血清HMGB1及PCT水平检测对新生儿坏死性小肠结肠炎诊断和病情评估的价值

Value of Serum HMGB1 and PCT Levels in Diagnosis and Evaluation of Neonatal Necrotizing Enterocolitis

目的探讨血清高迁移率族蛋白B1(high mobility group box protein 1,HMGB1)及降钙素原(procalcitonin,PCT)水平对新生儿坏死性小肠结肠炎(necrotizing enterocolitis,NEC)诊断和病情评估的价值。方法选取2017年1月~2020年3月海口市妇幼保健院收治的75例新生儿NEC作为病例组和60例健康新生儿作为对照组。75例NEC新生儿根据修正Bell分期分为Ⅰ期(n=28),Ⅱ期(n=37)和Ⅲ期(n=10),根据75例患儿30天的预后情况,将其分为存活组(n=58)和死亡组(n=17)。对照组于出生3天后、病例组于治疗前检测血清HMGB1及PCT水平变化。应用ROC曲线分析血清HMGB1及PCT水平对新生儿NEC诊断及病情评估的价值。结果病例组血清HMGB1(15.60±4.85μg/L vs 3.18±1.14μg/L)及PCT(1.74±0.92ng/ml vs 0.03±0.01 ng/ml)水平明显高于对照组(t=13.628,10.427,P<0.05)。死亡组血清HMGB1(24.50±7.13μg/L vs 9.24±3.18μg/L)及PCT(3.02±1.35ng/ml vs 0.85±0.38 ng/ml)水平明显高于存活组(t=16.217,12.308,P<0.05),差异均有统计学意义。Ⅱ~Ⅲ期血清HMGB1(20.16±6.37μg/L vs 10.54±3.20μg/L)及PCT(2.85±1.30 ng/ml vs 0.94±0.42 ng/ml)水平均明显高于Ⅰ期,差异均有统计学意义(t=8.263,7.624,均P<0.05)。ROC曲线分析显示,HMGB1及PCT两项联合诊断新生儿NEC的曲线下面积(0.872,95%CI:0.814~0.930)最大,其敏感度和特异度较高,分别为87.4%和83.5%。HMGB1及PCT两项联合预测新生儿NEC死亡的曲线下面积(0.893,95%CI:0.836~0.952)最大,其敏感度和特异度较高,分别为89.0%和86.4%。结论血清HMGB1及PCT水平在新生儿NEC中明显升高,且与患儿病情严重程度相关,两项联合检测对新生儿NEC诊断及病情评估具有一定价值。

Objective To explore the value of serum high mobility group box protein B1(HMGB1)and procalcitonin(PCT)levels in the diagnosis and disease assessment of neonatal necrotizing enterocolitis(NEC).Methods The 75 cases of neonatal NEC admitted to Haikou Maternal and Child Health Hospital from January 2017 to March 2020 were selected as case group and 60 healthy neonates as control group.75 NEC neonates were divided into I stage(n=28),II stage(n=37)and III stage(n=10)according to modified bell stage.According to the prognosis of 75 neonates at 30 days,they were divided into survival group(n=58)and death group(n=17).The changes of serum HMGB1 and PCT levels were detected before treatment in the case group and three days after birth in the control group.The value of serum HMGB1 and PCT levels in diagnosis and disease assessment of neonatal NEC was analyzed by ROC curve.Results The serum levels of HMGB1(15.60±4.85μg/L vs 3.18±1.14μg/L)and PCT(1.74±0.92ng/ml vs 0.03±0.01ng/ml)in the case group were significantly higher than those in the control group(t=13.628,10.427,P<0.05).The serum levels of HMGB1(24.50±7.13μg/L vs 9.24±3.18μg/L)and PCT(3.02±1.35ng/ml vs 0.85±0.38 ng/ml)in the death group were significantly higher than those in the survival group(t=16.217,12.308,P<0.05),the differences were statistically significant,respectively.The serum levels of HMGB1(20.16±6.37μg/L vs 10.54±3.20μg/L)and PCT(2.85±1.30ng/ml vs 0.94±0.42ng/ml)in II-III stage were significantly higher than those in I stage,the difference was statistically significant(t=8.263,7.624,all P<0.05).ROC curve analysis showed that the area under the curve(0.872,95%CI:0.814~0.930)of the combined diagnosis of HMGB1 and PCT for neonatal NEC was the largest,with a higher sensitivity and specificity of 87.4%and 83.5%.The area under the curve(0.893,95%CI:0.836~0.952)of HMGB1 and PCT combined to predict neonatal NEC death was the largest,with a higher sensitivity and specificity of 89.0%and 86.4%.Conclusion Serum levels of HMGB1 and PCT were significantly increased in neonatal NEC,and were related to the severity of the disease.The combined detection of HMGB1 and PCT was valuable for the diagnosis and disease assessment of neonatal NEC.