Zheng Zebing,Liu Yuanmei,Zhang Fan,et al.Applicable value of operative opportunity for procalcitonin, interleukin-6 and C-reactive protein in neonatal necrotizing enterocolitis[J].Journal of Clinical Pediatric Surgery,,18():361-367.[doi:10.3969/j.issn.1671-6353.2019.05.005]
Applicable value of operative opportunity for procalcitonin, interleukin-6 and C-reactive protein in neonatal necrotizing enterocolitis
- Keywords:
- Enterocolitis; Necrotizing/SU; Enterocolitis; Necrotizing/ET; Procalcitonin; Interleukin-6; C reactive protein; Infant; Newborn
- CLC:
- R722.1;R392.7
- Abstract:
- Objective To explore the applicable values of operative opportunity for procalcitonin (PCT),interleukin-6 (IL-6) and C-reactive protein (CRP) in neonatal necrotizing enterocolitis (NEC). Methods A total of 31 hospitalized NEC children were divided into non-operative group (n=33),operative group (n=47) and control group (n=36) according to treatment options. The samples of PCT,IL-6 and CRP were collected at 1 h,6 h and 12 h and analyzed by an automatic electrochemiluminsecence (ECL) analyzer according the Bell stage. Multivariable Logistic regression analysis was performed for the influencing factors of selecting treatment options. The diagnostic powers of three biomarkers were constructed by the curves of receiver operating characteristics (ROC). The effects of three biomarkers were evaluated for selecting surgical options. Results Significant differences existed in gestational age among three groups (P<0.05). The gestational age of operative group was the lowest,followed by non-operative and control groups. The birth weight of operative group was significantly lower than that of non-operative and control groups (P<0.05). However,no significant difference existed in birth weight between non-operative group and control groups. No significant difference existed in gender ratio and onset time among three groups (P>0.05). The major complications were hypoglycemia,neonatal pneumonia,low body weight and asphyxia. The incidences of neonatal pneumonia and mortality were statistically significant in three groups (P<0.05). When three groups were diagnosed,the serum levels of PCT,IL-6 and CRP in operative group were significantly higher than those in non-operative and control groups (P<0.05). In the same monitoring time group,the serum levels of PCT,IL-6 and CRP in Bell stages (Ⅰ)-(Ⅲ) showed a gradual increase (P<0.05); within the same Bell staging group,at 1 h after onset,the serum levels of PCT,IL-6 and CRP showed a rising trend at 6/12 h (P<0.05). No interaction existed between different Bell stages and different detection timepoints (P>0.05). The highest value of CRP occurred in subgroup of Bell stage (Ⅲ) in 12h group after onset and the lowest value appeared in subgroup of Bell stage (Ⅰ) in 1 h group after onset. Serum PCT (OR=2.612,95% CI:1.725-4.781) at 6 h after onset,serum IL-6 (OR=1.896,95% CI:1.439-3.234) at 6 h after onset and serum CRP at 12 h after onset (OR=1.330). A significant increase in the level of 95% CI:1.004-2.314 was a major factor affecting operative choice. The areas under the ROC curve (AUC) of PCT 6 h,IL-6 6 h and CRP 12 h were 0.86 (95% CI:0.768-0.934),0.89 (95% CI:0.803-0.967) and 0.73 (95% CI:0.652-0.806) respectively. Considering the rigor of operative indications,each test result needs to be combined with 95% medical reference range so that optimal critical point was 0.62 (0.38-0.86) ng/mL,145.85 (137.70-154.01) pg/mL and 8.35. (7.27-9.43) mg/L. Conclusion PCT,IL-6 and CRP levels have certain significance for operative timing of NEC. However,whether or not NEC children requires surgery should be considered in junctions with medical reference range,clinical manifestations and other auxiliary examination results.
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Memo
收稿日期:2018-10-13。
基金项目:贵州省科技厅联合基金资助项目（编号：黔科合LH字[2017]7100号）
通讯作者:刘远梅,Email:yuanmei116@aiyun.com