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目的探讨不同血清生物学标志物在新生儿坏死性小肠结肠炎(NEC)手术评估中的作用,以指导临床把握最佳手术时机。方法应用巢式病例对照研究方法进行分析,对68例NEC患儿分为非手术组(n=33)与手术组(n=35),设对照组42例,以患儿入院日为研究起点,手术或死亡为终点。研究因素包括血清降钙素原(PCT)、C反应蛋白(CRP)、血小板、乳酸(Lac)、纤维蛋白原(Fib)、白蛋白、白细胞、p H值、血糖共9个变量,作病例对照、单因素分析,并采用Logistic回归进行多因素分析,计算OR及95%CI。结果 68例患儿中手术治疗共35例(51.47%),包括消化道穿孔29例,感染性休克5例,门静脉积气1例。共死亡12例,病死率为17.65%。病例对照研究显示,68例NEC患儿血清PCT、CRP、血小板、乳酸、白蛋白、白细胞、p H值、血糖与对照组差异有统计学意义,单因素分析显示与NEC手术治疗相关的变量为PCT、CRP、血小板、乳酸、白蛋白,经逐步引入剔除法建立Logistic回归模型,仍然与手术相关的变量为血小板计数和降钙素原。针对降钙素原检测值做ROC曲线分析,得出最佳界值为3.32 ng/m L,其敏感性为71.40%,特异性为81.80%,阳性预测值为80.60%,阴性预测值为72.90%。结论血清生物学标志物对于NEC手术时机的选择有指导价值,血小板减低及降钙素原明显升高(≥3.32 ng/m L)预示着NEC需要手术治疗。
Objective To explore the role of different serum biomarkers in the evaluation of neonatal necrotizing enterocolitis (NEC) surgery to guide the clinical operation of the best timing of surgery. Methods 68 patients with NEC were divided into non-operation group (n = 33) and operation group (n = 35), 42 patients in control group were enrolled in the study. , Surgery or death as the end point. The study included nine variables, serum PCT, CRP, Lac, Fib, albumin, leukocyte, p H value and blood glucose Control, univariate analysis, and multivariate analysis using Logistic regression to calculate OR and 95% CI. Results A total of 35 cases (51.47%) were treated surgically in 68 cases, including 29 cases of perforation of the digestive tract, 5 cases of septic shock and 1 case of portal vein gas. A total of 12 deaths, the fatality rate was 17.65%. Case-control study showed that there were significant differences in serum PCT, CRP, platelet, lactate, albumin, leukocyte, p H value, blood glucose and control group in 68 cases of NEC. Univariate analysis showed that the variables related to surgical treatment of NEC were PCT, CRP, platelets, lactate and albumin. Logistic regression model was established by gradually introducing culling method. The variables related to surgery were still platelet count and procalcitonin. According to the ROC curve analysis of procalcitonin, the best cutoff value was 3.32 ng / m L, the sensitivity was 71.40%, the specificity was 81.80%, the positive predictive value was 80.60%, the negative predictive value was 72.90 %. Conclusions Serum biomarkers have guiding value for the timing of NEC surgery. The thrombocytopenia and procalcitonin (≥3.32 ng / m L) obviously indicate the need for surgical treatment of NEC.