标题：新生儿EOS的血清乳酸、PCT、炎症指标水平变化及其临床意义

      作者：张磊 1，贾阳 1，安婷婷 1，苏芬玲 1，习颖 2    1.西安大兴医院新生儿科，陕西 西安 710000；2.空军军医大学唐都医院儿科，陕西 西安 710000

      卷次： 2023年34卷9期

      【摘要】 目的 探讨新生儿早发型败血症(EOS)的血清乳酸、降钙素原(PCT)、炎症指标水平变化及其临床意义。方法 回顾性分析2019年1月至2022年1月在西安大兴医院分娩及诊治的98例EOS患儿的临床资料(EOS组)，另选择同期在我院分娩的健康新生儿100例作为对照组，比较两组新生儿血清乳酸、PCT、炎症指标[包括白介素-6 (IL-6)、高敏C反应蛋白(Hs-CRP)]水平。依据新生儿休克评分将EOS新生儿分为轻症组(≤6分，63例)与重症组(>6分，35例)，比较两组新生儿的血清乳酸、PCT、IL-6、Hs-CRP水平。同时以EOS组新生儿作为阳性样本，健康新生儿为阴性样本，分析血清乳酸、PCT、IL-6、hs-CRP单独及联合诊断新生儿EOS的价值。结果 EOS组新生儿的血清乳酸、PCT、IL-6、Hs-CRP水平分别为(5.41±1.79) mmol/L、(10.42±3.15) ng/mL、(498.26±13.85) pg/mL、(27.48±3.90)mg/L，明显高于对照组的(1.37±0.38) mmol/L、(0.20±0.05) ng/mL、(13.49±4.06) pg/mL、(1.88±0.53) mg/L，差异均有统计学意义(P<0.05)；重症组新生儿的血清乳酸、PCT、IL-6、Hs-CRP水平分别为(7.92±2.05) mmol/L、(16.25±4.68) ng/mL、(537.89±18.37) pg/mL、(34.95±5.05) mg/L，明显高于轻症组的(4.16±1.55) mmol/L、(4.58±1.49) ng/mL、(468.11±11.95) pg/mL、(20.16±3.47) mg/L，差异均有统计学意义(P<0.05)；血清乳酸、PCT、IL-6、Hs-CRP联合诊断新生儿EOS的灵敏度、特异度、准确度分别为90.82%、92.00%、91.41%，明显高于乳酸(72.45%、61.00%、66.67%)、PCT(86.73%、59.00%、72.73%)、IL-6 (66.32%、64.00%、65.15%)、hs-CRP (85.71%、83.00%、84.34%)单独诊断，差异均有统计学意义(P<0.05)。结论 相较于健康新生儿，EOS新生儿的血清乳酸、PCT、IL-6、Hs-CRP水平明显升高，且随着病情加重，血清乳酸、PCT、IL-6、Hs-CRP水平也逐渐升高，同时血清乳酸、PCT、IL-6、Hs-CRP联合诊断新生儿EOS的价值较高。
      【关键词】 新生儿早发型败血症；乳酸；降钙素原；白介素-6；高敏C反应蛋白；临床意义
      【中图分类号】 R722.13+1 【文献标识码】 A 【文章编号】 1003—6350（2023）09—1299—04

Changes of serum lactate, PCT, and inflammatory indexes in neonates with early-onset sepsis and their clinicalsignificance.
ZHANG Lei 1, JIA Yang 1, AN Ting-ting 1, SU Fen-ling 1, XI Ying 2. 1. Department of Neonatology, Xi'anDaxing Hospital, Xi'an 710000, Shaanxi, CHINA; 2. Department of Paediatrics, Tangdu Hospital of Air Force MedicalUniversity, Xi'an 710000, Shaanxi, CHINA
【Abstract】 Objective To investigate the changes of serum lactate, procalcitonin (PCT), and inflammatory in-dexes in neonates with early-onset sepsis (EOS) and their clinical significance. Methods The clinical data of 98 neo-nates with EOS delivered and treated in Xi'an Daxing Hospital from January 2019 to January 2022 were retrospectivelyanalyzed (EOS group). In addition, 100 healthy newborns delivered in the hospital at the same time were selected as thecontrol group. The levels of serum lactic acid, PCT, and inflammatory indicators [including interleukin-6 (IL-6), high-sensi-tivity C-reactive protein (hs-CRP)] of the two groups were compared. According to the neonatal shock score, EOS neonateswere divided into mild group (≤6 points, 63 cases) and severe group (>6 points, 35 cases), and the serum lactate, PCT,IL-6, and hs-CRP levels were compared between the two groups. At the same time, using neonates in the EOS group as pos-itive samples and the healthy neonates as negative samples, the values of serum lactate, PCT, IL-6, and hs-CRP in diagnos-ing neonatal EOS alone and in combination were analyzed. Results The serum lactate, PCT, IL-6, hs-CRP levels inthe EOS group were (5.41±1.79) mmol/L, (10.42±3.15) ng/mL, (498.26±13.85) pg/mL, (27.48±3.90) mg/L, whichwere significantly higher than (1.37±0.38) mmol/L, (0.20±0.05) ng/mL, (13.49±4.06) pg/mL, and (1.88±0.53) mg/L inthe control group (P<0.05). The serum lactate, PCT, IL-6, hs-CRP levels of the neonates in the severe group were(7.92±2.05) mmol/L, (16.25±4.68) ng/mL, (537.89±18.37) pg/mL, (34.95±5.05) mg/L, significantly higher than (4.16±1.55) mmol/L, (4.58±1.49) ng/mL, (468.11±11.95) pg/mL, (20.16±3.47) mg/L in the mild group (P<0.05). The sensitiv-ity, specificity, and accuracy of serum lactate, PCT, IL-6, and hs-CRP in combination for diagnosing neonatal EOSwere 90.82% , 92.00% , and 91.41% , significantly higher than those of lactate (72.45% , 61.00% , 66.67% ), PCT(86.73%, 59.00%, 72.73%), IL-6 (66.32%, 64.00%, 65.15%), hs-CRP (85.71%, 83.00%, 84.34%) alone (P<0.05).Conclusion Compared with healthy neonates, the levels of serum lactic acid, PCT, IL-6, and Hs-CRP in neonates withEOS are significantly increased, and the levels gradually increased with the aggravation of the disease. Combination ofthe four indexes has higher diagnostic value in EOS.
      【Key words】 Neonatal early-onset sepsis; Lactate; Procalcitonin; Interleukin-6; High-sensitivity C-reactive pro-tein; Clinical significance