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山东大学学报（医学版） ›› 2015, Vol. 53 ›› Issue (6): 73-76.doi: 10.6040/j.issn.1671-7554.0.2014.471

• 临床医学 • 上一篇    下一篇

血清生物学标志物在新生儿坏死性小肠结肠炎手术评估中的价值

高南南1, 陈栋2, 于永慧1, 张丽丽3   

  1. 1. 山东大学附属省立医院新生儿科, 山东 济南 250021;
    2. 山东大学齐鲁儿童医院新生儿科, 山东 济南 250022;
    3. 聊城市东昌府人民医院儿科, 山东 聊城 252000
  • 收稿日期:2014-07-17 修回日期:2015-04-22 发布日期:2015-06-10
  • 通讯作者: 于永慧。 E-mail:alice20402@126.com E-mail:alice20402@126.com
  • 基金资助:
    山东省科技发展计划(2014GSF118110);山东省计生委科技计划(2014)

Significance of different biomarkers on assessing the surgical treatment of necrotizing enterocolitis in the newborn

GAO Nannan1, CHEN Dong2, YU Yonghui1, ZHANG Lili3   

  1. 1. Department of Neonatology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, Shandong, China;
    2. Department of Neonatology, Qilu Children's Hospital of Shandong University, Jinan 250022, Shandong, China;
    3. Department of Pediatrics, Liaocheng Dongchangfu People's Hospital, Liaocheng 252000, Shandong, China
  • Received:2014-07-17 Revised:2015-04-22 Published:2015-06-10

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摘要： 目的 探讨不同血清生物学标志物在新生儿坏死性小肠结肠炎(NEC)手术评估中的作用,以指导临床把握最佳手术时机。方法 应用巢式病例对照研究方法进行分析,对68例NEC患儿分为非手术组(n=33)与手术组(n=35),设对照组42例,以患儿入院日为研究起点,手术或死亡为终点。研究因素包括血清降钙素原(PCT)、C反应蛋白(CRP)、血小板、乳酸(Lac)、纤维蛋白原(Fib)、白蛋白、白细胞、pH值、血糖共9个变量,作病例对照、单因素分析,并采用Logistic回归进行多因素分析,计算OR及95%CI。结果 68例患儿中手术治疗共35例(51.47%),包括消化道穿孔29例,感染性休克5例,门静脉积气1例。共死亡12例,病死率为17.65%。病例对照研究显示,68例NEC患儿血清PCT、CRP、血小板、乳酸、白蛋白、白细胞、pH值、血糖与对照组差异有统计学意义,单因素分析显示与NEC手术治疗相关的变量为PCT、CRP、血小板、乳酸、白蛋白,经逐步引入剔除法建立Logistic回归模型,仍然与手术相关的变量为血小板计数和降钙素原。针对降钙素原检测值做ROC曲线分析,得出最佳界值为3.32 ng/mL,其敏感性为71.40%,特异性为81.80%,阳性预测值为80.60%,阴性预测值为72.90%。结论 血清生物学标志物对于NEC手术时机的选择有指导价值,血小板减低及降钙素原明显升高(≥3.32 ng/mL)预示着NEC需要手术治疗。

关键词: 坏死性小肠结肠炎, 生物学标志物, 外科手术, 降钙素原, 新生儿

Abstract: Objective To investigate the significance of different biomarkers in evaluating the necessity and the optimal time of operation for neonatal necrotizing enterocolitis (NEC). Methods A nest case control study was conducted, in which 68 neonates with NEC (NEC group) were divided into two groups, non-surgical group (n=33) and surgical group (n=35), another 42 healthy neonates without infectious disease were enrolled as control group. From the start of hospitalization, to surgery or death as the end point, 9 variables including procalcitonin (PCT), C-reactive protein (CRP), platelet (PLT), lactic acid (Lac), fibrinogen (Fib), albumin, white blood cell (WBC), pH and blood sugar were examined. Case control, univariate analysis, and logistic regression analysis were performed. OR and 95%CIwere calculated. Results Of the 68 patients with NEC, 35 (51.47%) required surgical treatment for digestive tract perforation (n=29), septic shock (n=5), and hepatic portal venous gas (n=1). The mortality was 17.65% (n=12). Case control study showed that PCT, CRP, platelet, lactic acid, albumin, WBC, pH and blood sugar of the NEC group were significantly different from those of the control group (P<0.05). Univariate analysis indicated that PCT, CRP, platelet, lactic acid and albumin were associated with surgical therapy (P<0.05). Logistic regression analysis showed that platelet and PCT were significantly relevant to surgical therapy (P<0.05). ROC curve showed the cut-off value of PCT was 3.32 ng/mL, sensitivity 71.40%, specificity 81.80%, positive predictive value 80.60% and negative predictive value 72.90%. Conclusion Serial changes in biomarkers may predict progression of NEC to surgery or death in neonates. Persistently low platelet count and significantly increased PCT value (≥3.32 ng/mL) indicated that the neonates with NEC required surgical treatment.

Key words: Biomarkers, Neonate, Procalcitonin, Surgery, Necrotizing enterocolitis

中图分类号: 

  • R722
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