CAL、S100A8、S100A9對新生兒敗血癥早期診斷及病情判斷的臨床價值

［摘 要］目的 探討血清鈣衛蛋白（CAL）、鈣結合蛋白A8（S100A8）、鈣結合蛋白A9（S100A9）對新生兒敗血癥早期診斷及病情判斷的臨床價值。方法 選取2020年2月至2023年2月期間于本院就診的118例新生兒敗血癥患兒作為研究對象，根據病情嚴重程度將其分為輕癥組（n=76）和重癥組（n=42），另選取同期健康新生兒64例作為對照組。采用酶聯免疫吸附法測定各組血清CAL、S100A8和S100A9水平；比較輕、重癥新生兒敗血癥患兒臨床資料；Spearman法分析血清CAL、S100A8和S100A9水平與SNAP-Ⅱ評分之間的相關性；多因素Logistic回歸分析重癥新生兒敗血癥發生的影響因素；采用受試者工作特征（ROC）曲線分析血清CAL、S100A8和S100A9水平對早期新生兒敗血癥及病情嚴重程度的診斷價值。結果 與對照組相比，敗血癥患兒血清CAL、S100A8和S100A9水平均明顯升高（P＜0.05），且重癥組患兒血清CAL、S100A8和S100A9水平明顯高于輕癥組（P＜0.05），

對照組、輕癥組、重癥組患兒血清CAL、S100A8和S100A9水平遞增（F＝54.894、64.181、67.572，P＜0.05）；血清CAL、S100A8和S100A9水平聯合診斷新生兒敗血癥的曲線下面積（AUC）為0.956，敏感度為86.44%；與輕癥組相比，重癥組患兒SNAP-Ⅱ評分、PCT、CRP水平更高，胎齡更低（t=23.398、6.239、7.783、4.457，P＜0.05）；血清CAL、S100A8和S100A9水平與SNAP-Ⅱ評分均呈正相關（rs=0.441、0.419、0.452，P＜0.001）；CAL、S100A8和S100A9為重癥新生兒敗血癥發生的危險因素（OR=2.176、1.654、1.812，P＜0.05）；血清CAL、S100A8和S100A9水平聯合診斷重癥新生兒敗血癥的AUC為0.961，敏感度為95.24%。結論 血清CAL、S100A8和S100A9水平對新生兒敗血癥早期診斷及病情判斷具有較高的臨床價值。

［關鍵詞］鈣衛蛋白；鈣結合蛋白A8；鈣結合蛋白A9；早期診斷；病情判斷

Doi：10.3969/j.issn.1673-5293.2024.09.010

［中圖分類號］R174.1""" ［文獻標識碼］A

［文章編號］1673-5293（2024）09-0064-07

Clinical value of CAL，S100A8 and S100A9 in the early diagnosis and

condition judgment of neonatal sepsis

［Abstract］ Objective To explore the clinical value of serum calprotectin （CAL），calcium-binding protein A8 （S100A8），and calcium-binding protein A9 （S100A9） in the early diagnosis and condition judgment of neonatal sepsis. Methods 118 cases of neonatal sepsis patients who admitted to our hospital from February 2020 to February 2023 were regarded as the study subjects.According to the severity of condition，they were divided into mild illness group （n=76） and severe illness group （n=42），and another 64 healthy newborns were selected as the control group during the same period.Enzyme-linked immunosorbent assay （ELISA） was applied to measure the levels of serum CAL，S100A8 and S100A9 in each group.The clinical data of neonatal sepsis patients with mild and severe conditions were compared.Spearmans method was applied to analyze the correlation between serum CAL，S100A8 and S100A9 levels and SNAP-Ⅱ scores.Multivariate Logistic regression analysis was conducted to identify the influencing factors for the occurrence of severe neonatal sepsis.Receiver operating characteristic （ROC） curve was plotted to analyze the diagnostic value of serum CAL，S100A8 and S100A9 levels in early neonatal sepsis and the severity of the disease. Results Serum levels of CAL，S100A8 and S100A9 in control group，mild illness group and severe illness group were increased （F＝54.894，64.181 and 67.572，respectively，P＜0.05）. Compared with the control group，the serum levels of CAL，S100A8 and S100A9 in children with sepsis were significantly increased （P＜0.05），and the serum levels of CAL，S100A8 and S100A9 in the severe group were significantly higher than those in the mild group （P＜0.05）.The area under the curve （AUC） of the combined diagnosis of serum CAL，S100A8 and S100A9 levels for neonatal sepsis was 0.956，with a sensitivity of 86.44%.Compared with the mild group，patients in the severe group had significantly higher Score for Neonatal Acute Physiology Ⅱ （SNAP-Ⅱ score），procalcitonin （PCT） and C-reactive protein （CRP） levels and significantly lower gestational age （t=23.398，6.239，7.783 and 4.457，respectively，P＜0.05）.The levels of serum CAL，S100A8 and S100A9 were positively correlated with the SNAP-Ⅱ scores （rs=0.441，0.419 and 0.452，respectively，all P＜0.001）.CAL，S100A8 and S100A9 were identified as risk factors for the occurrence of severe neonatal sepsis （OR=2.176，1.654 and 1.812，respectively，P＜0.05）.The combined diagnosis of serum CAL，S100A8 and S100A9 levels for severe neonatal sepsis had an AUC of 0.961，with a sensitivity of 95.24%. Conclusion Serum levels of CAL，S100A8 and S100A9 have high clinical value for the early diagnosis and condition judgment of neonatal sepsis.

［Key words］ calprotectin;calcium-binding protein A8;calcium-binding protein A9;early diagnosis;condition judgment

新生兒敗血癥是指新生兒出生不到28天，機體由于病原體侵入，導致血液受到嚴重感染，早期可能會伴有嗜睡、喂養不良、易怒等，而隨著病情發展，患兒會出現發熱、低血壓、呼吸窘迫及休克癥狀，病情嚴重時會引發多器官功能衰竭，死亡風險大幅增加［1］。……