粪便钙卫蛋白水平检测在极低出生体质量儿坏死性小肠结肠炎中的意义

Application of fecal calprotectin in diagnosing necrotizing enterocolitis of very low birth weight infants

目的探讨中性粒细胞源性粪便标志物粪便钙卫蛋白(FC)检测在极低出生体质量(VLBW)儿坏死性小肠结肠炎(NEC)诊断中的价值。方法选取2011年7月至2013年6月江苏省常州市儿童医院新生儿科和江苏省常州市妇幼保健院新生儿科收治的胎龄≥28孕周的35例有NEC表现的VLBW儿为研究对象,并纳入NEC组,按照是否确诊为NEC,将其进一步分为确诊NEC亚组(n=15)和疑似NEC亚组(n=20)。选择江苏省常州市儿童医院新生儿科和江苏省常州市妇幼保健院同期收治的30例喂养不耐受VLBW儿纳入喂养不耐受组(n=30),以及江苏省常州市妇幼保健院同期收治的无胃肠道症状且喂养情况良好的30例VLBW儿纳入对照组(n=30)。4组患儿性别构成比、平均胎龄、平均出生体质量等一般临床病历资料比较,差异无统计学意义(P>0.05)。本研究遵循的程序符合江苏省常州市儿童医院和江苏省常州市妇幼保健院人体试验委员会制定的伦理学标准,得到该委员会批准,分组征得受试对象监护人的知情同意,并与受试对象监护人签署临床研究知情同意书。对4组VLBW儿FC水平及大便隐血(OB)进行检测,并对4组VLBW儿FC水平及OB阳性检出率进行对比分析。结果确诊NEC亚组早期和极期FC水平较对照组FC水平明显升高,差异有统计学意义(t=6.62,8.44;P<0.05),确诊NEC亚组极期FC水平较早期和恢复期明显升高,且3者比较,差异有统计学意义(F=9.563,P<0.05),喂养不耐受组FC水平与对照组比较,差异无统计学意义(t=0.64,P>0.05)。确诊NEC亚组患儿极期OB阳性检出率和对照组比较,差异有统计学意义(χ2=15.469,P<0.05),确诊NEC亚组早期和恢复期分别与对照组比较,差异均无统计学意义(χ2=0.703,0.000;P>0.05)。疑似NEC亚组疑似期和恢复期及喂养不耐受组OB阳性检出率分别与对照组比较,差异均无统计学意义(χ2=2.000,0.000,0.185;P>0.05)。结论 FC水平检测比OB检测在NEC早期诊断方面具有更高灵敏度,可以作为VLBW儿NEC的诊断、严重程度判断及疗效预测的有效指标,同时还可以作为NEC与喂养不耐受患儿相鉴别的客观依据。

Objective To explore the diagnostic value of neutrophil-derived fecal marker fecal calprotectin（FC）in diagnosing necrotizing enterocolitis（NEC）for very low birth weight（VLBW）infants.Methods A total of 35 cases of VLBW infants with NEC symptoms who were gathered from Changzhou Children′s Hospital and Changzhou Maternal and Child Health Care Hospital between July 2011 to June2013were selected as NEC group.NEC group were further divided into diagnosed NEC sub-group（n=15）and suspected NEC sub-group（n=20）.Meanwhile,30 VLBW infants with feeding intolerance were selected into feeding intolerance group（n=30）,and 30 VLBW infants with normal milk-feeding and no gastrointestinal symptoms were selected into control group（n=30）.The study protocol was approved by the Ethical Review Board of Investigation in Human Being of Changzhou Children′s Hospital and Changzhou Maternal and Child Health Care Hospital.Informed consent was obtained from the parents of each participating child.The FC levels and occult blood（OB）were detected among different groups.And the FC levels and positive detection rates of OB among 4groups were compared.Results The FC levels in the early stage and critical stage of diagnosed NEC sub-group were higher than that of control group（t=6.62,8.44;P〈0.05）,and there was significant difference in the aspect of FC levels among early stages,critical stage and recovery stage in diagnosed group（F=9.563,P〈0.05）.There was no significant difference in the aspect of FC levels between feeding intolerance group and control group（t=0.64,P〉0.05）.Furthermore,there was significant difference in the aspect of positive detection rate of OB between critical stage in diagnosed NEC sub-group and control group（χ^2=15.469,P 0.05）,but there were no significant differences between early stage in diagnosed NEC sub-group and control group,recovery stage in diagnosed NEC sub-group and control group（χ^2=0.703,0.000;P〉0.05）.But there were no significant differences between suspected stage in suspected NEC sub-group and control group,recovery stage in suspected NEC sub-group and control group,feeding intolerance group and control group（χ^2=2.000,0.000,0.185;P〉0.05）.Conclusions Compared with fecal OB test,the examination of FC was more sensitive in diagnosing early-stage NEC.FC level can be considered as an effective index to diagnose and evaluate VLBW infants combined with NEC.It can also be used to distinguish NEC and feeding intolerance.