彭锐军 温庆辉

【摘要】 目的：探究血清降鈣素原（PCT）、血清淀粉样蛋白A（SAA）及中性粒细胞CD64检测诊断新生儿败血症的临床价值及与患儿心肌损伤的关系。方法：选取2018年7月-2020年7月在本院就诊的新生儿败血症150例设为A组，同时选取本院100例非感染新生儿设为B组，选取本院健康新生儿100例设为C组。A组、B组治疗前及C组新生儿体检时对血清PCT、SAA、CD64及心肌损伤标志分子进行检测，分析PCT、SAA、CD64单独诊断和联合诊断新生儿败血症的价值;对A组患儿进行血培养，分析细菌感染类型、心肌损伤标志分子与PCT、SAA、CD64的关系。结果：A组、B组血清PCT、SAA、CD64及心肌肌钙蛋白I（cTnI）、心肌肌钙蛋白T（cTnT）均明显高于C组（P<0.05），且A组均明显高于B组（P<0.05）。血清PCT、SAA、CD64联合诊断的敏感度、特异度、阳性预测值、阴性预测值均明显高于三项指标单独诊断（P<0.05）。A组经血培养分离出革兰阴性菌89株，革兰阳性菌61株，革兰阴性菌感染患儿血清PCT、CD64水平均明显高于革兰阳性菌感染患儿（P<0.05），两者SAA水平比较差异无统计学意义（P>0.05）。A组血清PCT、SAA、CD64与cTnI、cTnT水平均呈正相关（P<0.05）。结论：新生儿败血症患儿血清PCT、SAA、CD64水平均明显高于健康儿童及非感染新生儿，三者联合检测对新生儿败血症有较高诊断价值，且对患儿细菌感染类型有一定鉴别作用，可反映患儿心肌损伤程度，对临床诊断及判断病情变化有重要意义。

【关键词】 新生儿败血症 降钙素原 血清淀粉样蛋白A CD64 心肌损伤

[Abstract] Objective： To explore the clinical value of serum procalcitonin （PCT）， serum amyloid protein A （SAA） and neutrophil CD64 in the diagnosis of neonatal septicemia and their relationship with myocardial injury. Method： From July 2018 to July 2020， 150 cases of neonatal septicemia in our hospital were selected as group A， 100 cases of non infected newborns in our hospital were selected as group B， and 100 cases of healthy newborns in our hospital were selected as group C. Serum PCT， SAA， CD64 and myocardial injury markers were detected before treatment in group A and group B and at the time of physical examination in group C. The value of PCT， SAA and CD64 in the diagnosis of neonatal septicemia was analyzed. Blood culture was performed in group A to analyze the relationship between bacterial infection types， myocardial injury markers and PCT， SAA and CD64. Result： Serum PCT， SAA， CD64， cTnI and cTnT in group A and B were significantly higher than those in group C （P<0.05）， and those in group A were significantly higher than those in group B （P<0.05）. The sensitivity， specificity， positive predictive value and negative predictive value of combined diagnosis of serum PCT， SAA and CD64 were significantly higher than those of single diagnosis （P<0.05）. In group A， 89 strains of Gram-negative bacteria were isolated by blood culture， and 61 strains were gram positive. The serum PCT and CD64 levels of children with gram-negative bacteria infection were significantly higher than those of children with Gram-positive bacteria infection （P<0.05）， but the SAA level was not statistically significant （P>0.05）. Serum PCT， SAA， CD64 were positively correlated with cTnI and cTnT levels in group A （P<0.05）. Conclusion： The levels of serum PCT， SAA and CD64 in neonatal septicemia are significantly higher than those in healthy children and non infected newborns. The combined detection of PCT， SAA and CD64 has a high diagnostic value for neonatal septicemia， and has a certain differential effect on the types of bacterial infection in children， which can reflect the degree of myocardial injury in children， and has important significance for clinical diagnosis and judgment of disease changes.

[Key words] Neonatal septicemia Procalcitonin Serum amyloid protein A CD64 Myocardial injury

First-authors address： Dongguan City Changan Hospital， Dongguan 523843， China

doi：10.3969/j.issn.1674-4985.2021.06.005

新生儿败血症主要是因新生儿期细菌通过血液进入全身的血液循环以后，在全身繁殖并产生毒素，导致新生儿多血管功能及心肌损伤[1]，并可能累及循环系统、消化系统、血液系统，引起各种炎症反应，甚至危及患儿生命[2]。由于新生儿败血症前期没有特别明显临床症状不易察觉，血培养检查是诊断新生儿败血症的金标准，但其培养过程所耗时间过长，且阳性率较低，会延误病情治疗时机[3]。近年来不少研究正在探索新的诊断标准，有研究指出生物标记物在诊断新生儿败血症中应用越来越广泛，且操作过程方便快捷，阳性率较高，有助于患儿的及早诊断[4]，血清降钙素原（PCT）在正常人的血浆中浓度很低一般小于0.5 ng/mL，如机体发生了严重的细菌感染、脓毒血症，这时该指标迅速升高，而且其升高程度与炎症严重程度呈正相关，在急性感染后的2 h即可在血浆中检测到[5]。……