Influencing Factors on C-Reactive Protein in Neonates

doi:10.3877/cma.j.issn.1673-5250.2012.01.003

Objective

To study the influential factors of C-reactive protein (CRP) in neonates.

Methods

A total of 220 neonates whose serum CRP exceeded 8 mg/mL were recruited in the department of Neonate Intensive Care Unit (NICU) of BaYi Children's Hospital of General Military Hospital of Beijing from January 2009 to December 2010. They were selected to study group According to the diagnostic criteria for neonatal disease of Practical Neonatology and in accordance with the diagnosis and examination results on admission, they were divided into following sub-groups: sepsis sub-group (n=19), premature low birth weight sub-group (n=50), neonatal pneumonia sub-group (n=151), hypoglycemia sub-group (n=14), hemolytic disease sub-group (n=20), respiratory distress syndrome of newborn (NRDS) sub-group (n=8), pathological jaundice sub-group (n=81), intracranial hemorrhage sub-group (n=13), hypoxic ischemic encephalopathy (HIE) sub-group (n=29), asphyxia sub-group (n=20), amniotic fluid pollution sub-group (n=62) and premature rupture of membranes sub-group (n=44). At the same time, a total of 2129 inpatient neonates without corresponding diseases were chosen as corresponding control group (n=201, 170, 69, 206, 200, 212, 139, 207, 191, 200, 158, 176), respectively. Procedures were performed according to the Helsinki Declaration and approved by institutional Review Board (Institutional Review Board of General Military Hospital of Beijing PLA). The blood sampling of neonates were collected according to patient condition after approval was obtained from their families during hospitalization period. There were no statistically significant difference about gender, age, feeding and delivery methods between two groups (P>0.05). The average rank of serum CRP took two-sample rank test (Mann Whitney U test), correlation analysis took Pearson correlation of multiple linear regression analysis.

Results

The preliminary screening results by Mann Whitney U test showed mean rank: Serum CRP of neonates septicemia (Yes: 138.32, No: 107.86; U=1381.0, P=0.046), NRDS (Yes: 66.44, No: 112.16; U=495.5, P=0.046), results of Pearson correlation showed possible correlation among serum CRP and hemoglobin (Hb), hematocrit (Hct), total bilirubin (TBIL), direct bilirubin (DBIL), glucose (Glu) (r=-0.149, -0.143, -0.164, 0.246, 0.316, P<0.05). Stepwise regression analysis was used further, dependent variable: Serum CRP, covariates: Neonatal septicemia, NRDS, Hb, Hct, TBIL, DBIL, Glu, only DBIL and Glu entered regression equation, standardized partial regression coefficient were 0.477, 0.311, respectively. The 95% confidence intervals were 0.608-2.265 and 0.588-9.445 (P=0.001, 0.028), respectively, so DBIL and Glu were positively correlated with serum CRP, the model had statistical significance (F=9.298, P=0.001), goodness of fit was slightly poorer (R²=0.341).

Conclusions

Serum CRP are positively correlated with DBIL and Glu, furthermore, DBIL has more positive effects on serum CRP than Glu. Some others important influential factors on serum CRP need to be detected.

Key words: C-reactive protein, direct bilirubin, glucose, neonate

表1 220例C－反应蛋白在不同疾病研究亚组与相应对照亚组的Mann－Whitney U检验结果

Table 1 Mann－Whitney U Test on CRP results in 220 cases with different diseases

研究组	n	血清CRP平均秩次	对照组	n	血清CRP平均秩次	U	P
败血症亚组	19	138.32	败血症对照亚组	201	107.87	1381.0	0.046
早产低体重亚组	50	114.80	早产低体重对照亚组	170	109.24	4035.0	0.587
新生儿肺炎亚组	151	111.90	新生儿肺炎对照亚组	69	107.43	4998.0	0.629
低血糖亚组	14	115.79	低血糖对照亚组	206	110.14	1368.0	0.748
溶血病亚组	20	102.60	溶血病对照亚组	200	111.29	1842.0	0.560
NRDS亚组	8	66.44	NRDS对照亚组	212	112.16	495.5	0.046
病理性黄疸亚组	81	100.14	病理性黄疸对照亚组	139	116.54	4790.0	0.065
颅内出血亚组	13	97.15	颅内出血对照亚组	207	111.34	1172.0	0.435
HIE亚组	29	113.24	HIE对照亚组	191	109.51	2661.0	0.767
窒息亚组	20	121.86	窒息对照亚组	200	108.39	1578.0	0.385
羊水污染亚组	62	112.56	羊水污染对照亚组	158	109.69	4770.0	0.764
胎膜早破亚组	44	119.11	胎膜早破对照亚组	176	108.35	3493.0	0.315
总计	220	?	总计	2129	?	?	?

表1 220例C－反应蛋白在不同疾病研究亚组与相应对照亚组的Mann－Whitney U检验结果

Table 1 Mann－Whitney U Test on CRP results in 220 cases with different diseases

研究组	n	血清CRP平均秩次	对照组	n	血清CRP平均秩次	U	P
败血症亚组	19	138.32	败血症对照亚组	201	107.87	1381.0	0.046
早产低体重亚组	50	114.80	早产低体重对照亚组	170	109.24	4035.0	0.587
新生儿肺炎亚组	151	111.90	新生儿肺炎对照亚组	69	107.43	4998.0	0.629
低血糖亚组	14	115.79	低血糖对照亚组	206	110.14	1368.0	0.748
溶血病亚组	20	102.60	溶血病对照亚组	200	111.29	1842.0	0.560
NRDS亚组	8	66.44	NRDS对照亚组	212	112.16	495.5	0.046
病理性黄疸亚组	81	100.14	病理性黄疸对照亚组	139	116.54	4790.0	0.065
颅内出血亚组	13	97.15	颅内出血对照亚组	207	111.34	1172.0	0.435
HIE亚组	29	113.24	HIE对照亚组	191	109.51	2661.0	0.767
窒息亚组	20	121.86	窒息对照亚组	200	108.39	1578.0	0.385
羊水污染亚组	62	112.56	羊水污染对照亚组	158	109.69	4770.0	0.764
胎膜早破亚组	44	119.11	胎膜早破对照亚组	176	108.35	3493.0	0.315
总计	220	?	总计	2129	?	?	?

表2 C－反应蛋白与血常规及生化主要指标的相关性比较

Table 2 Pearson correlation among CRP and main indicators of hepatic function, blood routine and biochemical

项目	WBC(×10⁹/L)	N(%)	L(%)	Plat(×10⁹/L)	Hct(%)	Hb(g/L)	ALT(U/L)	TBIL(μmol/L)	DBIL(μmol/L)	ALB(g/L)	Glu(mmol/L)
n	220	219	218	220	219	220	181	184	183	108	47
r	－0.007	0.049	－0.064	－0.027	－0.143	－0.149	0.109	－0.164	0.246	－0.174	0.316
P	0.915	0.470	0.346	0.688	0.034	0.027	0.146	0.026	0.001	0.072	0.031

表2 C－反应蛋白与血常规及生化主要指标的相关性比较

Table 2 Pearson correlation among CRP and main indicators of hepatic function, blood routine and biochemical

项目	WBC(×10⁹/L)	N(%)	L(%)	Plat(×10⁹/L)	Hct(%)	Hb(g/L)	ALT(U/L)	TBIL(μmol/L)	DBIL(μmol/L)	ALB(g/L)	Glu(mmol/L)
n	220	219	218	220	219	220	181	184	183	108	47
r	－0.007	0.049	－0.064	－0.027	－0.143	－0.149	0.109	－0.164	0.246	－0.174	0.316
P	0.915	0.470	0.346	0.688	0.034	0.027	0.146	0.026	0.001	0.072	0.031

表3 多重线性回归分析结果

Table 3 Multiple linear regression analysis results

Model	Unstandardizedcoefficients	?	Standardizedcoefficients	t	P	95% confidence interval for B
Model	B	Std.Error	Beta	t	P	Lower bound upper bound
Constant	－12.788	12.040	－	－1.062	0.295	－37.206～11.630
DBIL	1.436	0.408	0.477	3.517	0.001	0.608～2.265
Glu	5.017	2.184	0.311	2.297	0.028	0.588～9.445

表3 多重线性回归分析结果

Table 3 Multiple linear regression analysis results

Model	Unstandardizedcoefficients	?	Standardizedcoefficients	t	P	95% confidence interval for B
Model	B	Std.Error	Beta	t	P	Lower bound upper bound
Constant	－12.788	12.040	－	－1.062	0.295	－37.206～11.630
DBIL	1.436	0.408	0.477	3.517	0.001	0.608～2.265
Glu	5.017	2.184	0.311	2.297	0.028	0.588～9.445

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