新生儿坏死性小肠结肠炎血清C反应蛋白、降钙素原、血小板活化因子、肠型脂肪酸结合蛋白表达水平及预后相关性研究

Expression levels of serum C reactive protein,procalcitonin,platelet activating factor,intestinal fatty acid binding protein and their correlation with prognosis in children with neonatal necrotizing enterocolitis

目的:探究新生儿坏死性小肠结肠炎(NEC)血清C反应蛋白(CRP)、降钙素原(PCT)、血小板活化因子(PAF)、肠型脂肪酸结合蛋白(I-FABP)表达水平及与患儿预后的相关性。方法:选择收治的60例NEC患儿(研究组)和40例健康新生儿(对照组)为对象。测定两组新生儿血清CRP、PCT、PAF、I-FABP水平,记录研究组患儿出生60 d内死亡数。ROC曲线法分析各血清指标在新生儿NEC诊断及不良预后预测中的价值。结果:研究组新生儿血清CRP、PCT、PAF、I-FABP含量均明显高于对照组(P<0.01);不同Bell分期NEC患儿血清CRP、PCT、PAF、I-FABP水平间比较差异具有统计学意义(P<0.01),Ⅱ期患儿高于Ⅰ期,Ⅲ期高于Ⅱ期(P<0.01)。血清CRP、PCT、PAF、I-FABP水平诊断新生儿NEC的最佳Cut-off值分别为5.836 mg/L、1.475 ng/ml、51.641μg/L、2.934 ng/ml,灵敏度为51.1%、76.1%、71.7%、78.3%,特异度为82.5%、87.3%、97.5%、92.6%。血清CRP、PCT、PAF、I-FABP水平预测新生儿NEC预后不良的ROC曲线下面积AUC分别为0.987(95%CI:0.967~1.000)、0.861(95%CI:0.763~0.969)、0.895(95%CI:0.816~0.975)、0.905(95%CI:0.827~0.983);灵敏度为61.5%、76.9%、92.3%、76.9%,特异度为96.2%、88.6%、86.1%、82.3%。结论:新生儿血清CRP、PCT、PAF、I-FABP在NEC发生早期即显著升高,且与患儿病情严重程度明显相关,可作为NEC早期诊断及预后的敏感性指标。

Objective:To investigate the expression levels of serum C reactive protein(CRP),procalcitonin(PCT),platelet activating factor(PAF),and intestinal fatty acid binding protein(I-FABP)and their correlation with prognosis in children with neonatal necrotizing enterocolitis(NEC).Methods:60 NEC children(research group)and 40 healthy newborns(control group)were selected as subjects.The levels of serum CRP,PCT,PAF,I-FABP in two groups were measured,and the number of deaths within 60 days of birth in the research group was recorded.ROC curve method was used to analyze the value of each serum index in neonatal NEC diagnosis and prediction of poor prognosis.Results:The levels of serum CRP,PCT,PAF and I-FABP in neonates in the research group were significantly higher than those in the control group(P<0.01).There were statistical differences in the levels of serum CRP,PCT,PAF and I-FABP in NEC children with different Bell stages(P<0.01),those in NEC children with stageⅡwere higher than those with stageⅠ,and those with stageⅢwas higher than those with stageⅡ(P<0.01).The best cut-off values of serum CRP,PCT,PAF and I-FABP for neonatal NEC diagnosis were 5.836 mg/L,1.475 ng/ml,51.641μg/L,2.934 ng/ml,and the sensitivity were 51.1%,76.1%,71.7%,78.3%,the specificity were 82.5%,87.3%,97.5%,92.6%,respectively.The areas under the ROC curve of serum CRP,PCT,PAF and I-FABP for predicting neonatal NEC prognosis were 0.987(95%CI:0.967-1.000),0.861(95%CI:0.763-0.969),0.895(95%CI:0.816-0.975),0.905(95%CI:0.827-0.983),and the sensitivity were 61.5%,76.9%,92.3%,76.9%,the specificity were 96.2%,88.6%,86.1%,82.3%,respectively.Conclusion:Neonatal serum CRP,PCT,PAF and I-FABP increase significantly in the early stage of NEC,and are significantly related to the severity of NEC,which can be used as a sensitivity indicator for early diagnosis and prognosis prediction of NEC.