SAA、NLR、CRP及PDW对新生儿坏死性小肠结肠炎手术时机的预测价值分析

Analysis of the Predictive Value of SAA,NFR,CRP and PDW on the Timing of Neonatal Necrotizing Enterocolitis Surgery

目的:探讨血清淀粉样蛋白A(SAA)、C反应蛋白(CRP)、外周血血小板分布宽度(PDW)及中性粒细胞/淋巴细胞比值(NLR)对新生儿坏死性小肠结肠炎(NEC)手术时机的预测价值。方法:选取2019年1月~2022年1月佛山市妇幼保健院收治的70例NEC患儿,根据治疗方式分为手术组35例和非手术组35例。收集NEC患儿临床资料,并检测两组患儿血清SAA、CRP、外周血PDW及NLR水平。采用单因素、多因素Logistic回归分析新生儿NEC手术的影响因素,受试者工作特征(ROC)曲线分析血清SAA、CRP、外周血PDW及NLR对新生儿NEC手术时机的预测价值。结果:手术组胎龄≥37周、诊断时体重>2500 g比例低于非手术组,诊断时体重1500~2500 g、精神反应差、腹胀、肠鸣音微弱比例和血清SAA、CRP、外周血PDW及NLR水平高于非手术组(均P<0.05)。多因素Logistic回归分析显示,诊断时体重>2500 g为新生儿NEC手术的独立保护因素,精神反应差、腹胀、肠鸣音微弱和血清SAA、CRP、外周血PDW及NLR水平升高为新生儿NEC手术的独立危险因素(均P<0.05)。ROC曲线分析显示,血清SAA、CRP、外周血PDW及NLR联合预测新生儿NEC手术时机的曲线下面积(AUC)大于各项指标单独预测。结论:血清SAA、CRP、外周血PDW及NLR水平升高与新生儿NEC手术密切相关,四项指标联合预测新生儿NEC手术时机的价值较高。

Objective:To investigate the predictive value of serum amyloid A(SAA),C-reactive protein(CRP),platelet distribution width(PDW)and neutrophil/lymphocyte ratio(NLR)for the timing of neonatal necrotizing enterocolitis(NEC)surgery.Methods:70 children with NEC who were admitted to Foshan Maternal and Child Health Hospital from January 2019 to January 2022 were selected,and they were divided into surgery group with 35 cases and non-surgery group with 35 cases according to treatment methods.Clinical data of children with NEC were collected,and the levels of serum SAA,CRP,peripheral blood PDW and NLR in the two groups were detected.Univariate and multivariate Logistic regression were used to analyze the influencing factors of neonatal NEC surgery.The predictive value of serum SAA,CRP,peripheral blood PDW and NLR on the timing of neonatal NEC surgery was analyzed by receiver operating characteristic(ROC)curve.Results:The gestational age≥37 weeks and the proportion of weight>2500 g at diagnosis in the surgery group were lower than those in the non-surgery group,the proportion of weight 1500~2500 g at diagnosis,poor mental response,abdominal distension,weak bowel sound and the levels of serum SAA,CRP,peripheral blood PDW and NLR were higher than those in the non-surgery group(all P<0.05).Multivariate Logistic regression analysis showed that weight>2500 g at diagnosis was an independent protective factor for neonatal NEC surgery,poor mental response,abdominal distension,weak bowel sound and increased levels of serum SAA,CRP,PDW and NLR were independent risk factors for neonatal NEC surgery(all P<0.05).ROC curve analysis showed that the area under the curve(AUC)of the combination of serum SAA,CRP,peripheral blood PDW and NLR in predicting the timing of neonatal NEC surgery was greater than that of each indicator alone.Conclusion:The increase levels of serum SAA,CRP,peripheral blood PDW and NLR are closely related to neonatal NEC surgery,and the combined value of these four indicators in predicting the timing of neonatal NEC surgery is higher.