central Hospital， Shanghai   201499， China

[Abstract] Objective To explore the value of interleukin-6 （IL-6） and procalcitonin （PCT） to predict bacterial infection in low birth weight neonates， and provide reference to prevent and timely treatment of neonatal infection. Methods From March 2015 to March 2017， 69 neonates with low birth weight in Department of Pediatrics， Fengxian District Central Hospital of Shanghai were selected as the low birth weight neonate group， and 30 normal neonates delivered in the delivery room during the same period were selected as the normal group. According to clinical symptoms， the low birth weight neonate group were divided into suspected bacterial infection subgroup （17 cases）， sepsis subgroup （6 cases） and non-infection subgroup （46 cases）. White blood cell （WBC）， neutrophil （Neu）， C-reactive protein （CRP）， PCT and IL-6 levels were measured in the normal group and the low birth weight neonate group within 4 h after admission （after admission）; WBC， Neu， CRP， PCT and IL-6 levels after admission and PCT and IL-6 levels within 4 h after treatment （after treatment） were measured between different subgroups. The predictive value of ROC curve in detecting low birth weight neonates sepsis. Results The levels of PCT and IL-6 in the low birth weight neonate group after admission were higher than those in the normal group， and the differences were statistically significant （all P < 0.05）. WBC， Neu and CRP levels of the two groups were not statistically significant （P > 0.05）. After admission， PCT and IL-6 levels were compared among three subgroups， and the differences were statistically significant （all P < 0.05）; while there were no significant differences in WBC， Neu and CRP levels among three subgroups （P > 0.05）. After treatment， there were no significant differences in PCT and IL-6 levels among three subgroups （P > 0.05）. ROC curve showed that the optimal critical values of PCT and IL-6 for predicting in low birth weight neonate sepsis were 2.15 ng/L and 12.34 pg/mL， sensitivity was all 83.3%， specificity were 81.0% and 71.4% respectively， and the sensitivity and specificity of the combined test were 87.3% and 83.3% respectively. Conclusion Both PCT and IL-6 test and their combined test have certain accuracy in predicting low birth weight neonate sepsis， among which combined test has the best value.

[Key words] Interleukin-6; Procalcitonin; Low birth weight; Neonate; Sepsis

新生儿免疫系统功能低下，出生后容易发生细菌感染性疾病，在院内和院外的发病率均较高[1]。新生儿病情进展迅速[2]，如未及时诊断治疗，易继发败血症，多器官功能受累[3]，病死率高。低出……