肠道病毒感染与新生儿坏死性小肠结肠炎的相关性

Correlation between enterovirus infection and neonatal necrotizing enterocolitis

目的分析肠道病毒感染与新生儿坏死性小肠结肠炎(NEC)的相关性。方法抽取2020年2月至2022年5月于濮阳市妇幼保健院就诊的103例NEC新生儿为研究对象并设为NEC组,另抽取同期收治且一般资料与NEC组相匹配的80例非肠道疾病新生儿作为对照组。采集两组新生儿5 g粪便标本于采样管,应用核酸检测方式逆转录-聚合酶链反应(RT-PCR)和实时荧光逆转录聚合酶链反应(Real-Time RT-PCR)行病毒提取,采用荧光PCR技术与凝胶成像仪行病毒阳性鉴定。比较两组病毒检出情况,并按照病毒阳性、阴性对NEC组新生儿进行再次分组,比较阳性组与阴性组患儿的临床相关资料。结果NEC组病毒核酸检测阳性率(69.90%,72/103)与对照组(73.75%,59/80)比较差异未见统计学意义(P>0.05)。NEC组检出病毒前三位为星状病毒(ASV)、腺病毒(ADV)、博卡病毒(HBoV),阳性率分别为44.66%(46/103)、29.13%(30/103)、18.45%(19/103);对照组检出病毒前三位为ASV、诺如病毒(NV)、ADV,阳性率分别为46.25%(37/80)、28.75%(23/80)、7.50%(6/80)。两组ASV、EB病毒(EBV)检测阳性率比较差异未见统计学意义(P>0.05),NEC组ADV、HBoV检出阳性率高于对照组,NV检出阳性率低于对照组(P<0.05)。ADV(+)NEC患儿中C反应蛋白(CRP)水平≥8 mg/L、发生败血症者占比均高于ADV(-)NEC患儿(P均<0.05),EBV(+)NEC患儿中CRP≥8 mg/L者占比高于EBV(-)NEC患儿(P<0.05),NV(+)NEC患儿中CRP≥8 mg/L者占比低于NV(-)NEC患儿(P<0.05)。结论ASV为定植于肠道的常见病毒,ADV、EBV、HBoV、NV等病毒感染均与新生儿NEC机体炎症反应调控相关。ADV、EBV、HBoV感染可引发新生儿NEC且与其病情进展相关,NV则与NEC恢复相关。

Objective To analyze the correlation between enterovirus infection and neonatal necrotizing enterocolitis(NEC).Methods A total of 103 neonates with NEC treated in Puyang Maternal and Child Health Hospital from February 2020 to May 2022 were selected as research objects,as NEC group;while 80 neonates with non-intestinal diseases who were admitted at the same time and whose general data matched with the NEC group were selected as the control group.In the two groups,5 g fecal samples of newborns in the two groups were collected by sampling tube.Viruses were extracted by nucleic acid detection methods of reverse transcription polymerase chain reaction(RT-PCR)and real-time fluorescence reverse transcription polymerase chain reaction(Real-Time RT-PCR).And PCR was used for virus positive determination.The virus detection of the two groups were compared.According to results of virus positive detection,neonates in the NEC group were divided into positive group and negative group,and the clinical data were compared between the positive group and the negative group.Results There was no significant difference in positive rate of viral nucleic acid test between the NEC group(69.90%,72/103)and the control group(73.75%,59/80),P>0.05.In the NEC group,virus with the top three positive rates were astrovirus(ASV),adenovirus(ADV)and Boca virus(HBV),which were 44.66%(46/103),29.13%(30/103)and 18.45%(19/103)respectively;in the control group,virus with the top three positive rates were ASV,Norovirus(NV)and ADV,which were 46.25%(37/80),28.75%(23/80)and 7.50%(6/80),respectively.There was no significant difference in positive detection rates of ASV and Epstein-Barr virus(EBV)between the two groups(P>0.05).The positive detection rates of ADV and HBoV in the NEC group were higher than those in the control group,while positive detection rate of NV was lower than that in the control group(P<0.05).The proportion of CRP≥8 mg/L and sepsis in NEC children with ADV(+)were higher than those in NEC children with ADV(-),P<0.05.The proportion of CRP≥8 mg/L in NEC children with EBV(+)was higher than that in NEC children with EBV(-),all P<0.05.The proportion of CRP≥8 mg/L in NEC children with NV(+)was lower than that in NEC children with NV(-),P<0.05.Conclusions ASV is a common virus colonized in the intestinal tract.The infection of ADV,EBV,HBV,NV and other viruses are related to the regulation of inflammatory response in neonates with NEC.The infection of ADV,EBV and HBV can cause NEC in neonates and are related to the progress of the disease,while NV is related to the recovery of NEC.