新生儿坏死性小肠结肠炎患儿血清肌酐水平的变化及临床意义

Changes and clinical significance of serum creatinine level in children with neonatal necrotizing enterocolitis

目的探讨血清肌酐(Scr)水平变化与新生儿坏死性小肠结肠炎(NEC)严重程度及预后的关系。方法回顾性收集2013年6月至2019年6月于苏州市立医院新生儿科就诊的NEC病例共160例,依据NEC Bell’s分期标准分为Ⅰ期74例(46.25%)、Ⅱ期36例(22.50%)和Ⅲ期50例(31.25%),并对各期患儿的一般资料、Scr水平变化、治疗预后情况进行统计分析。结果各期患儿的基线资料具有可比性(均P>0.05);NEC病程中Scr水平分别为Ⅰ期(36.13±14.59)μmol/L、Ⅱ期(45.98±28.23)μmol/L、Ⅲ期(55.51±31.55)μmol/L,Ⅲ期Scr水平显著高于Ⅰ期(F=4.68,P<0.05);NEC治愈后Scr水平均显著下降,分别为Ⅰ期(23.11±7.71)μmol/L、Ⅱ期(21.82±6.73)μmol/L、Ⅲ期(21.08±10.22)μmol/L,各期之间差别无统计学意义(P>0.05);未治愈出院患儿在NEC病程中Scr水平显著高于治愈出院者(t=3.16,P<0.05);病程中Scr水平与NEC严重程度分期呈正相关,与其预后呈负相关(r值分别为0.31、-0.32,均P<0.05)。结论NEC病程中Scr水平与其疾病严重程度相关,并在NEC预后评估中有一定的价值。

Objective To explore the relationship between the changes of serum creatinine(Scr)level and the severity and prognosis of neonatal necrotizing enterocolitis(NEC).Methods A total of 160 NEC cases treated in the Department of Neonatology of Suzhou Municipal Hospital from June 2013 to June 2019 were collected retrospectively.According to NEC Bell’s staging standard,NEC infants were divided into 74 cases(46.25%)in stageⅠ,36 cases(22.50%)in stageⅡand 50 cases(31.25%)in stageⅢ.The general data,changes of Scr level,and prognosis of treatment of children in each stage were statistically analyzed.Results The baseline data in each stage were comparable(all P>0.05).During the treatment of NEC,Scr levels were respectively as follows:stageⅠ(36.13±14.59)μmol/L,stageⅡ(45.98±28.23)μmol/L and stageⅢ(55.51±31.55)μmol/L.The Scr level in stageⅢwas significantly higher than that in stageⅠ(F=4.68,P<0.05).After NEC was cured,Scr levels were significantly decreased to the levels in stageⅠ(23.11±7.71)μmol/L,stageⅡ(21.82±6.73)μmol/L and stageⅢ(21.08±10.22)μmol/L,and no statistically significant difference was found in the three stages(P>0.05).The Scr level of uncured discharged children during NEC was significantly higher than that of cured discharges(t=3.16,P<0.05).Correlation analysis showed Scr level was positively correlated with NEC severity,and negatively correlated with its prognosis(r=0.31 and-0.32,respectively,both P<0.05).Conclusion The Scr level in the course of NEC is related to the severity of NEC,and has a certain value in the prognostic evaluation.