Interleukin-6, calcitonin original and white blood cell in the diagnosis of neonatal intrauterine bacterial infection and guidance of antibiotics application
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摘要:
目的 探讨白介素-6（IL-6）、降钙素原（PCT）、白细胞在新生儿宫内细菌感染诊断和治疗过程中的价值。 方法 选取2014~2015年在中山市人民医院产科分娩且有宫内感染高危因素的新生儿，分为感染组（38例）和无感染组（162例），检测分析两组血清中IL-6、PCT、白细胞水平的灵敏度、特异度，并检测分析感染组抗生素使用前后IL-6、PCT、白细胞水平的变化。 结果 新生儿宫内感染组IL-6、PCT、白细胞水平均高于无感染组，差异有统计学意义（P<0.05），ROC曲线分析显示IL-6敏感度83.3%，PCT特异度84.2%，白细胞特异度91.2%；IL-6与PCT联合诊断敏感度为90.9%。新生儿宫内细菌感染组中IL-6、PCT、白细胞治疗前后差异有统计学意义（P<0.05）。 结论 IL-6、PCT、白细胞可以作为诊断新生儿宫内细菌感染重要指标，还可在病程监测中作为抗生素使用的指导性指标。 Abstract:Objective To investigate the value of interleukin 6 (IL-6), calcitonin (PCT) and white blood cell (WBC) in diagnosis and treatment of neonatal intrauterine bacterial infection. Methods Neonates with high risk factors of intrauterine infection in obstetrics department of Zhongshan People’s Hospital in 2014-2015 were chosed. They were divided into infection group (34 cases) and no infection group (102 cases). The sensitivity and specificity of serum IL-6, PCT and WBC levels in two groups were tested. Changes of IL-6, PCT and WBC levels before and after antibiotic application in infection group were analyzed. Results IL-6, PCT, the WBC levels in infection group were higher than that of no infection group (P<0.05). ROC curve showed: sensitivity of IL – 6 was 83.3%, specificity of PCT was 84.2%, specificity of WBC was 91.2%; sensitivity of IL-6 in combination with PCT was 90.9%. The differences of IL-6, PCT and WBC before and after treatment in infection group were significant (P<0.05). Conclusion IL-6, PCT and WBC can be used as an important index for the diagnosis of intrauterine bacterial infection, and used as a guideline for the use of antibiotics in the course of disease monitoring. -
Key words:
- interleukin-6 /
- calcitonin original /
- white blood cells /
- neonatus /
- intrauterine bacterial infection
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表 1 感染组与无感染组炎症指标比较（
$\, \overline{{x}}{{±}}{{s}}$ ）分组 IL-6（pg/mL） PCT（mg/mL） WBC（10–9/L） 感染组 235.6±399.0 9.3±29.6 17.09±6.2 无感染组 66.6±77.4 1.4±8.4 13.2±4.8 P 0.007 0.003 0.000 IL-6: 白介素-6; PCT: 降钙素原; WBC: 白细胞. 
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表 2 炎症指标在诊断宫内感染中的敏感性和特异性（%）
指标 WBC IL-6 PCT IL-6+WBC PCT+WBC IL-6+PCT 敏感性 37.5 83.3 45.8 89.6 66.1 90.9 特异性 91.2 52.6 84.2 48 76.8 44.3 阳性预测值 81 64 74 63 74 62 阴性预测值 59 76 61 82 69 83 WBC: 白细胞; IL-6: 白介素-6; PCT: 降钙素原.
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表 3 IL6、PCT、WBC在宫内细菌感染中预测价值的比较
炎症指标 95%CI 曲线下面积（%） 标准误 P 最佳截断点 阳性似然比 阴性似然比 白细胞 0.564~0.815 68.9 0.064 0.007 20.7 4.26 0.68 IL-6 0.577~0.813 69.5 0.065 0.012 33.45 1.76 0.32 PCT 0.550~0.805 67.8 0.060 0.006 0.531 2.9 0.64 WBC: 白细胞; IL-6: 白介素-6; PCT: 降钙素原.
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表 4 宫内细菌感染抗生素治疗前后比较（
$\, \overline{{x}}{{±}}{{s}}$ ）组别 治疗前 治疗后 P WBC 17.09±4.49 9.32±2.62 0.004 IL-6 248.31±221.91 40.36±86.18 0.001 PCT 0.31±0.28 0.26±0.17 0.002 WBC: 白细胞; IL-6: 白介素-6; PCT: 降钙素原.
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