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

doi:10.7499/j.issn.1008-8830.2307011

摘要
图/表
参考文献(20)
相关文章 (15)
点击分布统计
下载分布统计

全文: PDF (608 KB) [HTML]
输出: BibTeX | EndNote (RIS) 背景资料

摘要目的探讨血红蛋白（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。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	蔡娜
	沈蕾蕾
	陈盛

关键词 ：晚发型败血症, 坏死性小肠结肠炎, 血红蛋白, 早产儿

Abstract：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.

Key words： Late-onset sepsis Necrotizing enterocolitis Hemoglobin Preterm infant

收稿日期: 2023-07-04

基金资助:国家自然科学基金项目（82301956、82170565）。

通讯作者: 陈盛，男，副主任医师，教授。Email：chensheng0123456@sina.com。 E-mail: chensheng0123456@sina.com

作者简介: 蔡娜，女，硕士，副主任医师；

引用本文:

蔡娜,沈蕾蕾,陈盛. 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[J]. 中国当代儿科杂志, 2024, 26(2): 145-150.

CAI Na,SHEN Lei-Lei,CHEN Sheng. Predictive value of hemoglobin decrease for necrotizing enterocolitis in preterm infants with late-onset sepsis[J]. CJCP, 2024, 26(2): 145-150.

链接本文:

http://www.zgddek.com/CN/10.7499/j.issn.1008-8830.2307011 或 http://www.zgddek.com/CN/Y2024/V26/I2/145

	Neu J, Pammi M. Pathogenesis of NEC: impact of an altered intestinal microbiome[J]. Semin Perinatol, 2017, 41(1): 29-35. PMID: 27986328. DOI: 10.1053/j.semperi.2016.09.015.
	Frost BL, Modi BP, Jaksic T, et al. New medical and surgical insights into neonatal necrotizing enterocolitis: a review[J]. JAMA Pediatr, 2017, 171(1): 83-88. PMID: 27893069. DOI: 10.1001/jamapediatrics.2016.2708.
	Zhang LP, Lei XP, Luo LJ, et al. Risk factors for necrotizing enterocolitis in very preterm infants: a case-control study in southwest China[J]. J Matern Fetal Neonatal Med, 2019, 32(6): 896-901. PMID: 29096567. DOI: 10.1080/14767058.2017.1395011.
	Wertheimer F, Arcinue R, Niklas V. Necrotizing enterocolitis: enhancing awareness for the general practitioner[J]. Pediatr Rev, 2019, 40(10): 517-527. PMID: 31575803. DOI: 10.1542/pir.2017-0338.
	Lu Q, Cheng S, Zhou M, et al. Risk factors for necrotizing enterocolitis in neonates: a retrospective case-control study[J]. Pediatr Neonatol, 2017, 58(2): 165-170. PMID: 27543379. DOI: 10.1016/j.pedneo.2016.04.002.
	Valdés-Ferrer SI, Papoin J, Dancho ME, et al. HMGB1 mediates anemia of inflammation in murine sepsis survivors[J]. Mol Med, 2016, 21(1): 951-958. PMID: 26736178. PMCID: PMC4818261. DOI: 10.2119/molmed.2015.00243.
	Amin SC, Remon JI, Subbarao GC, et al. Association between red cell transfusions and necrotizing enterocolitis[J]. J Matern Fetal Neonatal Med, 2012, 25(Suppl 5): 85-89. PMID: 23025777. PMCID: PMC4422169. DOI: 10.3109/14767058.2012.715465.
	Patel RM, Knezevic A, Shenvi N, et al. Association of red blood cell transfusion, anemia, and necrotizing enterocolitis in very low-birth-weight infants[J]. JAMA, 2016, 315(9): 889-897. PMID: 26934258. PMCID: PMC4805423. DOI: 10.1001/jama.2016.1204.
	中华医学会儿科学分会新生儿学组, 中国医师协会新生儿科医师分会感染专业委员会. 新生儿败血症诊断及治疗专家共识（2019年版）[J]. 中华儿科杂志, 2019, 57(4): 252-257. PMID: 30934196. DOI: 10.3760/cma.j.issn.0578-1310.2019.04.005.
	10 邵肖梅, 叶鸿瑁, 丘小汕. 实用新生儿学[M]. 5版. 北京: 人民卫生出版社, 2019: 632-639.
	11 安瑶. 新生儿败血症并发坏死性小肠结肠炎的危险因素研究[D]. 重庆: 重庆医科大学, 2018.
	Singh R, Visintainer PF, Frantz ID, et al. Association of necrotizing enterocolitis with anemia and packed red blood cell transfusions in preterm infants[J]. J Perinatol, 2011, 31(3): 176-182. PMID: 21273983. PMCID: PMC3234132. DOI: 10.1038/jp.2010.145.
	Sharma R, Hudak ML. A clinical perspective of necrotizing enterocolitis: past, present, and future[J]. Clin Perinatol, 2013, 40(1): 27-51. PMID: 23415262. PMCID: PMC3575605. DOI: 10.1016/j.clp.2012.12.012.
	Tei?erskas J, Barta?ien? R, Tamelien? R. Associations between red blood cell transfusions and necrotizing enterocolitis in very low birth weight infants: ten-year data of a tertiary neonatal unit[J]. Medicina (Kaunas), 2019, 55(1): 16. PMID: 30650594. PMCID: PMC6359099. DOI: 10.3390/medicina55010016.
	Cunningham KE, Okolo FC, Baker R, et al. Red blood cell transfusion in premature infants leads to worse necrotizing enterocolitis outcomes[J]. J Surg Res, 2017, 213: 158-165. PMID: 28601308. PMCID: PMC5467453. DOI: 10.1016/j.jss.2017.02.029.
	Sayari AJ, Tashiro J, Sola JE, et al. Blood transfusions, increased rates of surgical NEC, and lower survival: a propensity score-matched analysis[J]. J Pediatr Surg, 2016, 51(6): 927-931. PMID: 26995520. DOI: 10.1016/j.jpedsurg.2016.02.052.
	Elshinawy M, Kamal M, Nazir H, et al. Sepsis-related anemia in a pediatric intensive care unit: transfusion-associated outcomes[J]. Transfusion, 2020, 60 (Suppl 1): S4-S9. PMID: 32134129. DOI: 10.1111/trf.15688.
	Chacko J, Brar G. Red blood cell transfusion thresholds in critically ill patients[J]. Indian J Crit Care Med, 2019, 23(Suppl 3): S181-S184. PMID: 31656374. PMCID: PMC6785819. DOI: 10.5005/jp-journals-10071-23248.
	Cable CA, Razavi SA, Roback JD, et al. RBC transfusion strategies in the ICU: a concise review[J]. Crit Care Med, 2019, 47(11): 1637-1644. PMID: 31449062. PMCID: PMC8319734. DOI: 10.1097/CCM.0000000000003985.
	Weiss G, Ganz T, Goodnough LT. Anemia of inflammation[J]. Blood, 2019, 133(1): 40-50. PMID: 30401705. PMCID: PMC6536698. DOI: 10.1182/blood-2018-06-856500.