Relationship between hs-CRP，CCL2，CCL3 and Neonatal Bacterial Infection and Their Predictive Value for Efficacy
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摘要:
目的 探讨超敏C反应蛋白（hs-CRP）、趋化因子CC基序配体（CCL）、CCL3与新生儿细菌感染病情关系及疗效预测价值。 方法 选取2021年1月至2023年1月廊坊市人民医院收治的70例新生儿细菌感染患儿作为细菌感染组，另按照1∶1比例选取70例新生儿病毒感染患儿、70例非感染性新生儿分别作为病毒感染组、对照组。比较3组及细菌感染组不同病情程度患儿入院时血清hs-CRP、CCL2、CCL3，比较细菌感染组不同疗效患儿血清各指标，绘制受试者工作特征曲线（ROC）分析血清各指标对治疗效果预测效能，用相对危险度（RR）分析血清各指标不同表达对新生儿细菌感染治疗效果的影响。 结果 细菌感染组、病毒感染组入院时血清hs-CRP、CCL2、CCL3表达均高于对照组（P < 0.05）；细菌感染中重症患儿入院时血清hs-CRP、CCL2、CCL3表达高于轻症患儿（P < 0.05），入院时及入院24 h、第3 天、第5 天无效亚组血清hs-CRP、CCL2、CCL3表达均高于有效亚组（P < 0.05）；入院时及入院24 h、第3 天、第5 天血清hs-CRP、CCL2、CCL3联合预测新生儿细菌感染疗效价值优于各时间点的单一指标预测效能，其中入院24 h各指标联合预测AUC最大；以入院24 h各指标截断值为界分为高表达、低表达，hs-CRP、CCL2、CCL3高表达患儿治疗无效风险是低表达患儿的3.577倍、3.357倍、2.630倍。 结论 在新生儿细菌感染血清中hs-CRP、CCL2、CCL3高表达，且与患儿病情程度、治疗效果密切相关，3者血清各指标联合在预测患儿治疗效果中具有良好的参考价值。 Abstract:Objective To explore the application value of high-sensitivity C-reactive protein （hs-CRP）, chemokine CC motif ligand （CCL）, and CCL3 in the treatment of neonatal bacterial infections. Methods A total of 70 cases of neonatal bacterial infection admitted to the People's Hospital of Langfang City from January 2021 to January 2023 were selected as the bacterial infection group. In addition, 70 cases of neonatal viral infection and 70 cases of non-infected newborns were selected as the viral infection group and control group, respectively, at a ratio of 1∶1. The serum hs-CRP, CCL2, and CCL3 levels of the three groups and the bacterial infection group were compared at admission, the serum levels of each index were compared among the bacterial infection group with different therapeutic effects, and a receiver operating characteristic curve （ROC） was drawn to analyze the predictive efficacy of each serum index on therapeutic effects. The relative risk （RR） was used to analyze the impact of different expression of each serum index on the therapeutic effect of neonatal bacterial infection. Results The expressions of hs-CRP, CCL2 and CCL3 in the bacterial infection group and viral infection group at admission were higher than those in the control group （P < 0.05）. The expressions of hs-CRP, CCL2 and CCL3 in severe children with bacterial infection at admission were higher than those in mild children （P < 0.05）. The levels of hs-CRP, CCL2 and CCL3 in the ineffective subgroup were higher than those in the effective subgroup at admission, 24 h, 3rd day and 5th day （P < 0.05）. The combined effect of serum hs-CRP, CCL2 and CCL3 on neonatal bacterial infection at admission, 24 h, 3 d and 5 d was better than that of single index at each time point, and the combined prediction of AUC at 24 h was the largest. According to the cut-off value of each index 24 hours after admission, the risk of treatment failure in children with high expression of hs-CRP, CCL2 and CCL3 was 3.577 times, 3.357 times and 2.630 times higher than that in children with low expression. Conclusions hs-CRP, CCL2 and CCL3 are highly expressed in the serum of neonatal bacterial infection, and they are closely related to the severity of the disease and the therapeutic effect of the children. The combination of the three serum indicators has good reference value in predicting the therapeutic effect of the children. -
Key words:
- ROC curve /
- hs-CRP /
- Inflammatory chemokines /
- Neonatal bacterial infection /
- Therapeutic effect /
- Value
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表 1 3组一般资料比较[n/（$ \bar x \pm s $）]
Table 1. Comparison of general information among the three groups[n/（$ \bar x \pm s $）]
组别 n 男/女 日龄（d） 出生体质量（kg） 孕周（周） 细菌感染组 70 34/36 12.10±2.41 3.30±0.34 38.88±0.93 病毒感染组 70 38/32 12.58±2.20 3.25±0.40 38.92±1.02 对照组 70 41/29 12.37±1.89 3.37±0.35 39.10±1.15 F/χ2 1.418 0.855 1.917 0.893 P 0.492 0.427 0.150 0.411 
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表 2 3组血清各指标水平（$\bar x \pm s $）
Table 2. Serum levels of various indicators among the three groups （$\bar x \pm s $）
组别 n hs-CRP（mg/L） CCL2（pg/mL） CCL3（pg/mL） 细菌感染组 70 55.08±5.64 102.08±14.36 71.77±6.13 病毒感染组 70 53.91±6.95 100.92±15.15 70.84±6.65 对照组 70 12.12±3.30 69.62±8.89 56.65±5.58 F 1382.020 138.343 133.520 P <0.001* <0.001* <0.001* *P < 0.05。
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表 3 细菌感染组不同病情程度患儿血清各指标水平（$\bar x \pm s $）
Table 3. Serum levels of various indicators in children with different degrees of bacterial infection（$\bar x \pm s $）
组别 n hs-CRP（mg/L） CCL2（pg/mL） CCL3（pg/mL） 轻症 40 50.42±4.46 74.74±9.43 60.66±6.44 中重症 30 61.30±5.78 138.53±20.24 86.58±8.13 t −8.894 −17.580 −14.886 P <0.001* <0.001* <0.001* *P < 0.05。
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表 4 细菌感染组不同疗效患儿血清hs-CRP、CCL2、CCL3水平（$\bar x \pm s $）
Table 4. Serum hs-CRP，CCL2 and CCL3 levels in children with different therapeutic effects in bacterial infection group （$\bar x \pm s $）
项目 组别 n 入院时 入院24 h 入院第3 天 入院第5 天 出院当天 组间 时间点 交互 hs-CRP（mg/L） 无效亚组 20 59.62±5.13 65.65±6.42 55.54±4.46 30.32±3.18 15.22±3.38 F=8.924，
P < 0.001*F=7.658，
P < 0.001*F=11.324，
P < 0.001*有效亚组 50 56.66±4.48 58.12±4.38 45.03±4.15 24.46±3.35 14.41±4.05 CCL2（pg/mL） 无效亚组 20 126.64±34.80 130.32±36.18 110.11±20.24 88.86±9.79 73.35±5.54 F=6.512，
P < 0.001*F=8.741，
P < 0.001*F=7.580，
P < 0.001*有效亚组 50 92.26±18.18 93.24±17.76 86.79±10.16 80.42±8.89 72.79±6.64 CCL3（pg/mL） 无效亚组 20 90.94±20.88 99.53±24.41 87.74±8.12 70.74±6.63 55.24±5.20 F=8.118，
P < 0.001*F=10.321，
P < 0.001*F=9.087，
P < 0.001*有效亚组 50 64.10±9.44 65.24±10.13 79.42±6.38 60.12±5.38 54.26±5.38 *P < 0.05。
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表 5 血清各指标预测新生儿细菌感染疗效价值
Table 5. Value of serum indicators in predicting the therapeutic effect of neonatal bacterial infection
项目 AUC（95%CI） 截断值 特异度（%） 敏感度（%） P 入院时 hs-CRP （mg/L） 0.763（0.646～0.856） >57.08 80.00 72.00 <0.001* CCL2 （pg/mL） 0.787（0.673～0.876） >95.22 75.00 80.00 <0.001* CCL3 （pg/mL） 0.752（0.634～0.847） >74.69 80.00 62.00 <0.001* 3者联合 0.893（0.796～0.954） − 75.00 95.00 <0.001* 入院24 h hs-CRP （mg/L） 0.847（0.741～0.922） >63.22 75.00 90.00 <0.001* CCL2 （pg/mL） 0.805（0.693～0.890） >123.51 70.00 82.00 <0.001* CCL3 （pg/mL） 0.803（0.691～0.888） >83.22 90.00 64.00 <0.001* 3者联合 0.926（0.838～0.975） − 80.00 94.00 <0.001* 3者联合 0.926（0.838～0.975） − 80.00 94.00 <0.001* *P < 0.05。
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表 6 血清各指标不同表达对新生儿细菌感染疗效的影响
Table 6. The effect of different expressions of serum indicators on the therapeutic effect of neonatal bacterial infection
项目 n 无效 有效 U RR（95%CI） P hs-CRP （mg/L） 高表达 35 18 17 3.577 9.000（2.256～35.907） <0.001* 低表达 35 2 33 CCL2 （pg/mL） 高表达 30 16 14 3.357 5.333（1.986～14.326） <0.001* 低表达 40 4 36 CCL3 （pg/mL） 高表达 32 15 17 2.630 3.563（1.454～8730） <0.001* 低表达 38 5 33 *P < 0.05。
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