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目的探讨超敏C反应蛋白(hs-CRP)在新生儿败血症诊断中的价值。方法选取2010年10月至2011年10月重庆医科大学附属儿童医院收治的确诊败血症新生儿81例、临床诊断败血症新生儿152例和非败血症新生儿103例,比较三组间hs-CRP浓度;以血培养为金标准,通过绘制ROC工作曲线,确定hs-CRP诊断新生儿败血症的最佳诊断界值点;同时对比分析hs-CRP、传统C-反应蛋白(CRP)、白细胞(WBC)计数、未成熟中性粒细胞与中性粒细胞总数比值(I/T)及血小板(PLT)计数在新生儿败血症诊断的灵敏度、特异度等。结果确诊新生儿败血症组、临床诊断新生儿败血症组及非败血症组hs-CRP中位数分别为15.0、11.0和1.0mg/L;hs-CRP诊断新生儿败血症的ROC曲线下面积为0.851,最佳诊断界值点为3.0mg/L;hs-CRP、CRP、WBC、I/T、PLT诊断新生儿确诊败血症组与非败血症组的阳性率比较差异有统计学意义(P<0.05);其灵敏度分别为90.1%、42.0%、34.6%、16.0%和22.2%,特异度为66.0%、95.1%、87.4%、95.1%和97.1%。结论 hs-CRP是一项诊断新生儿败血症的理想的初筛项目。
Objective To investigate the value of hs-CRP in the diagnosis of neonatal sepsis. Methods Totally 81 neonates with confirmed sepsis, 152 neonates with clinical diagnosis of sepsis and 103 neonates with non-sepsis were selected from Children’s Hospital of Chongqing Medical University from October 2010 to October 2011. The concentrations of hs-CRP in the three groups were compared. Using blood culture as the gold standard, the optimal diagnostic cut-off point of hs-CRP in diagnosing neonatal sepsis was determined by plotting ROC working curve. Meanwhile, hs-CRP, C-reactive protein , Immature neutrophil and neutrophil ratio (I / T) and platelet count (PLT) in the diagnosis of neonatal sepsis sensitivity, specificity and so on. Results The median hs-CRP was 15.0, 11.0 and 1.0 mg / L in the neonatal sepsis group, neonatal sepsis group and non-sepsis group respectively. The area under the ROC curve of hs-CRP in diagnosing neonatal sepsis was 0.851 The diagnostic cutoff value of good diagnosis was 3.0mg / L. The positive rates of hs-CRP, CRP, WBC, I / T and PLT in diagnosing neonatal sepsis and non-sepsis were significantly different (P <0.05) Sensitivity were 90.1%, 42.0%, 34.6%, 16.0% and 22.2%, specificity was 66.0%, 95.1%, 87.4%, 95.1% and 97.1% respectively. Conclusion hs-CRP is an ideal screening project for the diagnosis of neonatal sepsis.