Shang Hua,Hu Bo,Dai Chunjuan,et al.Predictive value of C reactive protein/albumin ratio for treatment options in neonates with necrotizing enterocolitis[J].Journal of Clinical Pediatric Surgery,2026,(08):770-774.[doi:10.3760/cma.j.cn101785-202310053]
C反应蛋白与白蛋白比值对新生儿坏死性小肠结肠炎治疗选择的预测价值研究
- Title:
- Predictive value of C reactive protein/albumin ratio for treatment options in neonates with necrotizing enterocolitis
- 关键词:
- 新生儿坏死性小肠结肠炎; C反应蛋白; 白蛋白; 外科手术; 儿童
- Keywords:
- Necrotizing Enterocolitis; C-reactive Protein; Albumin; Surgical Procedures; Operative; Child
- 摘要:
- 目的 探讨C反应蛋白(C-reactive protein,CRP）与白蛋白(albumin,ALB）比值对新生儿坏死性小肠结肠炎(necrotizing enterocolitis,NEC)治疗选择的预测价值。方法 本研究为病例对照研究。收集2020年7月至2023年6月天津市儿童医院新生儿外科收治的120例NEC患儿临床资料，其中保守组（采用保守治疗）72例、手术组（采用手术治疗）48例，比较两组基本资料及临床指标，通过单因素及多因素分析筛选出影响NEC手术治疗的危险因素，绘制相关因素的受试者操作特征（receiver operating characteristic,ROC）曲线，根据约登指数及灵敏度、特异度评估其对于NEC需手术治疗的预测价值。结果 单因素分析显示，保守组与手术组血白细胞[9.42(5.66,13.63)×109/L比4.97 (3.85,10.08)×109/L]、淋巴细胞[1.92(1.02,3.07)×109/L比1.39(0.86,2.09)×109/L]、血小板[237(194,302)×109/L比143(89,209)×109/L]、白蛋白[(32.37±3.70) g/L比(27.03±2.41) g/L]、CRP[18.7(12.1,30.9) mg/L比53.5(37.6,69.4) mg/L]、CRP/ALB比值[0.548(0.325,0.934)比1.932(1.490,2.548)]及降钙素原(procalcitonin,PCT）[0.91(0.49,1.43) ng/mL比4.09(1.68,6.32) ng/mL]水平比较，差异均具有统计学意义（P<0.05）。多因素Logistic回归分析显示，CRP/ALB比值升高为NEC需手术治疗的独立危险因素（OR=7.417,95%CI1.651～33.324）。ROC曲线分析显示，CRP/ALB比值的曲线下面积为0.936，高于CRP（0.918）及PCT（0.874）。当CRP/ALB比值大于1.448时，约登指数最大（0.750），此时灵敏度和特异度分别为83.3%、91.7%。结论 CRP、ALB、PCT及CRP/ALB比值在预测NEC合并肠坏死需手术干预中具有一定价值，CRP/ALB比值的灵敏度、特异度更高，因此，CRP/ALB比值结合临床症状及实验室、影像学指标可为NEC患儿及时手术干预提供参考。
- Abstract:
- Objective To explore the predictive value of C reactive protein (CRP)/albumin (ALB) ratio in treatment options in neonates with necrotizing enterocolitis (NEC). Methods This study was a case-control study.Clinical data of 120 neonates diagnosed with NEC admitted to the Department of Neonatal Surgery, Tianjin Children’s Hospital, from July 2020 to June 2023 were collected.They were divided into the conservative group (n=72, receiving conservative treatment) and the surgical group (n=48, receiving surgical treatment).Baseline data and clinical indicators were compared between the two groups.Univariate and multivariate analyses were performed to screen the risk factors affecting surgical treatment in neonates with NEC.Receiver operating characteristic (ROC) curves were plotted for the relevant factors.The Youden index, sensitivity and specificity were used to evaluate their predictive value for the need of surgical treatment in NEC. Results Single factor analysis revealed that leukocyte [9.42(5.66,13.63) vs. 4.97 (3.85,10.08)×109/L],lymphocyte [1.92(1.02,3.07) vs. 1.39 (0.86,2.09)×109/L],platelet [237(194,302) vs. 143 (89,209)×109/L],albumin [(32.37±3.70) vs. (27.03±2.41) g/L],CRP [18.7(12.1,30.9) vs. 53.5(37.6, 69.4) mg/L],CRP/ALB ratio [0.548(0.325,0.934) vs. 1.932(1.490,2.548)]and procalcitonin (PCT) [0.91(0.49,1.43) vs. 4.09(1.68,6.32) ng/mL]in conservative and surgical groups.All differences were statistically significant (P<0.05).Multivariate Logistic regression confirmed elevated CRP/ALB ratio as an independent risk factor for NEC requiring surgery (OR=7.417,95%CI1.651～33.324).ROC curve analysis indicated that the area under the curve of CRP/ALB ratio was 0.936 and it was higher than CRP (0.918) and PCT (0.874).When CRP/ALB ratio surpassed 1.448,maximal Youden index for predicting surgery was 0.750 and the sensitivity and specificity were 83.3% and 91.7%. Conclusions CRP,ALB,PCT and CRP/ALB ratio have some values in predicting NEC complicated with intestinal necrosis.CRP/ALB ratio is more sensitive and specific.Therefore,CRP/ALB ratio combined with other symptoms,laboratory and imaging indicators can provide reference value for predicting surgical intervention timely in NEC children.
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备注/Memo
收稿日期:2023-10-29。
通讯作者:胡博,Email:surgeonhubo@163.com