外周血淋巴细胞绝对值对新生儿坏死性小肠结肠炎需手术治疗的预测作用

Predictive value of absolute lymphocyte count in peripheral blood for neonatal necrotizing enterocolitis

目的探讨外周血淋巴细胞绝对值对需手术治疗新生儿坏死性小肠结肠炎(necrotizing enterocolitis,NEC)的预测价值。方法收集2016年1月至2021年6月广州市妇女儿童医疗中心诊断为NEC(Bell分期Ⅱ期及以上)224例患儿的临床资料,其中男124例,女100例,检测发病时和发病后24 h的外周血淋巴细胞绝对值,<2.0×10^(9)/L的患儿分为淋巴细胞减少组,其余为淋巴细胞正常组。采用1∶1倾向评分匹配法匹配两组患儿的性别、出生胎龄、出生体重、发病日龄、发病前合并败血症比例、发病前输血比例等因素以均衡组间协变量。匹配后的数据进行logistic回归分析发病时淋巴细胞减少与需手术治疗之间的相关性,并绘制ROC曲线评估淋巴细胞绝对值预测NEC患儿需行手术治疗的诊断效能。结果纳入研究的NEC患儿共有224例,其中淋巴细胞减少组104例,淋巴细胞正常组120例。共84对完成倾向性评分匹配,匹配后两组间协变量达到基本平衡。发病时淋巴细胞减少是NEC患儿需手术治疗的危险因素(OR=2.750,95%CI:1.453~5.206)。发病时、发病后24 h淋巴细胞绝对值预测NEC患儿需手术治疗的ROC曲线下面积分别为0.704(95%CI:0.623~0.785)、0.786(95%CI:0.716~0.855),最佳截断值分别为1.23×10^(9)/L、2.10×10^(9)/L,灵敏度分别为42%、80%,特异度分别是93%、70%。结论发病时淋巴细胞减少是NEC患儿需手术治疗的危险因素,并且外周血淋巴细胞绝对值可作为NEC患儿需手术治疗的早期生物学标志物。

Objective:To explore the predictive value of absolute lymphocyte count in peripheral blood for neonatal necrotizing enterocolitis(NEC).Methods:From January 2016 to June 2021,the relevant clinical data were retrospectively reviewed for 224 children of NEC at Bell stage II or higher.There were 124 boys and 100 girls.Based upon whether or not absolute lymphocyte count was<2.0×10^(9)/L at an onset of NEC,they were assigned into two groups of lymphocytopenia(n=104)and normal lymphocyte(n=120).General profiles,absolute value of peripheral blood lymphocyte at onset(T0)and within 24h after onset(T1)were recorded.Propensity score matching(PSM)was utilized for balancing at a ratio of 1∶1.The matched data were analyzed by Logistic regression for exploring the relationship between lymphocytopenia and NEC.Receiver operating characteristic(ROC)curve was plotted for evaluating the diagnostic efficacy of absolute lymphocyte count in predicting NEC.Results:A total of 84 pairs completed propensity score matching and covariates between two groups were basically balanced after matching.Logistic regression analysis showed that lymphocytopenia at an onset of NEC was a risk factor of NEC(OR=2.750,95%CI 1.453-5.206).The area under the ROC curve of absolute value of T0 and T1 lymphocytes for predicting surgical need was 0.704(95%CI,0.623-0.785)and 0.786(95%CI,0.716-0.855).Optimal cut-off values were 1.23×10^(9)/L and 2.10×10^(9)/L.And sensitivity and specificity were 42%and 80%,93%and 70%.Conclusion:Lymphocytopenia at an onset of NEC is a risk factor of NEC.Absolute value of peripheral blood lymphocytes may be employed as an early biomarker for potients with NEC requiring surgery.It helps clinicians to early identify surgical NEC cases.