高铁血红蛋白在早期识别早产儿消化道症状相关性感染的临床价值

Clinical value of methemoglobin in early identification of gastrointestinal symptom-related infection in premature infants

目的 探讨高铁血红蛋白(MetHb)在消化道症状起病早产儿中,早期识别新生儿感染的价值。方法 选取2021年9月至2022年8月上海交通大学医学院附属上海儿童医学中心新生儿科就诊的住院期间以消化道症状起病的早产儿为研究对象,所有受试者均在起病的24 h内就诊,并在应用抗生素治疗前测定其C反应蛋白(CRP)、血清淀粉样蛋白A(SAA)、MetHb等相关指标。MaxMetHb定义为疾病活动期监测到的MetHb最高水平与血红蛋白的比值(%)。比较感染及非感染患儿的CRP、SAA、MaxMetHb等指标水平,采用受试者工作特性(ROC)曲线评价MaxMetHb及相关炎症指标早期识别新生儿感染的效能。结果 53例以消化道症状为首发表现的早产儿中,感染组29例,非感染组24例,两组患儿的相关消化道症状未见显著差异,提示早产儿感染的消化道症状缺乏特异性。辅助检查方面,感染组患儿的CRP、SAA、中性粒细胞百分比及MaxMetHb较非感染组显著升高,而嗜酸性粒细胞百分比显著降低,差异有统计学意义(P<0.05)。同时,感染组患儿的禁食时间、抗生素使用时间及特殊抗生素使用比例均明显高于非感染组,差异有统计学意义(P<0.001)。MaxMetHb可用于新生儿感染的早期鉴别,其最佳切点为1.6%,此时的敏感性、特异性和曲线下面积(AUC)分别为86.2%、62.5%和0.766,可成功判别75.5%(40/53)的消化道起病早产儿。若在MaxMetHb基础上联合CRP和中性粒细胞百分比,其敏感性、特异性和AUC可进一步提升至93.1%、87.5%和0.961,可以成功判别90.6%(48/53)的患儿。结论 MaxMetHb联合CRP和中性粒细胞百分比可用于消化道症状起病早产儿感染与否的早期评估。

Objective To investigate the value of methemoglobin(MetHb) in early identification of neonatal infection in premature infants with gastrointestinal symptoms at onset of the disease.Methods Premature infants who were hospitalized in the NICU from September 2021 to August 2022,with gastrointestinal symptoms at onset were included in this study.All the participants were admitted to our hospital within 24 hours of onset.The related indicators such as C-reactive protein(CRP),serum amyloid A(SAA) and MetHb were measured before antibiotic therapy.MaxMetHb(%) was defined as the ratio of the highest MetHb to hemoglobin monitored during active disease.The CRP,SAA and MaxMetHb between infected and non-infected neonates were compared.The receiver operating characteristic(ROC) curve was used to evaluate the efficacy of those indicators in early identification of neonatal infection.Results Among the 53 premature infants with gastrointestinal symptoms at onset,29 subjects were infected and the remaining 24 were non-infected.However,there was no significant difference in the gastrointestinal symptoms between those two groups,suggesting that gastrointestinal symptoms were not specific in premature infants with infection.Compared to those non-infected subjects,CRP,SAA,neutrophils%(Neu%) and MaxMetHb were significantly increased in those infected neonates,while the eosinophils% was significantly lower(all P<0.05).In addition,the fasting time,course of antibiotic use and special antibiotic use rate of infected neonates were significantly higher than those of the non-infected(all P<0.001).MaxMetHb could be used for the early identification of neonatal infection,with its optimal cut-off point being 1.6%,with sensitivity of 86.2%,specificity of 62.5%,and area under the curve(AUC) of 0.766,and 75.5%(40/53) subjects could be successfully identified.When combining CRP and Neu% with MaxMetHb,the sensitivity,specificity and AUC could be further improved up to 93.1%,87.5%,and 0.961,respectively,and 90.6% patients(48/53) could be successfully identified.Conclusion MaxMetHb,combined with CRP and Neu%,is considered to be a suitable indicator for early identification of neonatal infection for premature infants with gastrointestinal symptoms at onset.