内科

目的探讨根据绒毛膜羊膜炎孕妇早产患儿出生时的脐带血血清淀粉样蛋白A（SAA）和C反应蛋白（CRP）水平诊断新生儿败血症的效果。方法选取并发和不并发新生儿败血症的早产儿各120例分别作为观察组和对照组（其母亲均患有绒毛膜羊膜炎），检测比较两组患儿出生时脐带血SAA和CRP水平，分析根据SAA和CRP水平诊断新生儿败血症的敏感性、特异性、阳性预测值、阴性预测值，分析SAA和CRP水平与序贯器官功能衰竭评估（SOFA）评分以及小儿危重病例评分（PCIS）的相关性。结果观察组患儿脐带血的SAA、CRP水平均显著高于对照组，差异有统计学意义（P＜0.05）。根据患儿脐带血SAA水平诊断新生儿败血症的敏感性为88.3%，特异性为78.3%，阳性预测值为80.3%，阴性预测值为87.0%；根据患儿脐带血CRP水平诊断新生儿败血症的敏感性为 65.8%，特异性为41.7%，阳性预测值为53.0%，阴性预测值为54.9%；根据患儿脐带血SAA、CRP水平联合诊断新生儿败血症的敏感性为83.3%，特异性为69.2%，阳性预测值为73.0%，阴性预测值为80.5%。Pearson检验结果显示，患儿脐带血SAA、CRP水平与SOFA评分呈正相关（r=0.732，0.655），SAA、CRP水平与PCIS评分呈负相关（r=-0.722，-0.558）。结论根据患儿脐带血SAA、CRP水平联合诊断新生儿败血症能获得较好临床效果，同时也能对患儿病情的严重程度作出比较准确的判断，具有一定的临床应用价值。

ObjectiveTo investigate the effect in accordance with the levels of serum amyloid A (SAA) and C-reactive protein (CRP) in cord blood from premature infant of pregnant women with chorioamnitis diagnosing neonatal septicemia. Methods120 premature infants with complicating and non-complicating neonatal septicemia were selected respectively as the observation group and the control group (with their mother were suffered from chorioamnionitis), and the levels of SAA and CRP in cord blood at birth were compared between the two groups. To analyze the sensitivity, specificity, positive predictive value, negative predictive value of SAA and CRP levels for the neonatal septicemia diagnosis; meanwhile, analyzing correlations between SAA and CRP levels, sequential organ failure assessment (SOFA) scores and pediatric critical illness score (PCIS). ResultsThe SAA and CRP levels of cord blood in the observation group were significantly higher than the control group, with statistically significant difference (P＜0.05). Diagnosing neonatal septicemia in accordance with SAA level in cord blood, was the sensitivity in 88.3%, the specificity in 78.3%, the positive predictive value in 80.3%, and the negative predictive value in 87.0%, whereas to diagnose neonatal septicemia in accordance with CRP level in cord blood, was the sensitivity in 65.8%, the specificity in 41.7%, the positive predictive value in 53.0%, and the negative predictive value in 54.9%. In terms of the levels of SAA and CRP in cord blood for neonatal septicemia combined diagnosis, was the sensitivity in 83.3%, the specificity in 69.2%, the positive predictive value in 73.0%, and the negative predictive value in 80.5%. Pearson test results revealed that the levels of SAA and CRP in cord blood were positively correlated with SOFA score (r=0.732, 0.655), and the levels of SAA and CRP were negatively correlated with PCIS score (r=-0.722, -0.558). ConclusionIn accordance with the levels of SAA and CRP in cord blood, the combined diagnosis of neonatal septicemia can obtain a better clinical result, and it can also make a relatively accurate judgment on the severity of the disease, which has a certain clinical application value.