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,2019,18(05):361-367.[doi:10.3969/j.issn.1671-6353.2019.05.005]
降钙素原、白细胞介素6、C反应蛋白在新生儿坏死性小肠结肠炎手术时机选择中的应用价值研究
- Title:
- 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
- 分类号:
- R722.1;R392.7
- 摘要:
- 目的 探讨降钙素原（procalcitonin，PCT）、白细胞介素6（interleukin-6，IL-6）及C反应蛋白（C reactive protein，CRP）指导新生儿坏死性小肠结肠炎手术时机选择的临床应用价值。方法 选取遵义医学院附属医院131例患儿为研究对象，其中非手术组33例，手术组47例，对照组36例。采用电化学发光法和速率散射比浊法检测三组患儿起病后1 h、6 h、12 h血清PCT、IL-6、CRP浓度，对可能影响治疗方式选择的因素进行Logistic回归分析。通过ROC曲线评价PCT、IL-6、CRP三者对手术时机选择的作用。结果 三组患儿胎龄差异有统计学意义（P<0.05），其中手术组胎龄最低，其后依次为非手术组、对照组；手术组出生体重显著低于非手术组和对照组，差异有统计学意义（P<0.05），但非手术组与对照组出生体重差异没有统计学意义（P>0.05）；三组间性别比例、发病时间差异无统计学意义（P>0.05）。合并症主要为低血糖、新生儿肺炎、低体重及窒息，三组间新生儿肺炎发生率及死亡率差异有统计学意义（P<0.05）。三组确诊时血清PCT、IL-6、CRP水平，手术组均显著高于非手术组和对照组（P<0.05）。同一监测时点组内，Bell分期从（Ⅰ）到（Ⅲ）期血清PCT、IL-6、CRP水平呈现出逐渐升高的趋势（P<0.05）；同一Bell分期组内，发病后1 h、6 h、12 h血清PCT、IL-6、CRP水平呈现出逐渐升高的趋势（P<0.05）；Bell分期与检测时间不存在交互效应（P>0.05），其中PCT、IL-6、CRP最高值均出现在发病后12 h组内Bell分期为（Ⅲ）期的亚组中，最低值均出现在发病后1 h组内Bell分期为（Ⅰ）期的亚组中。发病后6 h血清PCT（OR=2.612，95%CI：1.725~4.781）、发病后6 h血清IL-6（OR=1.896，95%CI：1.439~3.234）及发病后12 h血清CRP（OR=1.330，95%CI：1.004~2.314）水平是NEC患儿是否选择手术治疗的主要影响因素。PCT 6 h、IL-6 6 h、CRP 12 h三个指标的ROC曲线下面积分别为0.86（95%CI：0.768~0.934）、0.89（95%CI：0.803~0.967）、0.73（95%CI：0.652~0.806）。考虑到手术指征的严谨性，每项检查结果需结合95%医学参考值范围，因此最佳临界点分别为0.62（0.38~0.86） ng/mL、145.85（137.70~154.01） pg/mL、8.35（7.27~9.43） mg/L。结论 PCT、IL-6、CRP水平对NEC手术时机的判断具有一定意义，但NEC患儿是否需要外科手术干预还应结合上述指标的医学参考值范围、临床表现和其他辅助检查结果。
- 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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备注/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