腹部超声对新生儿食物蛋白诱导的小肠结肠炎综合征与早期新生儿坏死小肠结肠炎的鉴别价值

The diagnostic value of abdominal ultrasound in the early differentiation of neonatal food protein-induced enterocolitis syndrome and neonatal necrotic enterocolitis

目的探讨腹部超声对新生儿食物蛋白诱导的小肠结肠炎综合征(NFPIES)与早期新生儿坏死小肠结肠炎(NEC)的鉴别诊断价值。方法选取确诊NFPIES患儿21例(NFPIES组)及早期NEC患儿48例(早期NEC组);收集患儿性别、胎龄、临床症状(呕吐、腹胀及血便)及出现临床症状8 h内的血嗜酸性粒细胞(EO)比例。所有患儿首次腹部超声检查时间为出现临床症状8 h内,腹部超声复查与首次检查间隔为8~24 h,动态比较患儿4个腹部超声征象(肠壁积气、肠蠕动、肠壁增厚及腹腔积液)的变化情况。结果 NFPIES组与早期NEC组患儿一般基线资料比较差异均无统计学意义。NFPIES组患儿外周血EO比例及EO比例≥0.05患儿的比例均显著高于早期NEC组(P<0.01)。NFPIES组中的腹部超声征象阳性患儿比例均低于早期NEC组(P<0.05),且其肠蠕动超声征象表现为病变部位肠蠕动减慢,余肠道蠕动正常,未出现肠蠕动消失及腹腔积液。复查腹部超声中,NFPIES组中肠壁积气、肠蠕动减慢超声征象阳性患儿比例较首次腹部超声检查均明显下降(P<0.05),而早期NEC组中4个腹部超声征象阳性患儿比例较首次检查差异无统计学意义。在复查腹部超声中,NFPIES组4个超声征象阳性患儿比例均低于早期NEC组(P<0.01)。结论腹部超声征象有助于鉴别NFPIES与早期NEC,且动态观察其变化意义更大。

Objective To explore the value of abdominal ultrasound in the differential diagnosis of neonatal food protein-induced enterocolitis syndrome(NFPIES) and early neonatal necrotic enterocolitis(NEC).Methods Twenty-one children diagnosed as NFPIES and early NEC(n=48) were selected in this study.Data of sex,gestational age,clinical symptoms(vomiting,abdominal distension and bloody stool) and the percentage of blood eosinophils(EO) within 8 hours of clinical symptoms were collected.The time of the first abdominal ultrasound examination of all children was within 8 hours of the occurrence of clinical symptoms,and the interval between the abdominal ultrasound examination and the first examination was 8-24 hours.The changes of abdominal ultrasound signs(intestinal wall pneumatosis,intestinal peristalsis,intestinal wall thickening and peritoneal effusion) were dynamically compared.Results There were no significant differences in general baseline data between the NFPIES group and the early NEC group.The proportion of peripheral blood EO and the proportion of children with EO ratio≥0.05 were significantly higher in the NFPIES group than those in the early NEC group(P<0.01).The proportion of children with positive abdominal ultrasound signs was lower in the NFPIES group than that in the early NEC group(P <0.05).The ultrasonographic signs of peristalsis showed slowing at the diseased site,and the remaining peristalsis was normal without peristalsis disappearance or peritoneal effusion.In the re-examination of abdominal ultrasound,the ultrasound signs of gas in the intestinal wall and slowing of bowel movement were significantly lower in the NFPIES group than those with positive abdominal ultrasound examination for the first time(P <0.05),while there was no significant difference in the proportion of four children with positive abdominal ultrasound signs in the early NEC group compared with the first examination.In the re-examination of abdominal ultrasound,the proportion of four children with positive ultrasound signs was lower in the NFPIES group than that in the early NEC group(P <0.01).Conclusion Abdominal ultrasound signs help to distinguish NFPIES from early NEC,and dynamic observation of its changes is of greater significance.