近红外光谱检测rSO_(2)对新生儿坏死性小肠结肠炎诊断价值分析

Analysis of the value of detecting rSO_(2)with near-infrared spectroscopy in diagnosing neonatal necrotizing enterocolitis

目的分析探讨近红外光谱(NIRS)检测局部氧饱和度(Regional Oxygen Saturation,rSO_(2))在新生儿坏死性小肠结肠炎(Necrotizing Enterocolitis,NEC)临床诊断中的实用价值。方法选择2020年11月—2023年11月本院收治的46例诊断为坏死性小肠结肠炎的新生儿作为研究组;另选取同期46例非NEC新生儿作为对照组。使用NIRS监测仪检测研究组和对照组肠道rSO_(2)水平、用试剂盒检测两组患儿血清C-反应蛋白(C-Reactive Protein,CRP)水平,Spearman双变量分析法探究NIRS测定rSO_(2)浓度与血清CRP水平、Bell分期临床相关性;二元Logistic回归分析检验NIRS测定rSO_(2)浓度、CRP水平对NEC的影响;受试者工作曲线(Receiver Operating Characteristic,ROC)分析NIRS测定rSO_(2)浓度对NEC的预测价值。结果研究组和对照组患儿在性别、胎龄、体重和日龄等基本资料无明显差异(P>0.05)。研究组患儿Bell分期(Ⅰ、Ⅱ、Ⅲ期)rSO_(2)平均水平分别为(78.6±3.2)、(75.7±4.9)和(72.9±5.1);CRP值分别为(10.85±0.23)、(11.77±0.68)、(12.02±0.51),组间差异有统计学意义(P<0.05)。研究组患儿肠道rSO_(2)平均值为(77.5±3.8)%,和对照组(79.8±3.9)%相比明显降低(P<0.05),血清CRP较对照组高(P<0.05),Spearman双变量分析结果提示rSO_(2)浓度、血清CRP浓度间呈现线性负相关(r=-0.721,P<0.05),rSO_(2)浓度与Bell分期线性负相关(r=-0.784,P<0.05),血清CRP与Bell分期线性正相关(r=0.739,P<0.05)。二元Logistic回归分析结果显示,rSO_(2)浓度[OR(95%CI):3.114(1.127~5.102),P=0.008]、血清CRP水平[OR(95%CI):6.876(2.808~10.943),P=0.010]是NEC发生的危险因素(P<0.05);ROC曲线分析结果显示,rSO_(2)浓度联合CRP水平诊断NEC效果显著(AUC=0.870(0.791~0.950),P<0.001)。结论新生儿肠道rSO_(2)水平降低时,发生NEC的风险增加,进一步说明NIRS检测患儿肠道rSO_(2)可能有助于NEC的早期预测和诊断,对临床干预治疗提供参考数据。

Objective To explore the application value of detecting regional oxygen saturation(rSO_(2))with near-infrared spectroscopy(NIRS)in the clinical diagnosis of neonatal necrotizing enterocolitis.Methods A total of 46 infants who were admitted to the hospital and diagnosed with necrotizing enterocolitis(NEC)from November 2020 to November 2023 were selected as the study group,and another 46 neonates without NEC were selected as the control group.NIRS monitors were used to measure rSO_(2)levels,and enzyme-linked immunosorbent assay(ELISA)kits were used to measure C-reactive protein(CRP)levels in both groups.Spearman's bivariate analysis was employed to investigate the clinical correlation between NIRS-determined rSO_(2)concentration and serum CRP levels,as well as the Bell staging system.Binary logistic regression analysis was conducted to examine the impact of NIRS-determined rSO_(2)concentration and CRP levels on NEC.Receiver operating characteristic(ROC)curve analysis was performed to assess the predictive value of rSO_(2)concentration measured by NIRS for NEC.Results There were no significant differences in sex,gestational age,body weight and age between the two groups(P>0.05).The average rSO_(2)levels in different Bell stages(stageⅠ,ⅡandⅢ)were(78.6±3.2),(75.7±4.9)and(72.9±5.1).The levels of serum CRP were 10.85±0.23,11.77±0.68 and 12.02±0.51,respectively,and there was significant difference between groups(P<0.05).The mean value of rSO_(2)in the study group was(77.5±3.8)%,significantly lower than(79.8±3.9)%in the control group(P<0.05),and the serum CRP was higher than that in the control group(P<0.05).Spearman's bivariate analysis showed that there was a negative linear correlation between rSO_(2)concentration and serum CRP concentration(r=-0.721,P<0.05),and there was a linear negative correlation between rSO_(2)concentration and Bell stage(r=-0.784,P<0.05).Serum CRP was positively correlated with Bell's stage(r=0.739,P<0.05).Binary Logistic regression analysis showed that rSO_(2)concentration[OR(95%CI):3.114(1.127-5.102),P=0.008],serum CRP level[OR(95%CI):6.876(2.808~10.943),P=0.010]were risk factors of NEC occurrence(P<0.05).ROC curve analysis showed that rSO_(2)concentration combined with CRP level had a significant effect in the diagnosis of NEC(AUC=0.870(0.791-0.950),P<0.001).Conclusions The results of this study show that the risk of developing NEC is increased when the intestinal rSO_(2)level is decreased in neonates,further illustrating that the detection of intestinal rSO_(2)by NIRS may contribute to the early prediction and diagnosis of NEC,providing reference data for clinical intervention and treatment.