摘要
目的:探讨新生儿坏死性小肠结肠炎(NEC)高危因素及NLR(中性粒细胞/淋巴细胞比值)、C-反应蛋白(CRP)、降钙素原(PCT)的预测价值。方法:选取2013年1月~2019年12月47例诊断为NEC的早产儿(观察组)和45例正常早产儿(对照组)为研究对象,对早产儿NEC发病危险因素进行单因素分析及多因素Logistic回归分析,检测两组早产儿大便培养阳性率,血清中血小板(PLT)计数、CRP水平、PCT水平及NLR值,并用受试者工作特征(ROC)曲线判断各指标在NEC发生中的预测价值。结果:两组早产儿抗生素使用时间、母乳喂养比例、益生菌使用时间及剖宫产率比较,差异均具有统计学意义(P<0.05),抗生素使用、剖宫产是发生NEC的危险因素,而母乳喂养和益生菌的使用是其保护因素。观察组早产儿大便培养阳性率,血清中的CRP水平、PCT水平、NLR值明显高于对照组,差异有统计学意义(P<0.05)。ROC曲线分析显示,CRP诊断NEC的最佳临界值为>19.02 mg/L,诊断灵敏度87.20%,特异度97.80%;PCT诊断NEC的最佳临界值为>18.82 ng/L,诊断灵敏度72.30%,特异度77.80%;NLR诊断NEC的最佳临界值为>3.67,诊断灵敏度44.7%,特异度82.2%。结论:抗生素使用、剖宫产是发生NEC的危险因素,而母乳喂养和益生菌的使用是其保护因素;菌群失调增加了NEC的发病风险;血清中CRP、PCT水平检测以及NLR值对NEC的预测有一定的参考价值,其中CRP预测价值更高。
Objective To discuss the high risk factors and predictive value of CRP、PCT、NLR in premature infants with necrotizing enterocolitis.Method Clinical data of 47 premature infants with NEC(observation group)and 45 normal premature infants(control group)were selected from January 2013 to December 2019.The NEC risk factors of premature infants in the two groups were analyzed by single factor analysis and multi-factor Logistic regression analysis.The positive rate of neonatal stool culture、NLR、CRP level and PCT level were detected.The working characteristic curve(ROC)curve was used to judge the value of each index in NEC prediction.Results The time of antibiotic use(day),the proportion of breast-feeding,the time of probiotics use(day)and the proportion of cesarean section in the two groups were statistically significant(P<0.05),and the use of antibiotics and cesarean section in premature infants were the risk factors for the occurrence of NEC,while the use of breast-feeding and probiotics was the protective factor.The positive rate of neonatal stool culture、NLR、CRP and PCT levels in the observation group was significantly higher than that in the control group(P<0.05).ROC curve analysis showed the best cutoff vaule of PCT、CRP、NLR as predicting factors for diagnosing NEC were PCT>18.82 ng/L,CRP>19.02 mg/L,NLR>3.67 with sensitivity 72.30%,87.20%,44.7%and specificity 77.80%,97.80%,82.2%,respectively.Conclusion Antibiotics use and cesarean section in preterm infants are risk factors for NEC,while breast-feeding and probiotics use are protective factors;intestinal dysbacteriosis increases the risk of NEC;the detection of NLR、CRP level and PCT level in serum has certain reference value for the prediction of NEC,among which the prediction value of CRP is higher.
作者
尹琳琳
蒋林
赵婧
李强
YIN Lin-lin;JIANG Lin;ZHAO Jing(Department of paediatrics,the Affiliated Hospital of North Sichuan Medical College,Nanchong 637000,China)
出处
《吉林医学》
CAS
2021年第1期24-27,共4页
Jilin Medical Journal
基金
四川省科技计划资助[项目编号:2017JY0115]
四川省卫生和计划生育委员会普及应用项目[项目编号:18PJ041]
川北医学院附属医院科技发展计划项目[项目编号:2018ZD010]。
