血红蛋白下降值对晚发型败血症早产儿继发坏死性小肠结肠炎的预测价值

Predictive value of hemoglobin decrease for necrotizing enterocolitis in preterm infants with late-onset sepsis

目的探讨血红蛋白(hemoglobin,Hb)下降值对晚发型败血症(late-onset sepsis,LOS)早产儿继发坏死性小肠结肠炎(necrotizing enterocolitis,NEC)的预测价值。方法收集93例LOS早产儿临床资料进行回顾性分析,其中继发NEC者16例,未继发NEC者77例。根据LOS发生前最近的一次Hb水平与LOS发病初期Hb水平的下降值,分为Hb未降低组(n=15)、Hb轻度下降组(Hb下降<15 g/L,n=35)、Hb重度下降组(Hb下降≥15 g/L,n=43)。采用多因素logistic回归分析探讨LOS继发NEC的预测因素,通过受试者操作特征曲线评估Hb下降值对LOS继发NEC的预测价值。结果Hb重度下降组、Hb轻度下降组和Hb未降低组NEC发生率分别为26%、14%和0%(P<0.05)。多因素logistic回归分析显示Hb下降值较大是LOS早产儿继发NEC的独立预测因素(OR=1.141,95%CI:1.061~1.277,P<0.001)。受试者操作特征曲线分析显示,Hb下降(临界值为20 g/L)预测LOS早产儿发生NEC的曲线下面积为0.803,灵敏度和特异度分别为0.69和0.78。结论Hb下降值可作为预测LOS早产儿继发NEC的指标。

Objective To study the predictive value of hemoglobin(Hb)decrease for the occurrence of necrotizing enterocolitis(NEC)in preterm infants with late-onset sepsis(LOS).Methods Clinical data of 93 LOS preterm infants were collected for retrospective analysis,among which 16 infants developed NEC while 77 infants did not.Based on the decrease in Hb levels from the most recent Hb measurement before LOS occurrence to the initial Hb levels during LOS,the infants were divided into three groups:no Hb decrease(n=15),mild Hb decrease(Hb decrease<15 g/L;n=35),and severe Hb decrease(Hb decrease≥15 g/L;n=43).Multivariate logistic regression analysis was conducted to explore the predictive factors for NEC secondary to LOS,and the value of Hb decrease in predicting NEC secondary to LOS was evaluated through receiver operating characteristic curve analysis.Results The incidence of NEC in the severe Hb decrease group,mild Hb decrease group,and no Hb decrease group were 26%,14%,and 0%(P<0.05),respectively.Multivariate logistic regression analysis revealed that a larger Hb decrease was an independent predictive factor for NEC in LOS preterm infants(OR=1.141,95%CI:1.061-1.277,P<0.001).Receiver operating characteristic curve analysis showed that the area under the curve for predicting NEC in preterm infants with LOS using Hb decrease(with a cut-off value of 20 g/L)was 0.803,with sensitivity and specificity of 0.69 and 0.78,respectively.Conclusions Hb decrease can serve as an indicator for prediction of NEC in preterm infants with LOS.