sICAM-1与suPAR联合检测对胎膜早破新生儿败血症的预测价值

早发型败血症（early onset neonatal septicemia ，

EONS ）是新生儿常见的急危重症，其发生率为0.77‰~

1.00‰，病死率高达24.4%[1]。有学者认为，胎膜早破导

傅潮琅

sICAM-1与suPAR 联合检测对胎膜早破新生儿败血症的预测价值

【摘要】目的

探讨可溶性细胞间黏附分子-1（sICAM-1）与可溶性尿激酶型纤溶酶原激活物受体（suPAR ）联合检测对胎膜

早破新生儿早发型败血症（EONS ）的预测价值。方法

选取足月新生儿为研究对象，其中胎膜早破（＞12h ）291例（发生EONS 31

例），健康对照147例。取新生儿娩出时脐动脉血2ml ，采用双抗体夹心ELISA 法检测sICAM-1及suPAR 水平。绘制ROC 曲线，并分析sICAM-1、suPAR 单独及联合检测对胎膜早破新生儿EONS 的预测价值。结果

胎膜早破组新生儿娩出时脐带动脉血sICAM

及suPAR 水平均明显高于健康对照组（均P ＜0.05）。胎膜早破时间＞18h 的新生儿脐动脉血sICAM 及suPAR 水平均明显高于≤18h 的新生儿（均P ＜0.05）。发生EONS 的胎膜早破新生儿脐动脉血sICAM 及suPAR 水平均高于未发生EONS 者（均P ＜0.05）。脐动脉血sICAM 及suPAR 水平预测EONS 诊断阈值为349.50、12.01μg/L 。以sICAM ＞349.50μg/L 与suPAR ＞12.01μg/L （联合）对EONS 进行预测，灵敏度为0.794，特异度为0.832，约登指数为0.626，阳性似然比为4.73，阴性似然比为0.25；其中特异度、约登指数、阳性似然比均高于两者单独检测，阴性似然比低于两者单独检测。结论

sICAM-1与suPAR 联合检测可作为早期诊断胎膜早破

新生儿EONS 的辅助实验室指标，有助于EONS 的早发现、早治疗，对改善患儿预后具有临床意义。

【关键词】可溶性细胞间黏附分子-1可溶性尿激酶型纤溶酶原激活物受体

胎膜早破

早发型新生儿败血症

Combined detection of sICAM-1and suPAR in predicting early-onset sepsis in neonates with premature rupture of membranes

China

【Abstract 】Objective

To assess the clinical value of combined detection of soluble intercellular adhesion molecule-1

(sICAM-1)and soluble urokinase type plasminogen activator receptor (suPAR)in predicting the occurrence of early-onset neonatal sepsis (EONS)in neonates with premature rupture of membranes.

Methods

Four hundred thirty-eight full-term

neonates born in our hospital were enrolled in the study,among whom there were 291cases of premature rupture of membranes and 147cases of healthy controls.and.The neonatal umbilical artery blood samples were taken during delivery,the sICAM-1and suPAR levels were detected with ELISA method.The value of combined detection of sICAM-1and suPAR in predicting EONS was analyzed with ROC curve.

Results

Compared with the healthy control group,the levels of sICAM and suPAR in the

umbilical artery blood were higher in the premature rupture group (P ＜0.05).The newborn babies with premature rupture of membranes ＞18h had higher sICAM-1and suPAR levels than those with premature rupture ≤18h (P ＜0.05).Among 291cases of premature rupture of membranes EONS occurred in 31cases,the sICAM and suPAR levels in EONS newborns were higher than those in non EONS newborns (P ＜0.05).Using sICAM ＞349.50μg/L and suPAR ＞12.01μg/L as cut-off values to predict EONS,the sensitivity was 0.794,the specificity was 0.832,the Youden index was 0.626,the positive likelihood ratio was 4.73,and the negative likelihood ratio was 0.25.The specificity,Youden index and positive likelihood ratio were all higher in combined detection than those in single detection while the negative likelihood ratio was lower.Conclusion

The combined detection of

sICAM-1and suPAR in neonatal umbilical arterial blood can be used as auxiliary laboratory index for diagnosis of EONS,which

may improve the prognosis of the newborns.

【Key words 】sICAM-1

suPAR

Premature rupture

Early-onset neonatal sepsis

doi ：10.12056/j.issn.1006-2785.2018.40.18.2018-587作者单位：315199

宁波明州医院新生儿科

通信作者：傅潮琅，E-mail ：fuchaolang8000@