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中华妇幼临床医学杂志(电子版) ›› 2012, Vol. 08 ›› Issue (06) : 689 -692. doi: 10.3877/cma.j.issn.1673-5250.2012.06.003

所属专题： 经典病例； 文献；

论著

新生儿败血症173例早期实验检查分析
花少栋1, 安胜利2, 黄婕婷1, 吴志新1, 刘秀香3, 封志纯1,*,*()   
  1. 1. 100700　北京，北京军区总医院八一儿童医院新生儿重症监护中心
    2. 南方医科大学生物统计学系
    3. 山东省滨州医学院附属医院新生儿科
  • 收稿日期:2012-05-22 修回日期:2012-08-12 出版日期:2012-12-01
  • 通信作者: 封志纯
  • 基金资助:
    国家卫生部科研基金资助项目(WKJ2007－3－001)

Analysis for Early Experimental Examination on Neonatal Septicemia in 173 Cases

Shao-dong HUA1, Sheng-li AN2, Jie-ting HUANG1, Zhi-xin WU1, Xiu-xiang LIU3, Zhi-chun FENG1()   

  1. 1. Department of Pediatric, BaYi Children's Hospital of the General Military Hospital of Beijing, Beijing 100700, China
  • Received:2012-05-22 Revised:2012-08-12 Published:2012-12-01
  • Corresponding author: Zhi-chun FENG
  • About author:
    (Corresponding author: FENG Zhi-chun, Email: )
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花少栋, 安胜利, 黄婕婷, 吴志新, 刘秀香, 封志纯. 新生儿败血症173例早期实验检查分析[J]. 中华妇幼临床医学杂志(电子版), 2012, 08(06): 689-692.

Shao-dong HUA, Sheng-li AN, Jie-ting HUANG, Zhi-xin WU, Xiu-xiang LIU, Zhi-chun FENG. Analysis for Early Experimental Examination on Neonatal Septicemia in 173 Cases[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2012, 08(06): 689-692.

目的

探讨新生儿败血症早期实验检查特点。

方法

选择2009年1月至2010年12月于北京军区总医院八一儿童医院新生儿重症监护中心(NICU)接受治疗的3111例新生儿的病历资料为研究对象。对其采用回顾性分析法进行相关研究，将本组3111例新生儿中，确诊为新生儿败血症的患儿纳入败血症组(n＝173)，其余新生儿纳入对照组(n＝2938)(本研究遵循的程序符合北京军区总医院八一儿童医院人体试验委员会所制定的伦理学标准，得到该委员会批准)。两组患儿性别、出生体重、分娩方式、胎龄等比较，差异无统计学意义(P>0.05)。

结果

败血症组与对照组组新生儿的血常规及血生化检测结果中，血红蛋白(Hb)、血小板(PLT)计数、红细胞平均容积(MCV)及血糖(Glu)水平在败血症组较对照组显著降低，而C－反应蛋白(CRP)，总胆红素(TBIL)，直接胆红素(DBIL)，血乳酸(LAC)，血尿素氮(BUN)在败血症组较对照组显著增高，且两组比较，差异均有统计学意义(P<0.05)。以上述初筛有意义的9项指标中，PLT，MCV，CRP，TBIL，BUN，Glu，LAC 7项指标为是否发生新生儿败血症的因变量，进一步进行多因素非条件logistic回归分析的结果显示，均为导致新生儿败血症的较敏感指标(OR＝0.744～1.512, 95%CI：0.631～1.772；P<0.05)。

结论

若新生儿CRP，TBIL，LAC，BUN值越高，而PLT，MCV，Glu值越低，则发生败血症的风险越大，临床上应尽早采取有力的治疗措施。

关键词: 新生儿, 败血症, C反应蛋白, 血小板, 乳酸
Objective

To study the characteristics of early laboratory tests on neonatal septicemia.

Methods

This was a prospective observational study with institutional ethics approval and written maternal consent. There were 3111 cases of clinical medical records of neonatal were selected from neonatal intensive care unit (NICU)of BaYi Children's Hospital in the General Military Hospital of Beijing from January 2009 to December 2010. a total of 173 neonates with neonatal septicemia were included in neonatal septicemia group (n=173)and the others included in control group(n=2938). The blood samples were collected from neonates for blood routine test and routine biochemical analysis, There had no significance difference between two groups among gender, birth weight, mode of delivery, gestational age at delivery, etc.(P>0.05). The relationship between neonatal septicemia related risk factors and results of blood routine test and routine biochemical analysis were analyzed by multivariate non-conditional logistic regression.

Results

Compared with the control group, hemoglobin (Hb), platelet (PLT), mean corpuscular volume (MCV), blood glucose (Glu)in neonatal septicemia group were significantly lower than those in control group (P<0.05), but C-reacting protein (CRP), total bilirubin (TBIL), direct bilirubin (DBIL), lactate (LAC), blood urea nitrogen (BUN) in neonatal septicemia group were significantly higher than those in control group (P<0.05). Multivariate non-conditional logistic regression analysis on risk factors of neonatal septicemia was used further, dependent variable, covariates were PLT, Hb, MCV, CRP, TBIL, DBIL, BUN, Glu, LAC, the results showed those close correlation risk factors of neonatal septicemia including: PLT, MCV, CRP, TBIL, BUN, Glu and LAC (OR=0.744-1.512, 95%CI: 0.631-1.772; P<0.05).

Conclusions

The higher of CRP, TBIL, LAC, BUN values and the lower of PLT, MCV, Glu vales, the greater of the risk of neonatal septicemia. It is necessary to take effective treatment measures as soon as possible.

Key words: neonatal, septicemia, C-reacting protein, platelet, lactate
表1 两组新生儿血常规、肝功能、C－反应蛋白、血气检验结果比较(±s)
Table 1 Compared of results of complete blood cell count，liver function, C－reacting protein and blood gas analysis between two groups(±s)
检查指标 败血症组 对照组 t/t' P
n 检查结果 n 检查结果
WBC(×109/L) 173 13.480±　8.200 2940 14.020±　7.870 0.872 0.383
N(%) 173 55.052±17.620 2898 56.970±16.900 1.448 0.148
L(%) 173 35.570±16.500 2892 34.260±16.370 －1.019 0.308
Hb(g/L) 173 149.930±27.880 2939 154.600±29.070 2.055 0.040
PLT(×109/L) 173 245.450±107.240 2936 263.220±108.480 2.096 0.036
HCT(%) 173 0.426±　0.079 2919 0.475±　1.101 0.579 0.563
MCV(fl) 173 103.780±　6.847 2921 105.930±　7.871 3.513 0.000
MCH(pg) 173 36.279±　2.959 2921 36.815±　6.648 1.054 0.292
MCHC(g/L) 173 350.300±16.390 2921 346.660±24.410 －1.935 0.053
RDW(%) 173 16.569±　1.859 2914 17.040±　5.323 1.165 0.244
PDW(%) 173 12.003±　2.306 2831 11.911±　2.784 －0.429 0.668
MPV(fl) 173 10.129±　1.111 2823 9.976±　3.478 －0.577 0.564
CRP(mg/L) 173 12.139±24.490 2095 3.735±　9.332 －4.485 0.000
ALT (U/L) 173 19.624±17.605 2358 16.826±32.860 －1.108 0.268
TBIL(μmol/L) 173 241.650±102.520 2483 170.030±102.730 －8.621 0.000
DBIL(μmol/L) 173 18.970±　8.964 2463 17.290±　9.913 －2.167 0.030
BUN(mmol/L) 173 6.688±　2.600 445 5.400±　3.119 －4.802 0.000
ALB(g/L) 173 34.978±　4.169 1437 34.954±　9.072 －0.034 0.973
TP(g/L) 173 52.700±　6.566 1435 51.792±　7.857 －1.460 0.145
Glu(mmol/L) 173 3.193±　1.720 1126 3.553±　2.207 2.050 0.041
LAC (mmol/L) 173 3.895±　1.607 1082 2.674±　2.422 －6.407 0.000
HCO3- (mmol/L) 173 19.643±　4.338 1046 20.307±　7.668 0.654 0.513
表2 与新生儿败血症相关的检测指标的多因素非条件logistic回归分析结果
Table 2 The results of multivariate non－conditional logistic regression analysis about laboratory test indicators in neonatal septicemia
因素 B SE Wald P OR 95%CI
上限 下限
PLT －0.005 0.001 10.171 0.001 0.995 0.992 0.998
MCV －0.127 0.023 30.566 0.000 0.881 0.842 0.921
CRP 0.039 0.011 12.570 0.000 1.039 1.017 1.062
TBIL 0.010 0.001 46.074 0.000 1.010 1.007 1.013
BUN 0.193 0.057 11.603 0.001 1.213 1.085 1.355
Glu －0.296 0.084 12.545 0.000 0.744 0.631 0.876
LAC 0.414 0.081 26.187 0.000 1.512 1.291 1.772
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