肠型脂肪酸结合蛋白和超敏C反应蛋白联合检测在诊断新生儿坏死性小肠结肠炎中的意义

Significance of combined detection of intestinal fatty acid binding protein and hypersensitive C-reactive protein in the diagnosis of neonatal necrotizing enterocolitis

目的探讨肠型脂肪酸结合蛋白(I-FABP)和超敏C反应蛋白(hs-CRP)联合检测在新生儿坏死性小肠结肠炎(NEC)诊断中的意义。方法选取2015年4月～2017年6月在本院新生儿科住院确诊为NEC的患儿29例作为NEC组,选取同期确诊为败血症的患儿29例(排除合并NEC)作为败血症组,另选同期无NEC及败血症临床症状且由实验室确认无感染的32例新生儿作为对照组。采用酶联免疫吸附法分别检测三组血清I-FABP水平,同时采取动脉血标本送本院检验科检测hs-CRP水平,比较三组患儿24 h内I-FABP水平及不同时间hs-CRP水平。结果 NEC组I-FABP水平为(36.09±14.78)ng/ml,败血症组I-FABP水平为(22.49±14.36)ng/ml,对照组I-FABP水平为(11.08±7.85)ng/ml。NEC组I-FABP水平高于败血症组和对照组,败血症组I-FABP水平高于对照组,差异均有统计学意义(P<0.05)。NEC组24 h内、3 d、6 d hs-CRP水平分别为(24.09±36.26)、(12.26±10.38)、(3.58±3.67)mg/L;败血症组24 h内、3 d、6 d hs-CRP水平分别为(28.24±45.36)、(12.07±13.23)、(3.49±2.58)mg/L;对照组24 h内hs-CRP水平为(2.08±0.85)mg/L。NEC组与败血症组24 h内、3 d、6 d hs-CRP水平比较,差异均无统计学意义(P>0.05);NEC组与败血症组24 h内hs-CRP水平均高于对照组,差异有统计学意义(P<0.05);NEC组与败血症组24 h内、3 d hs-CRP水平均高于本组6 d, 24 h内hs-CRP水平高于本组3 d,差异均有统计学意义(P<0.05)。结论 I-FABP水平可能成为NEC早期诊断的一个预测指标,虽然hsCRP的特异性不高,但是其血清水平的连续监测却可以评估疾病的进展情况。

Objective To discuss the significance of combined detection of intestinal fatty acid binding protein(I-FABP) and hypersensitive C-reactive protein(hs-CRP) in the diagnosis of neonatal necrotizing enterocolitis(NEC). Methods A total of 29 neonates diagnosed as NEC in our hospital during April 2015 ~June 2017 were selected as NEC group, 29 neonates with sepsis diagnosed at the same time(excluding the combination of NEC) selected as the sepsis group, and 32 neonates without NEC and clinical symptoms of sepsis confirmed by laboratory as the control group. Enzyme-linked immunosorbent assay(ELISA) was used to detect the levels of serum I-FABP in three groups. Meanwhile, artery blood samples were sent to the laboratory of our hospital to detect the levels of hs-CRP. The I-FABP level within 24 h and hs-CRP at different times in three groups was compared. Results NEC group had I-FABP level as(36.09±14.78) ng/ml, which was(22.49±14.36) ng/ml in sepsis group, and(11.08±7.85) ng/ml in control group. Their difference was statistically significant(P<0.05).NEC group had hs-CRP level within 24 h, 3 d and 6 d respectively as(24.09±36.26),(12.26±10.38) and(3.58±3.67) mg/L, sepsis group had hs-CRP level reapectively as(28.24±45.36),(12.07±13.23) and(3.49±2.58) mg/L and control group had hs-CRP level within 24 h as(2.08±0.85) mg/L. NEC group and sepsis group had no statistically significant difference in hs-CRP within 24 h, 3 d and 6 d(P>0.05). NEC group and sepsis group had higher hs-CRP level within 24 h than the control group, and the difference was statistically significant(P<0.05). NEC group and sepsis group had higher hs-CRP level within 24 h and 3 d than those within6 d, and higher hs-CRP level within 24 h than those within 3 d. Their difference was statistically significant(P<0.05). Conclusion I-FABP level may be a predictor of early diagnosis of NEC. Although the specificity of hs-CRP is not high, continuous monitoring of its serum level can assess the progress of the disease.