CAL、S100A8、S100A9对新生儿败血症早期诊断及病情判断的临床价值

Clinical value of CAL, S100A8 and S100A9 in the early diagnosis and condition judgment of neonatal sepsis

摘要

目的 探讨血清钙卫蛋白(CAL)、钙结合蛋白A8(S100A8)、钙结合蛋白A9(S100A9)对新生儿败血症早期诊断及病情判断的临床价值。方法 选取2020年2月至2023年2月期间于本院就诊的118例新生儿败血症患儿作为研究对象,根据病情严重程度将其分为轻症组(n=76)和重症组(n=42),另选取同期健康新生儿64例作为对照组。采用酶联免疫吸附法测定各组血清CAL、S100A8和S100A9水平;比较轻、重症新生儿败血症患儿临床资料;Spearman法分析血清CAL、S100A8和S100A9水平与SNAP-Ⅱ评分之间的相关性;多因素Logistic回归分析重症新生儿败血症发生的影响因素;采用受试者工作特征(ROC)曲线分析血清CAL、S100A8和S100A9水平对早期新生儿败血症及病情严重程度的诊断价值。结果 对照组、轻症组、重症组患儿血清CAL、S100A8和S100A9水平递增(F=54.894、64.181、67.572,P<0.05);血清CAL、S100A8和S100A9水平联合诊断新生儿败血症的曲线下面积(AUC)为0.956,敏感度为86.44%;与轻症组相比,重症组患儿SNAP-Ⅱ评分、PCT、CRP水平更高,胎龄更低(t=23.398、6.239、7.783、4.457,P<0.05);血清CAL、S100A8和S100A9水平与SNAP-Ⅱ评分均呈正相关(rs=0.441、0.419、0.452,P<0.001);CAL、S100A8和S100A9为重症新生儿败血症发生的危险因素(OR=2.176、1.654、1.812,P<0.05);血清CAL、S100A8和S100A9水平联合诊断重症新生儿败血症的AUC为0.961,敏感度为95.24%。结论 血清CAL、S100A8和S100A9水平对新生儿败血症早期诊断及病情判断具有较高的临床价值。

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. Spearman's 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). 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.

关键词

钙卫蛋白 / 钙结合蛋白A8 / 钙结合蛋白A9 / 早期诊断 / 病情判断

Key words

calprotectin / calcium-binding protein A8 / calcium-binding protein A9 / early diagnosis / condition judgment

参考文献

[1] 杜晨, 徐征, 夏兰兰, 等. 新生儿脐血中Cyt-C和ELR及sTNFR-Ⅱ对早发型败血症发病风险的预测价值[J]. 中国妇幼健康研究, 2023, 34(8): 14-18.

[2] Dong G, Ma T, Xu Z, et al. Fibrinogen-to-Albumin Ratio in Neonatal Sepsis[J]. Int J Gen Med, 2023, 16: 4965-4972.

[3] Parke Å, Unge C, Yu D, et al. Plasma calprotectin as an indicator of need of transfer to intensive care in patients with suspected sepsis at the emergency department[J]. BMC Emerg Med, 2023, 23(1): 16.

[4] Russo A, Schürmann H, Brandt M, et al. Alarming and calming: opposing roles of S100A8/S100A9 dimers and tetramers on monocytes[J]. Adv Sci (Weinh), 2022, 9(36): e2201505.

[5] 田圆, 梁群, 潘郭海容, 等. 钙卫蛋白S100A8/A9在脓毒症发生发展中的作用机制[J]. 中国感染控制杂志, 2022, 21(11): 1143-1150.

[6] 赵聪, 王琳, 刘亚兰. 调节性T细胞在新生儿败血症诱发的免疫抑制中的作用及机制研究进展[J]. 华中科技大学学报(医学版), 2023, 52(3): 393-396.

[7] 中华医学会儿科学分会新生儿学组, 中国医师协会新生儿科医师分会感染专业委员会. 新生儿败血症诊断及治疗专家共识(2019年版)[J]. 中华儿科杂志, 2019, 57(4): 252-257.

[8] Richardson DK, Corcoran JD, Escobar GJ, et al. SNAP-Ⅱ and SNAPPE-Ⅱ: simplified newborn illness severity and mortality risk scores[J]. J Pediatr, 2001, 138(1): 92-100.

[9] Roca A, Camara B, Bognini JD, et al. Effect of intrapartum azithromycin vs placebo on neonatal sepsis and death: a randomized clinical trial[J]. JAMA, 2023, 329(9): 716-724.

[10] Boscarino G, Migliorino R, Carbone G, et al. Biomarkers of neonatal sepsis: where we are and where we are going[J]. Antibiotics (Basel), 2023, 12(8): 1233.

[11] Jethani S, Bhutani N, Yadav A, et al. Diagnostic utility of combined immature and total neutrophil counts along with C-reactive protein in early detection of neonatal sepsis: A cross-sectional study[J]. Ann Med Surg (Lond), 2022, 77: 103589.

[12] 张世杰, 孟宪春, 丁健生, 等. 降钙素原与白蛋白比值、单核细胞分布宽度、中性粒细胞与淋巴细胞比值和C-反应蛋白在新生儿败血症早期诊断及疾病严重程度预测中的价值[J]. 中国卫生检验杂志, 2023, 33(14): 1668-1672.

[13] Habib A, Raza S, Ali U, et al. Diagnostic accuracy of serum procalcitonin (PCT) as an early biomarker of neonatal sepsis using blood culture as gold standard[J]. J Coll Physicians Surg Pak, 2021, 31(4): 383-387.

[14] 高榕悦, 韩玉珍, 李文雄, 等. 钙卫蛋白与脓毒症关系研究进展[J]. 中国急救医学, 2022, 42(1): 87-91.

[15] Wang J, Chen G, Li L, et al. Sustained induction of IP-10 by MRP8/14 via the IFNβ-IRF7 axis in macrophages exaggerates lung injury in endotoxemic mice[J]. Burns Trauma, 2023, 11: tkad006.

[16] Lin C, Garcia-Gerique L, Bonner E E, et al. S100A8/S100A9 promote progression of multiple myeloma via expansion of megakaryocytes[J]. Cancer Res Commun, 2023, 3(3): 420-430.

[17] Zhan X, Wu R, Kong X H, et al. Elevated neutrophil extracellular traps by HBV-mediated S100A9-TLR4/RAGE-ROS cascade facilitate the growth and metastasis of hepatocellular carcinoma[J]. Cancer Commun (Lond), 2023, 43(2): 225-245.

[18] Nakatani A, Tsuda T, Maeda Y, et al. S100A8 enhances IL-1β production from nasal epithelial cells in eosinophilic chronic rhinosinusitis[J]. Allergol Int, 2023, 72(1): 143-150.

基金资助

河北省保定市科技计划项目(2341ZF389)