降钙素原、C反应蛋白及白细胞计数在新生儿缺氧缺血性脑病中的诊断价值
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摘要
目的通过分析新生儿缺氧缺血性脑病(hypoxic-ischemic encephalopathy,HIE)患儿外周血中降钙素原(PCT)、C反应蛋白(CRP)和白细胞计数(WBC)水平,探讨三种炎性指标在HIE中的诊断价值。方法选择2017年1月～2018年8月我院儿科收治的HIE患儿66例,依据产妇病史,患儿临床表现、头部CT报告以及Apgar评分等将HIE患儿分为轻、中、重三组。分别用瑞士罗氏公司Cobas E601电化学发光免疫分析仪和日本Sysmex公司XE-2100全自动血液分析仪检测血清中PCT、CRP及全血中WBC水平。分析对照组及各患儿组三种炎性指标水平、治疗前后变化,并通过ROC曲线分析各指标在HIE诊疗中的价值。结果 HIE患儿血清PCT、CRP和全血中WBC水平均较对照组明显升高(P<0.05)。PCT、CRP水平随HIE病情加重而升高(P<0.05)。轻中度HIE患儿组间WBC水平差异无统计学意义(P>0.05),其他各患儿组间WBC水平差异有统计学意义(P<0.05)。结论 PCT、CRP及WBC可作为HIE诊断及病情判断的辅助依据,其中PCT对HIE患儿诊断价值和特异性最高,WBC最低。
Objective To investigate the clinical value of procalcitonin(PCT), C-reactive protein(CRP) and white blood cell count(WBC) in neonatal hypoxic-ischemic encephalopathy(HIE). Methods 66 children with HIE were selected in our hospital from Jan 2017 to Aug 2018. According to history of maternity, clinical manifestation, imaging examination and Apgar score of children, they were divided into three groups: mild group, moderate group and severe group. The levels of PCT, CRP in serum and WBC in whole blood were detected by Cobas E601 Electrochemiluminescence Immunoanalyzer of Roche Company of Switzerland and XE-2100 automatic Blood Analyzer of Sysmex Company of Japan. The levels of three inflammatory indexes in the control group and each HIE group and the changes before and after treatment were analyzed. The value of each index in the diagnosis and treatment of HIE was analyzed by ROC curve. Results The levels of serum PCT, CRP and WBC in HIE patients were significantly higher than those in the control group(P<0.05). The serum PCT and CRP levels increased with the severity of the disease(P<0.05). There was no significant difference in WBC level between mild group and moderate group(P>0.05), but there were significant differences between other groups(P<0.05). Conclusion PCT, CRP and WBC can be used as auxiliary evidence for diagnosis and condition judgement of HIE. The diagnostic value and specificity in children with HIE of PCT is the highest, and WBC is the lowest.
Objective To investigate the clinical value of procalcitonin(PCT), C-reactive protein(CRP) and white blood cell count(WBC) in neonatal hypoxic-ischemic encephalopathy(HIE). Methods 66 children with HIE were selected in our hospital from Jan 2017 to Aug 2018. According to history of maternity, clinical manifestation, imaging examination and Apgar score of children, they were divided into three groups: mild group, moderate group and severe group. The levels of PCT, CRP in serum and WBC in whole blood were detected by Cobas E601 Electrochemiluminescence Immunoanalyzer of Roche Company of Switzerland and XE-2100 automatic Blood Analyzer of Sysmex Company of Japan. The levels of three inflammatory indexes in the control group and each HIE group and the changes before and after treatment were analyzed. The value of each index in the diagnosis and treatment of HIE was analyzed by ROC curve. Results The levels of serum PCT, CRP and WBC in HIE patients were significantly higher than those in the control group(P<0.05). The serum PCT and CRP levels increased with the severity of the disease(P<0.05). There was no significant difference in WBC level between mild group and moderate group(P>0.05), but there were significant differences between other groups(P<0.05). Conclusion PCT, CRP and WBC can be used as auxiliary evidence for diagnosis and condition judgement of HIE. The diagnostic value and specificity in children with HIE of PCT is the highest, and WBC is the lowest.
引文
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2许小琴,张悦.关于新生儿缺氧缺血性脑病的认识[J].大家健康(学术版),2016,10(10):198-199
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8黄红华,丁凯宏,班副植,等.血清降钙素原、超敏C反应蛋白、白细胞介素6检测对急性上呼吸道感染患儿的临床意义[J].国际检验医学杂志,2013,34(14):1906-1908
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10 Chen S,Martens-Lobenhoffer J,Weissenborn K,et al.Association of dimethylarginines and mediators of inflammation after acute ischemic stroke[J].J Neuroinflammation,2012,9:251
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12 Pavlovic V,Sarac M.The role of ascorbic acid and mono-sodium glutamate in thymocyete apoptosis[J].Bratisl Lek Listy,2010,111(6):357-360
13 Pundik S,Xu K,Sundararajan S.Reperfusion brain injury:focus on cellular bioenergetics[J].Neurology,2012,79(Suppl 1):44-51
14陈国飞,杨学文.感染性疾病患儿血清降钙素原、C反应蛋白及白细胞计数的变化及临床价值分析[J].中国处方药,2016,14(2):7
15孙家祥,李艳,叶敏.窒息新生儿白细胞及血小板参数变化分析[J].吉林医学,2016,37(3):571-573
16 Shang Y,Mu L,Guo X,et al.Clinical significance of interleukin-6,tumor necrosis factor-αand high-sensitivity C-reactive protein in neonates with hypoxic-ischemic encephalopathy[J].Experimental and Therapeutic Medicine,2014,8(4):1259-1262
2许小琴,张悦.关于新生儿缺氧缺血性脑病的认识[J].大家健康(学术版),2016,10(10):198-199
3 Negro S,Benders MJNL,Tataranno ML,et al.Early Prediction of Hypoxic-Ischemic Brain Injury by a New Panel of Biomarkers in a Population of Term Newborns[J].Oxidative Medicine and Cellular Longevity,2018,2018:7608108
4 Aly H,Khashaba MT,El-Ayouty M,et al.IL-1 beta,IL-6and TNF-alpha and outcomes of neonatal hypoxic ischemic encephalopathy[J].Brain Dev,2006,28(3):178-182
5 Jacobs SE,Berg M,Hunt R,et al.Cooling for newborns with hypoxic ischaemic encephalopathy[J].Cochrane Database Syst Rev,2017:CD003311
6 Lai MC,Yang SN.Perinatal hypoxic-ischemic encepha-lopathy[J].JBiomed Biotechnol,2011,6(9):8-13
7 Liu F,Mc Cullough LD.Inflammatory responses in hypoxic ischemic encephalopathy[J].Acta Pharmacol Sin,2013,34:1121-1130
8黄红华,丁凯宏,班副植,等.血清降钙素原、超敏C反应蛋白、白细胞介素6检测对急性上呼吸道感染患儿的临床意义[J].国际检验医学杂志,2013,34(14):1906-1908
9 Lippi G.Procalcitonin for diagnosing and monitoring bacterial infections:for or against?[J].Clinical Chemistry and Laboratory medicine,2018,56(8):1193-1195
10 Chen S,Martens-Lobenhoffer J,Weissenborn K,et al.Association of dimethylarginines and mediators of inflammation after acute ischemic stroke[J].J Neuroinflammation,2012,9:251
11杨新军,田培超.超敏C反应蛋白在新生儿缺氧缺血性脑病诊断中的临床意义[J].中国实用神经疾病杂志,2014,17(13):7-9
12 Pavlovic V,Sarac M.The role of ascorbic acid and mono-sodium glutamate in thymocyete apoptosis[J].Bratisl Lek Listy,2010,111(6):357-360
13 Pundik S,Xu K,Sundararajan S.Reperfusion brain injury:focus on cellular bioenergetics[J].Neurology,2012,79(Suppl 1):44-51
14陈国飞,杨学文.感染性疾病患儿血清降钙素原、C反应蛋白及白细胞计数的变化及临床价值分析[J].中国处方药,2016,14(2):7
15孙家祥,李艳,叶敏.窒息新生儿白细胞及血小板参数变化分析[J].吉林医学,2016,37(3):571-573
16 Shang Y,Mu L,Guo X,et al.Clinical significance of interleukin-6,tumor necrosis factor-αand high-sensitivity C-reactive protein in neonates with hypoxic-ischemic encephalopathy[J].Experimental and Therapeutic Medicine,2014,8(4):1259-1262