CAJ | 학술논문

目的探讨可溶性髓系细胞触发受体-1(sTREM-1)在诊断早发型新生儿败血症(EONS)中的价值.方法选择2014年1至6月入住淮安市妇幼保健院具有细菌感染危险因素或有疑似细菌感染征象,且出生后24 h内入院的新生儿90例.根据是否符合EONS的诊断标准和是否发生感染,将患儿分为败血症组(33例)、一般感染组(23例)和非感染病例对照组(34例),败血症组又分为确诊组(6例)和临床诊断组(27例).选择20名同期出生健康新生儿作为健康对照组.分别在患儿出生后1、3和7d留取外周血样本(健康对照组仅检测出生后第1天的外周血样本),采用双抗体夹心酶联免疫吸附法(ELISA)测定血清中sTREM-1和白细胞介素(IL)-6水平,并采用受试者工作特征(ROC)曲线分析其在EONS诊断中的价值.结果败血症组患儿血清sTREM-1水平高于一般感染组、非感染病例对照组和健康对照组,差异均有统计学意义(P值均＜0.05);一般感染组和非感染病例对照组的血清sTREM-1水平均高于健康对照组(P值均＜0.05);一般感染组和非感染病例对照组之间比较差异无统计学意义(P＞0.05).败血症组中,确诊组和临床诊断组间出生后第1天、第3天和第7天血清sTREM-1水平比较,差异均无统计学意义(P值均＞0.05).败血症组患儿血清sTREM-1在第1～3天呈上升趋势,第3～7天呈下降趋势.出生后第1天和第3天时的血清sTREM-1水平诊断EONS的ROC曲线下面积(AUC)分别为0.810和0.811,最佳诊断界值分别为234.44和269.79 ng/L,均对诊断EONS有统计学意义(P值均＜0.05).联合检测新生儿出生后第1天时的血清sTREM-1与IL-6水平诊断EONS的AUC为0.858,敏感性为92.00％,特异性为93.10％.结论新生儿早期血清sTREM-1水平对EONS的诊断有价值,sTREM-1和IL-6联合检测能提高EONS诊断的敏感性和特异性.
목적 탐토가용성수계세포촉발수체-1(sTREM-1)재진단조발형신생인패혈증(EONS)중적개치.방법 선택2014년1지6월입주회안시부유보건원구유세균감염위험인소혹유의사세균감염정상,차출생후24 h내입원적신생인90례.근거시부부합EONS적진단표준화시부발생감염,장환인분위패혈증조(33례)、일반감염조(23례)화비감염병례대조조(34례),패혈증조우분위학진조(6례)화림상진단조(27례).선택20명동기출생건강신생인작위건강대조조.분별재환인출생후1、3화7d류취외주혈양본(건강대조조부검측출생후제1천적외주혈양본),채용쌍항체협심매련면역흡부법(ELISA)측정혈청중sTREM-1화백세포개소(IL)-6수평,병채용수시자공작특정(ROC)곡선분석기재EONS진단중적개치.결과 패혈증조환인혈청sTREM-1수평고우일반감염조、비감염병례대조조화건강대조조,차이균유통계학의의(P치균＜0.05);일반감염조화비감염병례대조조적혈청sTREM-1수평균고우건강대조조(P치균＜0.05);일반감염조화비감염병례대조조지간비교차이무통계학의의(P＞0.05).패혈증조중,학진조화림상진단조간출생후제1천、제3천화제7천혈청sTREM-1수평비교,차이균무통계학의의(P치균＞0.05).패혈증조환인혈청sTREM-1재제1～3천정상승추세,제3～7천정하강추세.출생후제1천화제3천시적혈청sTREM-1수평진단EONS적ROC곡선하면적(AUC)분별위0.810화0.811,최가진단계치분별위234.44화269.79 ng/L,균대진단EONS유통계학의의(P치균＜0.05).연합검측신생인출생후제1천시적혈청sTREM-1여IL-6수평진단EONS적AUC위0.858,민감성위92.00％,특이성위93.10％.결론 신생인조기혈청sTREM-1수평대EONS적진단유개치,sTREM-1화IL-6연합검측능제고EONS진단적민감성화특이성.
Objective To assess the clinical value of serum soluble triggering receptor expressed on myeloid cell-1 (sTREM-1) for diagnosis of early-onset neonatal sepsis (EONS).Methods A total of 90 neonatal cases with risk factors or symptoms of bacterial infections were enrolled in the study.All infants were admitted to Huai' an Maternity and Child Healthcare Hospital within 24 h after birth during January and June 2014.The enrolled neonates were divided into sepsis group (n =33),general infection group (n =23) and non-infected group (n =34);and the sepsis group was further divided into culture-confirmed group (n =6) and clinical-diagnosed group (n =27).Twenty healthy neonates were also enrolled as the healthy control group.Blood samples were obtained from neonatal patients on d1,d3 and d7 after birth,and for healthy controls,the blood samples were only obtained at the first day.Serum levels of sTREM-1 and interleukin (IL)-6 were measured by double-antibody sandwich enzyme-linked immunosorbent assay (ELISA).The receiver operating characteristic (ROC) curve was applied to evaluate the values of sTREM-1 and IL-6 in diagnosis of EONS.Results Compared with that in general infection group,non-infected group and healthy control group,the serum level of sTREM-1 was significantly higher in sepsis group (all P ＜ 0.05);serum levels of sTREM-1 in general infection group and non-infected group were also higher than that in healthy control group (all P ＜ 0.05);but no difference was observed between general infection group and non-infected group,between culture-confirmed group and clinical-diagnosed group (P ＞ 0.05).Serum level of sTREM-1 showed upward trend during d1-3 after the birth,and downward trend during d3-7.The areas under the ROC curve (AUC) were 0.810 and 0.811 (all P ＜ 0.05) for sTREM-1 levels on d1 and d3 in diagnosis of EONS,and the optimal cut-off values were 234.44 ng/L and 269.79 ng/L,respectively.If sTREM-1 and IL-6 on d1 were combined for diagnosis of EONS,the AUC,sensitivity and specificity were 0.858,92.00％ and 93.10％,respectively.Conclusion Serum level of sTREM-1 in early stage is valuable for diagnosis of EONS,and the combined use of serum sTREM-1 and IL-6 may improve the diagnostic value.