新生儿坏死性小肠结肠炎血浆肠脂肪酸结合蛋白水平变化的意义

Significance of plasma intestinal fatty acid binding proteinlevel in neonatal necrotizing enterocolitis

目的探讨血浆肠脂肪酸结合蛋白(I-FABP)水平变化在指导新生儿坏死性小肠结肠炎(NEC)诊断及治疗中的意义。方法选择2011年5月至2012年12月我院新生儿科收治的患儿,按入院先后顺序,以明确诊断NEC的50例新生儿为NEC组,其中NECⅡ期30例,NECⅢ期20例,以非NEC新生儿50例为对照组。NEC组在确诊后24 h内、对照组在相应日龄取血,采用酶联免疫吸附法(ELISA)检测血浆I-FABP水平,根据NEC患儿病情转归分为存活组及病死组,按治疗方法分为保守治疗组和手术治疗组,比较不同组间血浆I-FABP水平、新生儿危重病例评分(NCIS)分值、脓毒症的发生率及病死率。结果 NECⅡ期组、NECⅢ期组和对照组血浆I-FABP水平分别为(95.6±18.5)μmol/L、(151.2±10.8)μmol/L和(1.2±2.3)μmol/L,组间比较差异有统计学意义(P<0.05);NECⅡ期组和NECⅢ期组NCIS评分明显低于对照组,脓毒症发生率和病死率均高于对照组,差异有统计学意义(P<0.05),NECⅡ期组和NECⅢ期组差异无统计学意义(P>0.05)。病死组血浆I-FABP水平、脓毒症发生率高于存活组,NCIS评分低于存活组;保守治疗组I-FABP水平低于手术治疗组,NCIS评分高于手术治疗组,差异均有统计学意义(P<0.05)。结论血浆I-FABP水平可较敏感地反映NEC患儿的病情变化,可作为预测NEC病情严重程度及指导采取内外科治疗的指标之一。

Objective To explore the significance of change in intestinal fatty acid binding protein （I-FABP） level in diagnosis and treatment of neonatal necrotizing enterocolitis （NEC）.Methods All infants enrolled in this study were recruited from NICU admissions of our hospital from May 2011 to December 2012.While 50 neonates with confirmed diagnosis of neonatal NEC （NEC Stage Ⅱ 30 cases,NEC stage Ⅲ 20 cases） were chosen for observation,50 infants without NEC were chosen as controls.Peripheral blood samples were obtained within 24 h of NEC confirmation and matched with blood samples from the infants of the same chronological ages in the control group.Plasma intestinal fatty acid binding protein （I-FABP） level was detected using enzyme-linked immunosorbent assay （ELISA）.Infants with NEC were divided into the Survival and Mortality groups based on the treatment outcomes; these infants were further divided into conservative and surgical intervention groups based on treatment methods.Plasma I-FABP level,neonatal critical illness score （NCIS）,incidence of sepsis and mortality rate were compared among the groups.Results Plasma I-FABP levels of the NEC Ⅱ,NEC Ⅲ and control groups were （95.6 ± 18） μmol/L,（151.2 ± 10） μmol/L and （1.2 ± 2.3） μmol/L respectively,with statistically significant differences （P 〈 0.05）.While infants with NEC had lower NCIS scores,higher incidence of sepsis and mortality rate than infants in the control group （P 〈 0.05）,no difference of NCIS scores was found between the stage Ⅱ ＆ Ⅲ NEC groups.Infants with mortality due to NEC had higher I-FABP levels,higher incidence of sepsis,and lower NCIS scores when compared with infants who survived （P 〈 0 05）.Comparing with infants in the surgical intervention group,those who received conservative treatment had lower plasma I-FABP levels,but higher NCIS scores （P 〈 0.05）.Conclusions Plasma I-FABP level is a sensitive marker throughout the disease course of NEC.I-FABP can be used as one of the severitypredictors of NEC in making clinical decisions of surgical vs.conservative treatment options.