新生儿坏死性小肠结肠炎所致回肠穿孔不同手术方式对血清学标志物的影响

Effect of different treatments on serum markers of neonate with ileal perforation caused by necrotizing enterocolitis

目的总结新生儿坏死性小肠结肠炎（NEC）所致新生儿回肠穿孔不同手术方式中血清学标志物的特点，并分析其与预后之间的关系。方法将74例NEC所致新生儿回肠穿孔，分为存活组（n=57）和死亡组（n=17），并将74例非肠穿孔患儿作为对照组。对患儿的血清学标志物c一反应蛋白（CRP）、白细胞（WBC）、血小板（PLT）、血清降钙素原（PCT）、白蛋白、纤维蛋白原进行单因素分析，并对其采用Logistic回归进行多因素分析，计算OR及95％CI。结果74例NEC所致新生儿回肠穿孔患儿中62例完成手术治疗，12例放弃治疗。共死亡（含放弃治疗）17例，病死率为22．97％。病例对照研究显示，74例肠穿孔患儿血清学标志物中CRP、WBC、PLT、PCT、白蛋白与对照组比较差异均有统计学意义（P〈0．05）。单因素分析显示CRP、WBC、PI｜T、PCT与患儿手术方式相关；多因素logistic回归分析显示，WBC、PLT、PCT与患儿手术方式相关；存活组与死亡组WBC减少率、PLT减少率、患儿病死率比较差异有统计学意义（P〈0．05）。结论血清生物学标志物对于NEC所致新生儿回肠穿孔手术方式的选择有指导价值，血小板计数及白细胞计数减少预示着患儿可能预后不良。

Objective To summarize the characteristics of the biomarkers in the optimal methods of operation for the neonatal ileal perforation caused by the neonatal necrotizing enterocolitis and the prog- nosis. Methods Seventy four cases of neonatal ileal perforation caused by NEC were divided into survial group （n = 57 ）, death group （n = 17）. And 74 children with non-intestinal perforation were selected as control group. Serological markers include C-reactive protein （CRP）, white blood cells （WBC）, plate- lets （PLT）, serum procaleitonin （PCT）, albumin, fibrinogen were analyzed by univariate analysis. Lo- gistic regression was used to conduct multivariate analysis and calculate OR and 95% CI. Results Among the 74 cases of neonatal ileal perforation caused by NEC, there were 62 cases who com- pleted surgery, 12 cases who given up treatment. A total of seventeen cases died （ including the abandon- ment of treatment）. The death rate was 22. 97%. Case-control study showed that serological markers of neonates with ileal perforation including CRP, WBC, PLT, PCT, albumin were significantly different from those of the control group, the differences were significant （P 〈 0. 05 ）. Univariate analysis showed that CRP, WBC, PLT and PCT were correlated with the surgical method in children. Multivariate logistic regression analysis showed that WBC, PLT and PCT were correlated with the operation mode of children. And WBC reduction rate, PLT reduction rate and mortality in children was significantly different between survial group and death group （P 〈 0.05 ）. Conclusions Serum biological markers for neonatal ileal perforation caused by NEC has guiding value for the selection of surgical methods. Reduced platelet count and low white blood cell count indicates poor prognosis.