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김천수 ( Kim Chun-Soo ) - 계명대학교 의과대학 소아과학교실
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Abstract
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신생아 집중치료술의 발달로 고위험 신생아의 생존
율은 향상되고 있지만 패혈증은 아직 신생아 사망의
주요 원인 중 하나로 남아 있다. 본 연구는 감염에 반
응하여 혈중에 증가되는 시기와 반응양상이 틀린 IL-
6와 CRP를 연속적으로 측정하여 신생아 패혈증을 조
기진단에 도움을 주는 지표를 규명하고자 2003년 1월
부터 2004년 6월까지 계명대학교 동산의료원 소아과
에 입원하였던 환아 중 패혈증 증상의 기간이 24시간
이하이며 실제 혈액 배양검사에서 균주가 동정된 환아
군(21례)과 대조군(20례)을 대상으로 시행하였다.
IL-6 검사는 0일차와 2일차에 각각 2mL의 혈액을
채취한 후 원심 분리하여 혈청을 얻은 후 -70℃의 질
소탱크에서 보관하였다가 면역분석 키트 이용하여 측
정하였고 cut-off치는 ROC curve fitting으로 결정하
였다. CRP 검사는 0, 2, 10일차에 혼탁면역분석법으
로 정량검사를 하였으며, 혈중 농도가 1.0㎎/dL 이상
인 경우를 증가한 것으로 판정하였다.
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Objectives : Neonatal sepsis remains a major cause of mortality in newborn infants. This study was undertaken to seach for parameters with interleukin-6(IL-6) and C-reactive protein(CRP) that could be helpful in the early diagnosis of neonatal sepsis.
Methods : Twenty one newborns with sepsis whose duration in the clinical symptoms was less than 24 hours after onset of infection were compared with 20 neonates who were ruled out infection as control. Serum IL-6 were sequentially checked using enzyme immunoassay kit on day 0 and 2. Also, CRP were sequentially checked by nephelometry on day 0, 2 and 10.
Results : Between sepsis and control group, demographic characteristics such as gestational age and birth weight were similar distribution. The common pathogens of sepsis in 21 patients were S. aureus(29%) and others such as C. albicans, K. pneumoniae, S. epidermidis, S. agalactiae etc. Level of IL-6 on day 0(150±158pg/mL) was significantly higher than day 2(34±27pg/mL) in the sepsis group(p＜0.005). Also, level of IL-6 on both day 0 and 2 in the sepsis group was significantly higher than the control group(p＜0.001). Level of CRP on day 2(4.2±3.6㎎/dL) was significantly higher than day 0(1.4±1.6㎎/dL) in the sepsis group(p＜0.005). Also, level of CRP on both day 0 and 2 in the sepsis group was significantly higher than the control group(p＜0.005) and level on day 10 was significantly lower with clinical improvement of sepsis than day 2(p＜0.001). IL-6 was superior to CRP on day 0, but CRP was superior to IL-6 on day 2 in the diagnostic validity, and combined use of IL-6 and CRP showed the most sensitivity and negative predictive value.
Conclusions : Serum IL-6 value is a sensitive parameter for diagnosis of neonatal sepsis at the early phase. Also, the combination and IL-6 and CRP considers to be a effective method for the early diagnosis.
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KeyWords
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interleukin-6, C-reactive protein, neonatal sepsis
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원문 및 링크아웃 정보
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등재저널 정보
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