摘要
目的探讨新生儿急性生理学评分(SNAP-Ⅱ)、新生儿急性生理学围产期补充-Ⅱ(SNAPPE-Ⅱ)以及血大分子B淋巴细胞瘤蛋白(Bcl-xL蛋白)水平与新生儿脓毒症危重程度、病情变化的关系。方法选取诊断为脓毒症新生儿作为研究对象,根据严重程度分为脓毒症休克亚组(n=16)和脓毒症亚组(n=21),同时将同期非脓毒症的新生儿纳入为对照组(n=20)。对3组病例进行SNAP-Ⅱ评分、SNAPPE-Ⅱ评分以及血Bcl-xL蛋白水平检测,比较3组SNAP-Ⅱ评分、SNAPPE-Ⅱ评分以及血Bcl-xL蛋白水平差异,运用受试者工作特征(ROC)曲线来评估SNAP-Ⅱ评分、SNAPPE-Ⅱ评分以及血Bcl-xL蛋白水平在诊断脓毒症和诊断脓毒性休克的价值。结果脓毒症组和对照组一般情况差异无统计学意义(P>0.05)。脓毒症组新生儿血Bcl-xL水平(3.41±0.56)ng/mL,较对照组(0.82±0.54)ng/mL高,两组差异有统计学意义(P=0.004);脓毒症组中,脓毒症休克组Bcl-xL水平[(5.64(1.95,8.66)]ng/mL,高于脓毒症亚组[0.93(0.66,1.40)]ng/mL,差异有统计学意义(P<0.001)。采用Bcl-xL对脓毒症进行ROC曲线分析,ROC曲线下面积是75.0%,95%可信区间为61.8%~85.5%。在取Bcl-xL>0.759ng/mL时,其敏感度和特异度分别为75.7%和75.0%。采用Bcl-xL对脓毒症严重程度进行分析,Bcl-xL曲线下面积为83.0%,95%可信区间为67.1%~93.3%。Bcl-xL>3.022ng/mL,其敏感度和特异度分别为75.0%和95.2%。当取SNAP评分>10时,诊断脓毒性休克的敏感度为75.0%,特异度为100%,阳性预测值为100%,阴性预测值为84%。采用血Bcl-xL水平与SNAP-Ⅱ或者SNAPPE-Ⅱ联合诊断脓毒性休克的敏感度为93.8%,特异度为95.2%,阳性预测值93.8%,阴性预测值95.2%。结论血Bcl-xL蛋白水平可望作为早期诊断脓毒症、脓毒症休克的分子标记物,结合SNAP-Ⅱ或者SNAPPE-Ⅱ可以提高诊断的敏感度和特异度。
Objective To investigate the prognostic significance of SNAP-Ⅱ score, SNAPP-Ⅱ score and serum Bcl-xL level in neonatal sepsis. Methods Patients who were diagnosed with neonatal sepsis were enrolled in the study and divided to septic shock subgroup and sepsis subgroup. Newborns without sepsis were enrolled into control group. SNAP-Ⅱ score, SNAPPE-Ⅱ score and serum Bcl-xL level were performed. Receiver operating curve(ROC) analysis was performed to obtain the diagnostic value of SNAP-Ⅱ score, SNAPPE-Ⅱ score and serum Bcl-xL level. Results Thirty-seven newborns were enrolled in septic shock subgroup(n=16) and sepsis subgroup(n=21), and 20 newborns without sepsis were enrolled in control group. There was no significant difference in general situation among the 3 groups. Serum Bcl-xL level of newborns in sepsis subgroup(3.41±0.56 ng/mL) was significantly higher than control group(0.82±0.54 ng/mL, P=0.004);while it was significantly higher in septic shock subgroup(5.48±3.51 ng/mL) than sepsis subgroup(1.40±2.05 ng/mL, P<0.000 1). Compared with control group, the area under ROC in experimental group was 75.0%. When Bcl-xL level was more than 0.759 ng/mL, the sensitivity and specificity values were 75.7% and 75.0%, respectively. Compared with sepsis subgroup, the area under ROC of septic shock subgroup was less than 83.0%. When Bcl-xL level was more than 3.022 ng/mL, the sensitivity value was 75.0% and the specificity value was 95.2%. When the value of SNAP-Ⅱ score was more than 10, for the diagnosis of septic shock, the sensitivity value, the specificity value, the positive predictive value and the negative predictive value were 75.0%, 100%, 100% and 84%, respectively. For the diagnosis of septic shock with combined serum Bcl-xL level and SNAP-Ⅱscore or SNAPPE-Ⅱ score, the sensitivity value, the specificity value, the positive predictive value and the negative predictive value were 93.8%, 95.2%, 93.8% and 95.2%, respectively. Conclusion Serum Bcl-xL may be useful as biomarker for early diagnosis of
作者
吴文燊
彭琪
黄天丽
廖金凤
谭槟滢
李宁
WU Wen-shen;PENG Qi;HUANG Tian-li;LIAO Jin-feng;TAN Bing-ying;LI Ning(Department of Neonatology,Dongguan Eighth People's Hospital ( Dongguan Children's Hospital) ,Dongguan 523000,Guangdong,China)
出处
《广东医学》
CAS
2019年第12期1763-1767,共5页
Guangdong Medical Journal
基金
东莞市社会科技发展项目(编号:2015108101031)
