IP-10联合PCT和hs-CRP检测对新生儿感染性疾病的诊断价值

目的：探讨干扰素诱导蛋白-10(interferon-induced protein 10,IP-10)、降钙素原(procalcitonin, PCT)和超敏C反应蛋白(hypersensitive C-reactive protein,hs-CRP)检测在诊断新生儿感染性疾病中的价值。方法：对早期感染组69例（细菌感染组43例、病毒感染组26例）、对照组30例新生儿（非感染组,包括重度窒息、缺氧缺血性脑病等）,分别采用酶联免疫吸附试验、双抗夹心免疫化学发光法、免疫比浊法测定其入院时血中的IP-10、PCT和hs-CRP水平,感染组于治疗2 d后及治愈后重复检测。结果：细菌感染组患儿治疗前的血IP-10、PCT、hs-CRP水平分别为（89.39±23.09） pg/mL、（2.08±0.30） μg/L、（10.49±6.97） mg/L,而对照组分别为（42.03±14.80） pg/mL、（0.27±0.30） μg/L、（5.39±4.20） mg/L,提示细菌感染组这3项指标均明显高于对照组（P<0.05）;病毒感染组患儿治疗前的血IP-10水平（62.91±6.79） pg/mL,也高于对照组（P<0.05）,但较细菌感染组低（P<0.05）。细菌及病毒感染组治疗2 d后及治愈后血中的3项指标均明显降低,与治疗前比较,差异有统计学意义（P<0.05）。对3项单项检测及联合检测进行ROC曲线分析发现,IP-10诊断新生儿感染性疾病的灵敏度、特异度分别为92.3%和94.0%,PCT诊断新生儿感染性疾病的灵敏度、特异度分别为93.1%和89.2%,而hs-CRP诊断新生儿感染性疾病的灵敏度、特异度较前两者低,分别为65.5%和72.6%,将3项指标进行平行检测的诊断灵敏度、特异度更高,分别为95.6%和96.8%。结论：IP-10、PCT对诊断病程48 h内的早期细菌感染有较高的价值;IP-10对诊断病毒感染有一定价值;hs-CRP对鉴别新生儿感染与非感染的诊断价值低于IP-10和PCT。3项指标联合检测能进一步提高对新生儿感染的诊断价值。

Value of IP-10 combined with PCT and hs-CRP for the diagnosis of neonatal infection

Objective: To investigate the value of interferon-induced protein 10 (IP-10) combined with procalcitonin (PCT) and hypersensitive C-reactive protein (hs-CRP) for the diagnosis of neonatal infection. Methods: IP-10 was detected by enzyme-linked immunosorbent assay, PCT was detected by double antibody sandwich immune chemiluminescence method, and hs-CRP was detected by immunoturbidimetric assay. The serum levels of IP-10, PCT and hs-CRP of newborn infants were determined at admission in 69 cases with infection, including 43 cases of bacterial infection and 26 cases of viral infection, and in 30 cases of control group. The cases in infection group were also detected after 2 days of treatment and after being cured. Results: The levels of IP-10, PCT and hs-CRP in bacterial infection group before treatment were (89.39±23.09) pg/mL, (2.08±0.30) μg/L and (10.49±6.97) mg/L, respectively, significantly higher than that in the control group (42.03±14.80) pg/mL, (0.27±0.30) μg/L and (5.39±4.20) mg/L, respectively (P<0.05). The level of IP-10 in viral infection group before treatment (62.91±6.79 pg/mL) was also higher than that in the control group but lower than that in the bacterial infection group (P<0.05). After 2 days of treatment and after being cured, levels of all the three markers were significantly decreased than that before treatment in both the two infection groups (P<0.05). The ROC curve analysis for the single marker and combined 3 markers indicated that the sensitivity and specificity of IP-10 (92.3% and 94.0%) and PCT (93.1% and 9.2%) were high, while that of hs-CRP were lower (65.5% and 2.6%). The sensitivity and specificity were elevated when the 3 markers were combined (95.6% and 6.8%). Conclusions: IP-10 and PCT has a high value for predicting early bacterial infection, and IP-10 has a value for predicting viral infection. The value of hs-CRP for identifying neonatal infection is lower than that of IP-10 and PCT. The combination of the three markers further elevates the diagnostic value for detecting newborn infection.