作　　者： (钟元枝）; (王金虎）; (陈玉霞）; (闫玉琴）; (肖体海）; (刘玲）; (何珍）; (宋威）; (黄国清）; (刘华艳）; (吴本清）;

机构地区： 518110,深圳市龙华区中心医院新生儿科

出　　处： 《中国新生儿科杂志》

摘　　要： 目的 探讨宫内感染与新生儿早发败血症的相关性.方法 选取深圳市龙华区中心医院新生儿科2015年10月至2016年9月、深圳市人民医院新生儿科2016年1～6月收治的宫内感染或疑似感染孕产妇及其新生儿共100对为观察组,同期无宫内感染的孕产妇及其新生儿共100对为对照组,足月儿和早产儿比例1∶1.检测母亲分娩当日外周血常规、CD64、C反应蛋白(C-reactive protein,CRP)、降钙素原(procalcitonin,PCT),新生儿脐静脉血血常规、CD64、CRP、PCT、血培养,胎盘常规送病理检查,对两组数据进行比较.结果 观察组胎盘病理阳性率、脐血培养阳性率均高于对照组,观察组中早产儿胎盘病理阳性率高于足月儿,差异有统计学意义(P＜0.05);观察组外周血培养阳性率与对照组差异无统计学意义(P＞0.05);观察组脐血培养阳性率高于外周血培养,差异有统计学意义(P＜0.05),对照组脐血培养与外周血培养阳性率差异无统计学意义(P＞0.05).观察组早发败血症发生率高于对照组,差异有统计学意义(P＜0.05),观察组母血和脐血CD64、PCT及母血CRP均高于对照组,差异有统计学意义(P＜0.05),两组脐血CRP差异无统计学意义(P＞0.05).母血CD64、PCT和脐血CD64、PCT诊断新生儿早发败血症的受试者工作特征曲线下面积分别为0.755、0.793和0.852、0.811.结论 宫内感染明显增加新生儿发生早发败血症的风险,联合脐血培养可提高败血症的诊断率.母血和脐血CD64、PCT对诊断新生儿早发败血症有预测价值. Objective To study the relationship between intrauterine infection and early neonatal sepsis.Method From October 2015 to September 2016,the clinical data of pregnant mothers and their newborns in Shenzhen Longhua District Central Hospital were collected,and data of Shenzhen People's Hospital from January 2016 to June 2016 were collected.100 pairs of pregnant mothers and their newborns with confirmed or suspected intrauterine infection were selected as the observation group,and another 100 pairs without intrauterine infection during the same period as the control group.The ratio of term infants vs.premature infants was 1∶ 1.The complete blood count (CBC),CD64,procalcitonin (PCT) and C-reactive protein (CRP) were measured in peripheral blood of all mothers on the day of delivery.The CBC,CD64,CRP,PCT,blood culture of both umbilical venous blood and peripheral blood in neonates were examined and the pathological examination of placenta was performed.Result The positive rate of placental pathology and umbilical cord blood culture in observation group were significantly higher than that in the control and the positive rate in preterms was higher than the terms in observation group (P ＜ 0.05).No significant differences existed between term and premature newborns on the positive rate of peripheral blood culture (P ＞ 0.05).The positive rate of blood culture from umbilical cord blood was higher than peripheral blood in observation group (P ＜ 0.05),but no significant difference in control group (P ＞ 0.05).The incidence of septicemia in term and premature newborns in observation group was significantly higher than the control group (P＜ 0.05).The CD64,PCT in mother's peripheral blood and umbilical cord blood,and CRP in mother's blood were all higher than the control group,the differences were statistically significant (P ＜ 0.05),but CRP in umbilical cord blood in both group were similar (P ＞ 0.05).The area under ROC curve of CD64 and PCT in mother's peripheral blood,CD64 and PCT in umbilical cord blood to diagnose early-onset septicemia in newborns was 0.755,0.793,0.852 and 0.811,respectively.Conclusion The risk of neonatal infections is significantly increased because of intrauterine infection.Combination of peripheral and umbilical blood cultures can increase the accuracy of sepsis diagnosis.Both CD64 and PCT in umbilical cord blood and maternal blood can be used as indicators of intrauterine infection with a predictive value in the diagnosis of early-onset neonatal sepsis.

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