血清CRP和FC与尿I-FABP联合检测对早产儿肠道感染并发NEC的早期预测价值

Value of combined detection of serum CRP, FC and urine I-FABP in early prediction of NEC in premature infants with intestinal infection

目的 探讨血清C-反应蛋白(CRP)、粪钙卫蛋白(FC)和尿肠型脂肪酸结合蛋白(I-FABP)联合检测对早产儿肠道感染并发坏死性小肠结肠炎(NEC)的早期预测价值。方法 选择2018年1月-2021年3月南通大学附属妇幼保健院84例肠道感染的早产儿为病例组研究对象,根据是否并发NEC分为NEC组26例、非NEC组58例。选择同期无肠道感染的早产儿50例为对照组。病例组患儿在怀疑NEC 12 h内、24 h内、48 h,对照组于纳入研究后第2天检测血清CRP、尿I-FABP和粪FC水平。受试者工作特征曲线(ROC)分析上述指标对NEC的预测价值。结果 病例组胎龄、出生体质量均低于对照组(P<0.05),NEC组胎龄、出生体质量均低于非NEC组,病前喂养、肺炎、呼吸衰竭、感染性休克、低钠血症占比均高于非NEC组(P<0.05),NEC组不同时间CRP、尿I-FABP和粪FC水平均高于非NEC组和对照组(P<0.05),非NEC组与对照组比较差异无统计学意义;24 h内CRP、尿I-FABP和粪FC联合检测预测NEC的曲线下面积为0.902,灵敏度为0.924,特异度为0.880。结论 早产儿肠道感染并发NEC受胎龄、出生体质量、病前喂养等多种因素影响,NEC发病24 h血清CRP、尿I-FABP和粪FC水平明显升高,且对NEC的发生有较高的预测价值。

OBJECTIVE To explore the value of combined detection of serum C-reactive protein(CRP), fecal calmodulin(FC) and urine enterotype fatty acid binding protein(I-FABP) in early prediction of necrotizing enterocolitis(NEC) in preterm infants with intestinal infection. METHODS A total of 84 preterm infants with intestinal infection who were treated in the Affiliated Maternity and Child Health Care Hospital of Nantong University from Jan 2018 to Mar 2021 were assigned as the case group and were divided into the NEC group with 26 cases and the non-NEC group with 58 cases according to the status of NEC. Meanwhile, 50 preterm infants without intestinal infection were chosen as the control group. The levels of serum CRP, urine I-FABP and FC were detected for the case group within 12, 24 and 48 hours of suspicion of NEC and for the control group 2 days after enrollment. The predictive value of NEC was analyzed by receiver operating characteristic(ROC) curve. RESULTS The gestational age and birth weight of the case group were lower than those of the control group(P<0.05);the gestational age and birth weight of the NEC group were lower than those of the non-NEC group. The percentages of the preterm infants with pre-disease feeding, pneumonia, respiratory failure, septic shock and hyponatremia were higher in the NEC group than in the non-NEC group(P<0.05). The levels of CRP, urine I-FABP and FC of the NEC group were higher than those of the non-NEC group and the control group(P<0.05), there were no significant differences between the non-NEC group and the control group. The area under curve(AUC) of the combined detection of CRP, urine I-FABP and FC within 24 hours was 0.902 in prediction of NEC, the sensitivity 0.924, the specificity 0.880. CONCLUSION The NEC in the preterm infants with intestinal infection is affected by multiple factors such as gestational age, birth weight and pre-disease feeding. The levels of serum CRP, urine I-FABP and FC are remarkably elevated after onset of NEC for 24 hours, which has high value in prediction of NEC.