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目的通过分析新生儿脓毒症的临床特点,寻找其更实用的诊断标准。方法选择2008年6月-2009年6月因疑诊脓毒症入住本院的285例新生儿,对其中87例确诊脓毒症和160例非脓毒症新生儿的临床资料进行回顾性研究。采用χ2检验和Lo-gistic回归分析筛选与脓毒症相关的临床指标,所有阳性指标的总和计算非权重临床评分(UWCS),而每个指标评分的总和为权重临床评分(WCS)。结果与新生儿脓毒症显著相关的5个临床指标分别为脓毒症临床表现(OR=2.308,95%CI=1.054～5.098)、未成熟与总中性粒细胞比(I/T)(OR=3.414,95%CI=0.527～22.110)、CRP(OR=4.312,95%CI=1.497～12.420)、病理性黄疸(OR=10.301,95%CI=4.684～22.654)、心率(OR=18.837,95%CI=1.968～180.292)(Pa<0.05)。WCS和UWCS诊断标准ROC曲线下的面积分别是0.845(95%CI=0.791～0.900)和0.794(95%CI=0.731～0.856),二者差异无统计学意义(P=0.085)。现行新生儿脓毒症临床诊断标准、WCS标准最佳诊断界点(总WCS值=12或15)和UWCS标准最佳诊断界点(总UWCS值=2)的Youden指数分别为0.235、0.604和0.401。结论新生儿脓毒症显著相关的5个临床指标组成的WCS标准最佳诊断界点(总WCS值=12或15)和UWCS标准最佳诊断界点(总UWCS值=2)的诊断准确度,均高于现行临床诊断标准。但其是否能应用于临床诊断,尚需大样本实验研究证明其可行性。
Objective To analyze the clinical features of neonatal sepsis and find out its more practical diagnostic criteria. Methods A total of 285 newborns admitted to our hospital from June 2008 to June 2009 were retrospectively studied in 87 newly diagnosed sepsis and 160 non-sepsis neonates . The clinical indicators related to sepsis were screened byχ2 test and Lo-gistic regression analysis. The sum of all the positive indicators was calculated as the non-weighted clinical score (UWCS), and the sum of each indicator score was the weighted clinical score (WCS). Results The five clinical indexes significantly correlated with neonatal sepsis were clinical manifestations of sepsis (OR = 2.308, 95% CI = 1.054-5.098), immature and total neutrophil ratio (I / T) OR = 3.414, 95% CI = 0.527-22.110), CRP (OR = 4.312,95% CI = 1.497-12.420), pathological jaundice (OR = 10.301,95% CI = 4.684 ~ 22.654) , 95% CI = 1.968-180.292) (Pa <0.05). The areas under the ROC curve of the diagnostic criteria of WCS and UWCS were 0.845 (95% CI = 0.791-0.900) and 0.794 (95% CI 0.731-0.856, respectively), with no significant difference (P = 0.085). The current Youden index for the clinical diagnosis of neonatal sepsis, the WDS standard best diagnostic cutoff (total WCS = 12 or 15), and UWCS best diagnostic cutoff (total UWCS = 2) are 0.235, 0.604 and 0.401. Conclusions The diagnostic accuracy of the WCS standard best diagnostic point (total WCS value = 12 or 15) and UWCS best diagnostic standard point (total UWCS value = 2) composed of 5 clinical indicators of neonatal sepsis significantly correlated , Higher than the current clinical diagnostic criteria. However, whether it can be used in clinical diagnosis, large sample experimental studies need to prove its feasibility.