肠道局部组织氧饱和度和C-反应蛋白在诊断早产儿坏死性小肠结肠炎中的价值

doi:10.7499/j.issn.1008-8830.2204047

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摘要目的探讨肠道局部组织氧饱和度（regional oxygen saturation，rSO₂）和C-反应蛋白（C-reactive protein，CRP）在早产儿坏死性小肠结肠炎（necrotizing enterocolitis，NEC）诊断中的临床价值。方法采用前瞻性观察性方法，选取2020年10月—2021年12月安徽医科大学附属省儿童医院住院的早产儿为研究对象，其中NEC组22例，非NEC组35例。NEC组在NEC确诊后24 h内监测肠道rSO₂，并于抗感染治疗前检测血清CRP水平；非NEC组对应时间点进行肠道rSO₂监测和血清CRP检测。比较2组肠道rSO₂和血清CRP水平的差异，并采用受试者工作特征曲线分析肠道rSO₂、血清CRP单独及二者联合诊断早产儿NEC的价值。结果 NEC组的肠道rSO₂低于非NEC组（P<0.05），血清CRP水平高于非NEC组（P<0.05）。受试者工作特征曲线分析显示：肠道rSO₂诊断早产儿NEC的最佳截断值为50.75%，灵敏度、特异度和曲线下面积（area under the curve，AUC）分别为81.8%、85.7%、89.4%；CRP诊断早产儿NEC的最佳截断值为12.05 mg/L，灵敏度、特异度和曲线下面积分别为72.7%、74.3%、74.8%；肠道rSO₂+CRP联合诊断的灵敏度、特异度和曲线下面积分别为90.9%、77.1%、91.9%。肠道rSO₂诊断NEC的AUC高于CRP（P<0.05）；肠道rSO₂+CRP联合诊断NEC的AUC与单独肠道rSO₂比较差异无统计学意义（P>0.05）。结论肠道rSO₂诊断早产儿NEC的价值高于CRP，且与肠道rSO₂联合CRP诊断早产儿NEC价值相当。

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关键词 ：坏死性小肠结肠炎, 局部组织氧饱和度, 近红外光谱, C-反应蛋白, 早产儿

Abstract：Objective To study the clinical value of intestinal regional oxygen saturation (rSO2) and C-reactive protein (CRP) in the diagnosis of necrotizing enterocolitis (NEC) in preterm infants. Methods A prospective observational study was conducted among the preterm infants who were hospitalized in Children's Hospital Affiliated to Anhui Medical University, from October 2020 to December 2021, with 22 infants in the NEC group and 35 infants in the non-NEC group. Intestinal rSO2 was monitored 24 hours after a confirmed diagnosis of NEC in the NEC group, and serum CRP levels were measured before anti-infection therapy. In the non-NEC group, intestinal rSO2 monitoring and serum CRP level measurement were performed at the corrospording time points. The two groups were compared in terms of intestinal rSO2 and serum CRP level. The receiver operating characteristic (ROC) curve was used to analyze the value of intestinal rSO2 alone, serum CRP alone, and intestinal rSO2 combined with CRP in the diagnosis of NEC in preterm infants. Results Compared with the non-NEC group, the NEC group had a significantly lower level of intestinal rSO2 (P<0.05) and a higher serum CRP level (P<0.05). The ROC curve analysis showed that intestinal rSO2 had an optimal cut-off value of 50.75% in the diagnosis of NEC in preterm infants, with a sensitivity of 81.8%, a specificity of 85.7%, and an area under the ROC curve (AUC) of 89.4%; CRP had an optimal cut-off value of 12.05 mg/L in the diagnosis of NEC in preterm infant, with a sensitivity of 72.7%, a specificity of 74.3%, and an AUC of 74.8%; intestinal rSO2 combined with CRP had a sensitivity of 90.9%, a specificity of 77.1%, and an AUC of 91.9% in the diagnosis of NEC. The AUC of intestinal rSO2 alone in the diagnosis NEC was higher than that of CRP (P<0.05). There was no significant difference in the AUC between intestinal rSO2 alone and intestinal rSO2 combined with CRP (P>0.05). Conclusions The value of intestinal rSO2 in the diagnosis NEC is higher than that of CRP, and is equivalent to that of the combination of intestinal rSO2 and CRP in preterm infants.

Key words： Necrotizing enterocolitis Regional oxygen saturation Near-infrared spectroscopy C-reactive protein Preterm infant

收稿日期: 2022-04-09

基金资助:中央医疗服务与保障能力提升项目（Z155080000004）。

通讯作者: 戴立英，女，主任医师。Email：dailiying200@sina.com。 E-mail: dailiying200@sina.com

作者简介: 接双双，女，硕士研究生；

引用本文:

接双双,戴立英,张健等. 肠道局部组织氧饱和度和C-反应蛋白在诊断早产儿坏死性小肠结肠炎中的价值[J]. 中国当代儿科杂志, 2022, 24(11): 1202-1206.

JIE Shuang-Shuang,DAI Li-Ying,ZHANG Jian et al. Value of intestinal regional oxygen saturation and C-reactive protein in the diagnosis of necrotizing enterocolitis in preterm infants[J]. CJCP, 2022, 24(11): 1202-1206.

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	Hunter CJ, Upperman JS, Ford HR, et al. Understanding the susceptibility of the premature infant to necrotizing enterocolitis (NEC)[J]. Pediatr Res, 2008, 63(2): 117-123. PMID: 18091350. DOI: 10.1203/PDR.0b013e31815ed64c.
	Palleri E, Wackernagel D, Wester T, et al. Low splanchnic oxygenation and risk for necrotizing enterocolitis in extremely preterm newborns[J]. J Pediatr Gastroenterol Nutr, 2020, 71(3): 401-406. PMID: 32404748. DOI: 10.1097/MPG.0000000000002761.
	Lin X, Zeng HP, Fang YF, et al. Predictive indicators for necrotizing enterocolitis with the presence of portal venous gas and outcomes of surgical interventions[J]. Front Pediatr, 2021, 9: 683510. PMID: 34195163. PMCID: PMC8238085. DOI: 10.3389/fped.2021.683510.
	Duci M, Fascetti-Leon F, Erculiani M, et al. Neonatal independent predictors of severe NEC[J]. Pediatr Surg Int, 2018, 34(6): 663-669. PMID: 29644455. DOI: 10.1007/s00383-018-4261-1.
	Patel AK, Lazar DA, Burrin DG, et al. Abdominal near-infrared spectroscopy measurements are lower in preterm infants at risk for necrotizing enterocolitis[J]. Pediatr Crit Care Med, 2014, 15(8): 735-741. PMID: 25068253. DOI: 10.1097/PCC.0000000000000211.
	van der Heide M, Hulscher JBF, Bos AF, et al. Near-infrared spectroscopy as a diagnostic tool for necrotizing enterocolitis in preterm infants[J]. Pediatr Res, 2021, 90(1): 148-155. PMID: 33036017. DOI: 10.1038/s41390-020-01186-8.
	Schat TE, Schurink M, van der Laan ME, et al. Near-infrared spectroscopy to predict the course of necrotizing enterocolitis[J]. PLoS One, 2016, 11(5): e0154710. PMID: 27183233. PMCID: PMC4868291. DOI: 10.1371/journal.pone.0154710.
	8 陈超, 杜立中, 封志纯. 新生儿学[M]. 北京: 人民卫生出版社, 2020: 165-168.
	Bowker RM, Yan X, De Plaen IG. Intestinal microcirculation and necrotizing enterocolitis: the vascular endothelial growth factor system[J]. Semin Fetal Neonatal Med, 2018, 23(6): 411-415. PMID: 30213591. DOI: 10.1016/j.siny.2018.08.008.
	Bruckner M, Pichler G, Urlesberger B. NIRS in the fetal to neonatal transition and immediate postnatal period[J]. Semin Fetal Neonatal Med, 2020, 25(2): 101079. PMID: 32007425. DOI: 10.1016/j.siny.2020.101079.
	Harer MW, Adegboro CO, Richard LJ, et al. Non-invasive continuous renal tissue oxygenation monitoring to identify preterm neonates at risk for acute kidney injury[J]. Pediatr Nephrol, 2021, 36(6): 1617-1625. PMID: 33389091. DOI: 10.1007/s00467-020-04855-2.
	谈娅娟, 谭从容, 唐敏, 等. 小剂量多巴胺辅助治疗对坏死性小肠结肠炎早产儿炎症因子及预后的影响[J]. 中国当代儿科杂志, 2020, 22(2): 136-140. PMID: 32051080. PMCID: PMC7390005. DOI: 10.7499/j.issn.1008-8830.2020.02.010.
	Cetinkaya M, Ozkan H, K?ksal N, et al. Comparison of the efficacy of serum amyloid A, C-reactive protein, and procalcitonin in the diagnosis and follow-up of necrotizing enterocolitis in premature infants[J]. J Pediatr Surg, 2011, 46(8): 1482-1489. PMID: 21843712. DOI: 10.1016/j.jpedsurg.2011.03.069.
	Kordasz M, Racine M, Szavay P, et al. Risk factors for mortality in preterm infants with necrotizing enterocolitis: a retrospective multicenter analysis[J]. Eur J Pediatr, 2022, 181(3): 933-939. PMID: 34636956. PMCID: PMC8897343. DOI: 10.1007/s00431-021-04266-x.
	汪莉, 倪申旺, 朱克然, 等. C-反应蛋白、降钙素原在新生儿坏死性小肠结肠炎患儿的水平变化及临床意义[J]. 中国当代儿科杂志, 2018, 20(10): 825-830. PMID: 30369357. PMCID: PMC7389044. DOI: 10.7499/j.issn.1008-8830.2018.10.008.
	16 尹琳琳, 蒋林, 赵婧, 等. 新生儿坏死性小肠结肠炎高危因素及血清C-反应蛋白、降钙素原、中性粒细胞/淋巴细胞的预测价值[J]. 吉林医学, 2021, 42(1): 24-27. DOI: 10.3969/j.issn.1004-0412.2021.01.006.
	Patel EU, Wilson DA, Brennan EA, et al. Earlier re-initiation of enteral feeding after necrotizing enterocolitis decreases recurrence or stricture: a systematic review and meta-analysis[J]. J Perinatol, 2020, 40(11): 1679-1687. PMID: 32683411. PMCID: PMC7368613. DOI: 10.1038/s41372-020-0722-1.
	Howarth CN, Leung TS, Banerjee J, et al. Regional cerebral and splanchnic tissue oxygen saturation in preterm infants: longitudinal normative measurements[J]. Early Hum Dev, 2022, 165: 105540. PMID: 35065416. DOI: 10.1016/j.earlhumdev.2022.105540.
	Isler H, Schenk D, Bernhard J, et al. Absorption spectra of early stool from preterm infants need to be considered in abdominal NIRS oximetry[J]. Biomed Opt Express, 2019, 10(6): 2784-2794. PMID: 31259051. PMCID: PMC6583346. DOI: 10.1364/BOE.10.002784.