中华围产医学杂志
中華圍產醫學雜誌
중화위산의학잡지
CHINESE JOURNAL OF PERINATAL MEDICINE
2008年
5期
296-301
,共6页
婴儿,新生%败血病%早期诊断
嬰兒,新生%敗血病%早期診斷
영인,신생%패혈병%조기진단
Infant,newborn%Septicemia%Early diagnosis
目的 通过比较不同指标在新生儿败血症诊断中的价值,探讨临床医生如何综合利用临床及实验室资料,进行新生儿败血症的早期快速诊断.方法 对2007年9月至2008年2月间所有入住新生儿病房的患儿,常规监测临床表现和实验室指标,详细记录患儿围产期情况、感染发生时间、临床表现及实验室指标.根据诊断分为败血症组(13例)、非败血症感染组(12例)和非感染对照组(12例).资料统计整理后,对各组数据应用灵敏度、特异度、误诊率、漏诊率、正确率、正确诊断指数(Youden指数)、阳性预测值、阴性预测值及ROC曲线等指标进行综合评价. 结果对于新生儿败血症的诊断:(1)临床表现中反应异常诊断价值最佳,正确诊断指数67.9%.(2)SIRS标准特异性高达95.8%,对诊断有重要参考价值.(3)常规实验室检查白细胞(WBC)、血小板(PLT)、血糖(GLU),其敏感性和特异性均不理想;I/T比有较高的特异性,但存在相当大的观察者差异.(4)C反应蛋白(CPR)、降钙素原(PCT)诊断新生儿败血症的ROC曲线下面积分别为0.734、0.878,最佳临界值分别为15 mg/L、0.81 ng/ml,P值分别为0.020、0.000,有统计学意义;正确诊断指数分别为45.5%、75.0%.结论 对临床表现的细心观察和重视,可有效发现感染败血症的患儿.对有临床表现异常的患儿,尽快完善SIRS标准评估,特异性高.常规实验室指标WBC、I/T、PLT,可作为对高危患儿经济简便的监测指标.CRP、PCT对新生儿败血症诊断有显著意义.
目的 通過比較不同指標在新生兒敗血癥診斷中的價值,探討臨床醫生如何綜閤利用臨床及實驗室資料,進行新生兒敗血癥的早期快速診斷.方法 對2007年9月至2008年2月間所有入住新生兒病房的患兒,常規鑑測臨床錶現和實驗室指標,詳細記錄患兒圍產期情況、感染髮生時間、臨床錶現及實驗室指標.根據診斷分為敗血癥組(13例)、非敗血癥感染組(12例)和非感染對照組(12例).資料統計整理後,對各組數據應用靈敏度、特異度、誤診率、漏診率、正確率、正確診斷指數(Youden指數)、暘性預測值、陰性預測值及ROC麯線等指標進行綜閤評價. 結果對于新生兒敗血癥的診斷:(1)臨床錶現中反應異常診斷價值最佳,正確診斷指數67.9%.(2)SIRS標準特異性高達95.8%,對診斷有重要參攷價值.(3)常規實驗室檢查白細胞(WBC)、血小闆(PLT)、血糖(GLU),其敏感性和特異性均不理想;I/T比有較高的特異性,但存在相噹大的觀察者差異.(4)C反應蛋白(CPR)、降鈣素原(PCT)診斷新生兒敗血癥的ROC麯線下麵積分彆為0.734、0.878,最佳臨界值分彆為15 mg/L、0.81 ng/ml,P值分彆為0.020、0.000,有統計學意義;正確診斷指數分彆為45.5%、75.0%.結論 對臨床錶現的細心觀察和重視,可有效髮現感染敗血癥的患兒.對有臨床錶現異常的患兒,儘快完善SIRS標準評估,特異性高.常規實驗室指標WBC、I/T、PLT,可作為對高危患兒經濟簡便的鑑測指標.CRP、PCT對新生兒敗血癥診斷有顯著意義.
목적 통과비교불동지표재신생인패혈증진단중적개치,탐토림상의생여하종합이용림상급실험실자료,진행신생인패혈증적조기쾌속진단.방법 대2007년9월지2008년2월간소유입주신생인병방적환인,상규감측림상표현화실험실지표,상세기록환인위산기정황、감염발생시간、림상표현급실험실지표.근거진단분위패혈증조(13례)、비패혈증감염조(12례)화비감염대조조(12례).자료통계정리후,대각조수거응용령민도、특이도、오진솔、루진솔、정학솔、정학진단지수(Youden지수)、양성예측치、음성예측치급ROC곡선등지표진행종합평개. 결과대우신생인패혈증적진단:(1)림상표현중반응이상진단개치최가,정학진단지수67.9%.(2)SIRS표준특이성고체95.8%,대진단유중요삼고개치.(3)상규실험실검사백세포(WBC)、혈소판(PLT)、혈당(GLU),기민감성화특이성균불이상;I/T비유교고적특이성,단존재상당대적관찰자차이.(4)C반응단백(CPR)、강개소원(PCT)진단신생인패혈증적ROC곡선하면적분별위0.734、0.878,최가림계치분별위15 mg/L、0.81 ng/ml,P치분별위0.020、0.000,유통계학의의;정학진단지수분별위45.5%、75.0%.결론 대림상표현적세심관찰화중시,가유효발현감염패혈증적환인.대유림상표현이상적환인,진쾌완선SIRS표준평고,특이성고.상규실험실지표WBC、I/T、PLT,가작위대고위환인경제간편적감측지표.CRP、PCT대신생인패혈증진단유현저의의.
Objective To compare the diagnostic values of different parameters for neonatal sepsis by observing clinical presentations and laboratory tests of hospitalized newborn infants and to find out the the early and fast way in neonatal sepsis diagnosis. Methods Newborn infants admitted to NICU from Sept.2007 to Feb.2008,who met all inclusion and exclusion criteria,were enrolled.The situations in perinatal period,exact time of the onset of infection,clinical manifestations and laboratory indexes were recorded.Infants were classified into 3 groups:septic group(n=13),nonseptic group(n=12) and noninfectious group(n=12).Sensitivity,specificity,false positive rate,false negative rate,Youden's index and positive and negative predictive values(PPV and NPV) were calculated for each test. Receiver-operating characteristic curves were analyzed to determine the optimal thresholds. Results Among all the clinical manifestations,abnormal reaction had the hightest specificity(84.6%) and accuracy(67.9%) in diagnosing neonatal sepsis.SIRS criteria,with the specificity of 95.8%,was helpful in clinical suspected eases.However,routine laboratory tests,such as WBC,PLT and GLU,had poor sensitivity or specificity;I/T had better specificity(100%),but was subject to discrepancy among different observers.The area under the ROC for CRP and PCT were 0.734 and 0.878,with the optimal threshold of 15 mg/L(P=0.020,Youden's index=45.5%) and 0.81 ng/ml(P-0.000,specificity=100%,Youden's index=75.0%),respectively.Conclusions Careful clinical inspection warrants early detection of sick infants.Evaluation of SIRS criteria in clinical suspected septic infants may help in early diagnosis.WBC,I/T,PLT can be used as routinely monitoring indexes for high risk neonates.CRP and PCT concentrations also have significant diagnostic values.
