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

Value of intestinal regional oxygen saturation and C-reactive protein in the diagnosis of necrotizing enterocolitis in preterm infants

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。

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.