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目的探讨血清IL-8和CRP联合测定对诊断新生儿细菌感染及减少抗生素应用的意义。方法收集出生体质量>1 500 g的新生儿150例,按有无感染分为临床感染组、可疑感染组和对照组,每组各50例。各组患儿入院后均立即采集静脉血2.0 mL,进行血清IL-8、CRP、血常规等检查。临床感染组、可疑感染组在抗生素应用1个疗程(7 d)后,再行血清IL-8、CRP、血常规等检查,以决定是否继续应用抗生素,如需要,则继续应用抗生素7 d后,再行血清IL-8、CRP、血常规等检查,直至痊愈或出院。结果治疗前IL-8、CRP水平临床感染组、可疑感染组显著高于对照组(Pa<0.01),临床感染组显著高于可疑感染组(Pa<0.01);临床感染组治疗7 d、14 d及可疑感染组治疗7 d血清IL-8、CRP水平显著低于治疗前(Pa=0.000)。临床感染组治疗14 d后根据经验使用抗生素率较根据IL-8≥70 ng·L-1和(或)CRP>10 mg·L-1使用抗生素率高出20%,差异有统计学意义(P=0.035);可疑感染组治疗7 d后根据抗生素应用指征使用抗生素率较根据IL-8≥70 ng·L-1和(或)CRP>10 mg·L-1使用抗生素率高出22%,差异有统计学意义(P=0.023)。结论联合测定血清IL-8和CRP水平可早期诊断新生儿感染,以IL-8≥70 ng·L-1和(或)CRP>10 mg·L-1作为诊断新生儿细菌感染的最佳临界值,可减少新生儿不必要的抗生素应用。
Objective To investigate the significance of combined detection of serum IL-8 and CRP in the diagnosis of neonatal bacterial infection and the reduction of antibiotics. Methods 150 cases of newborns with birth mass> 1 500 g were collected and divided into clinical infection group, suspicious infection group and control group according to their presence or absence of infection, with 50 cases in each group. Venous blood 2.0 mL was collected immediately after admission in each group, and serum IL-8, CRP and blood routine examination were performed. In the clinical infection group and the suspicious infection group, after one course of antibiotics application (7 days), the serum IL-8, CRP, blood routine examination and other tests were conducted to decide whether to continue the antibiotics treatment. If necessary, continue the antibiotics treatment for 7 days , Then serum IL-8, CRP, blood tests, etc., until cured or discharged. Results Before treatment, the levels of IL-8 and CRP in clinical infection group and suspicious infection group were significantly higher than those in control group (Pa <0.01), and those in clinical infection group were significantly higher than those in suspicious infection group (Pa <0.01) d and serum levels of IL-8 in the suspected infection group on the 7th day were significantly lower than those before treatment (Pa = 0.000). In the clinical infection group, the rate of antibiotic use based on experience after 14 days of treatment was 20% higher than that of IL-8≥70 ng · L-1 and / or CRP> 10 mg · L-1, the difference was statistically significant ( P = 0.035). The rate of antibiotic use in the suspicious infection group after 7 days of treatment was higher than that of IL-8≥70 ng · L-1 and / or CRP> 10 mg · L-1 according to the antibiotic indication %, The difference was statistically significant (P = 0.023). Conclusions The combined determination of serum IL-8 and CRP levels can be used to diagnose neonatal infections early. IL-8≥70 ng · L-1 and / or CRP> 10 mg · L-1 may be the best threshold to diagnose neonatal bacterial infections Value, can reduce neonatal unnecessary antibiotic use.