| 摘要: |
| 目的:探究血清淀粉样蛋白 A(SAA)、白细胞介素-18(IL-18)联合检测对新生儿败血症伴急性器官功能障碍的判断价 值。 方法:选择我院就诊的 130 例新生儿败血症患儿作为败血症组,根据是否并发急性器官功能障碍分为无器官功能障碍组 (78 例)、器官功能障碍组(52 例)。 另选择同期 130 例同部位感染(非败血症)患儿纳入非败血症组,130 例体检健康新生儿作 为健康对照组。 检测新生儿败血症患儿病原菌分布情况;ELISA 法检测血清 SAA、IL-18 表达水平;Pearson 相关性评估血清水 平与临床严重程度指标的关系;多因素 logistic 回归分析影响器官功能障碍的因素;ROC 曲线分析判断价值。 结果:130 例患儿 分离出 126 株病原菌,其中革兰阴性菌占比为 49. 21%,革兰阳性菌占比 35. 71%,真菌占比 15. 08%;血清 SAA、IL-18 水平:健康 对照组<非败血症组<败血症组(P< 0. 05);与无器官功能障碍组相比,器官功能障碍组肌酐、胆红素、乳酸、白细胞(WBC)、 SAA、IL-18 水平均升高(P<0. 05);新生儿败血症患儿血清 SAA、IL-18 水平与乳酸、肌酐、胆红素、WBC 均呈正相关(P<0. 05); SAA、IL-18 高表达是影响器官功能障碍的独立危险因素(P<0. 05);血清 SAA、IL-18 水平单独诊断器官功能障碍的 AUC 分别为 0. 813、0. 829,二者联合诊断的 AUC 为 0. 940,优于二者单独诊断(Z 分别为 3. 606、3. 184,均 P<0. 05)。 结论:血清中 SAA、IL-18 水平升高与新生儿败血症病情严重程度密切相关,联合检测对识别败血症伴急性器官功能障碍具有较高的判断价值,但临床应 用中需要兼顾灵敏度与特异度的折中关系,避免片面追求单一指标。 |
| 关键词: 新生儿败血症 淀粉样蛋白 A 白细胞介素-18 病原菌 判断价值 |
| DOI：10.13407/j.cnki.jpp.1672-108X.2026.09.008 |
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| 基金项目:保定市科技计划项目,编号 2141ZF108。 |
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| Clinical Value of Combined Detection of Serum Amyloid A and Interleukin-18 in Neonatal Sepsis with Acute Organ Dysfunction |
| Zhen Weina, Li Fang, Wang Tianyi, Song Yiqin, Huo Xuerui |
| (Baoding Hospital, Beijing Children’ s Hospital, Capital Medical University, Hebei Baoding 071000, China) |
| Abstract: |
| Objective: To explore the diagnostic value of combined detection of serum amyloid A (SAA) and interleukin-18 (IL-18) in neonatal sepsis with acute organ dysfunction. Methods: Totally 130 cases of neonatal sepsis admitted into our hospital were extracted as the sepsis group. Based on the presence or absence of concurrent acute organ dysfunction, patients were divided into the group without organ dysfunction (78 cases) and the group with organ dysfunction (52 cases). Additionally, 130 children with infections at the same site (non-sepsis) during the same period were extracted as the non-sepsis group, and 130 healthy individuals who underwent physical examinations were extracted as the healthy control group. Distribution of pathogenic bacteria in neonatal septicemia patients were detected. The expression levels of serum SAA and IL-18 were detected by ELISA method. Pearson correlation was used to evaluate the correlation between serum levels and clinical severity indicators. Multivariate logistic regression analysis was performed to identify the factors influencing organ dysfunction. ROC curve was used to analyze the diagnostic value. Results: Totally 126 strains of pathogenic bacteria were isolated from 130 children, of which 49. 21% were Gram negative bacteria, 35. 71% were Gram positive bacteria, and 15. 08% were fungi. The levels of serum SAA and IL-18 in the healthy control group, the non-sepsis group, and the sepsis group increased significantly in sequence (P<0. 05). Compared with the group without organ dysfunction, the levels of creatinine, bilirubin, lactate, white blood cell (WBC), SAA, and IL-18 increased significantly in the group with organ dysfunction (P<0. 05). The levels of serum SAA and IL-18 in neonatal septicemia patients were positively correlated with lactate, creatinine, bilirubin, and WBC (P<0. 05). High expression of SAA and IL-18 was independent risk factor affecting organ dysfunction (P<0. 05). The AUC of levels of SAA and IL-18 for diagnosing organ dysfunction individually were respectively 0. 813 and 0. 829. The AUC of the combined diagnosis was 0. 940, which was superior to that of either one alone (Z = 3. 606 and 3. 184, P<0. 05). Conclusion: The elevated levels of SAA and IL-18 in serum are closely correlated with the severity of neonatal sepsis, and combined detection holds high diagnostic value in identifying sepsis accompanied by acute organ dysfunction. However, in clinical practice, a balance between sensitivity and specificity is required, the tendency to focus on a single indicator should be avoided. |
| Key words: neonatal sepsis amyloid A interleukin-18 pathogenic bacteria diagnostic value |
