新生儿先天性巨结肠预测因素分析

Risk factors of neonate with congenital megacolon

目的 探讨新生儿先天性巨结肠诊断相关影响因素,为其早期诊治提供依据。方法 回顾性分析苏州大学附属儿童医院2015年7月至2019年12月收治的怀疑为新生儿先天性巨结肠并进行钡剂灌肠造影的107例新生儿的病例资料,并按照病理结果分组为病例组和对照组。比较病例组和对照组患者的一般资料,应用受试者操作特征曲线(receiver operator characteristic curve,ROC曲线)分析评价相关因素的诊断能力。结果 107例患儿中,确诊先天性巨结肠(病例组)共51例(男41例,女10例)。在单变量分析中,两组患者的呕吐、腹胀、胎粪排出延迟、钡剂灌肠及直肠指检结果比较均有显著性,多变量回归分析显示,钡剂灌肠结果(95%CI11.718~999.99)是先天性巨结肠诊断的独立影响因素,钡剂灌肠诊断新生儿先天性巨结肠的ROC曲线下面积为0.949,诊断灵敏度为92.2%,特异性为94.6%。结论 肠腔积气、直肠指检、呕吐、腹胀、24h无胎粪排出是先天性巨结肠的诊断相关因素,而钡剂灌肠是诊断新生儿先天性巨结肠的独立影响因素。

Objective To evaluate the predictive value of barium enema in the diagnosis of congenital megacolon. Method The clinical data of 107 infants admitted to the Children’s Hospital of Suzhou University from July 2015 to December 2019 were analyzed retrospectively, the patients were divided into case group and control group according to pathological results. The results were compared between case group and control group.Receiver operator characteristic curve ROC curve, analysis was used to determine the diagnostic ability of the relevant factors. Result Among the 107 children, 51 cases of congenital megacolon(case group) were diagnosed(41 males and 10 females). In univariate analysis,the results of vomiting, abdominal distention, delayed meconium excretion, barium enema and digital rectal examination were significantly compared between the two groups. Multivariate regression analysis showed that the results of barium enema(95%CI 11.718 ~ 999.99) were independent factors affecting congenital megacolon. The area under the ROC curve of barium enema in the diagnosis of neonatal congenital megacolon was 0.949, the diagnostic sensitivity was 92.2%, and the specificity was 94.6%.Conclusion Abdominal distension, vomiting, no meconium excretion in 24 hours, gas in intestinal cavity and bursting sensation after digital rectal examination are relevant factors in the diagnosis of congenita megacolon, and barium enema is an independent factor in the diagnosis of neonatal congenital megacolon.