血清CRP与SAA水平对早产儿坏死性小肠结肠炎病情的评估及预后预测

doi:10.11958/20253327

摘要/Abstract

摘要：

目的探讨血清C反应蛋白（CRP）与血清淀粉样蛋白A（SAA）水平在早产儿坏死性小肠结肠炎（NEC）病情严重程度评估及预后预测中的临床价值。方法纳入90例NEC早产儿作为NEC组，依据修正Bell-NEC分期标准分为Ⅱ期49例、Ⅲ期41例，以出院28 d的治疗结局分为预后好转组（64例）和预后不良组（26例）；另选取同期收治的健康早产儿90例作为对照组。比较NEC组和对照组一般临床资料及血清CRP、SAA水平差异；分析不同NEC分期患儿CRP、SAA的差异及其与分期的相关性。采用受试者工作特征（ROC）曲线评估血清CRP、SAA对NEC的诊断效能及对预后的预测价值；构建多因素Logistic回归模型，控制混杂因素后分析两者对预后的影响。结果 NEC组血清CRP、SAA及降钙素原（PCT）、白细胞介素（IL）-6水平高于对照组（P<0.01）；Ⅲ期NEC患儿血清CRP、SAA水平高于Ⅱ期（P<0.01）；Spearman相关分析显示，血清CRP、SAA水平与NEC分期均呈正相关（P<0.01）；血清CRP、SAA及两者联合诊断NEC的曲线下面积（AUC）分别为0.883（95%CI：0.798~0.941）、0.863（95%CI：0.774~0.926）和0.960（95%CI：0.896~0.990）。预后不良组的血清CRP、SAA水平高于预后好转组（P<0.01）。多因素Logistic分析显示，血清CRP和SAA升高均是NEC患者预后不良的独立危险因素（P<0.05）。血清CRP、SAA及联合检测预测NEC患者预后不良的AUC分别为0.896（95%CI：0.813~0.951）、0.889（95%CI：0.817~0.953）、0.951（95%CI：0.884~0.986）。结论血清CRP、SAA水平与早产儿NEC病情严重程度有关，且其水平升高是NEC早产儿预后不良的独立危险因素。

关键词: 小肠结肠炎, 坏死性, C反应蛋白质, 血清淀粉样蛋白A, 婴儿, 早产, 预后

Abstract:

Objective To investigate the clinical value of serum C-reactive protein (CRP) and serum amyloid A (SAA) levels in evaluating the severity and predicting the prognosis of necrotizing enterocolitis (NEC) in preterm infants. Methods A total of 90 preterm infants with NEC were enrolled as the NEC group. According to the modified Bell-NEC staging criteria, the patients were divided into stage Ⅱ (49 cases) and stage Ⅲ (41 cases). In accordance with the therapeutic outcomes at 28 days after discharge, patients were categorized into the improved prognosis group (64 cases) and the poor prognosis group (26 cases). Another 90 healthy preterm infants admitted during the same period were selected as the control group. Differences in general clinical data and serum CRP and SAA levels were compared between the NEC group and the control group. The differences of CRP and SAA levels in infants with different NEC stages and their correlations with disease staging were analyzed. Receiver operating characteristic (ROC) curve was adopted to evaluate the diagnostic efficacy of serum CRP and SAA for NEC and their predictive value for prognosis. A multivariate Logistic regression model was established to control confounding factors, and to analyze the effects of the above two indicators on prognosis. Results Serum levels of CRP, SAA, procalcitonin (PCT) and interleukin (IL)-6 were significantly higher in the NEC group than those in the control group (P<0.01). Serum CRP and SAA levels in children with stage Ⅲ NEC were higher than those in stage Ⅱ (P<0.01). Spearman correlation analysis showed that serum CRP and SAA levels were significantly positively correlated with NEC stage (P<0.01). The area under the curve (AUC) for serum CRP, SAA, and their combined diagnosis of NEC were 0.883 (95%CI: 0.798-0.941), 0.863 (95%CI: 0.774-0.926), and 0.960 (95%CI: 0.896-0.990), respectively. The levels of serum CRP and SAA in the poor prognosis group were higher than those in the improved prognosis group (P<0.01).Multivariate Logistic regression analysis revealed that elevated serum CRP and SAA were both independent risk factors for poor prognosis in patients with NEC (P<0.05). The AUC (95%CI) of serum CRP, SAA and combined detection for patients with poor prognosis of NEC were 0.896 (0.813-0.951), 0.889（95%CI：0.817-0.953） and 0.951(0.884-0.986), respectively. Conclusion Serum CRP and SAA levels are positively correlated with the severity of NEC in premature infants, and their elevated levels are independent risk factors for poor prognosis of NEC premature infants.

Key words: enterocolitis, necrotizing, C-reactive protein, serum amyloid A protein, infant, premature, prognosis

中图分类号:

R722.1

图/表 9

参考文献 20

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组别		n	性别（男/女）	胎龄/周	出生体质量/kg	羊水污染
对照组		90	49/41	28.19±2.48	1.62±0.41	19（21.11）
NEC组		90	46/44	27.94±2.31	1.57±0.33	24（26.67）
χ²或t			0.201	0.708	0.840	0.764
组别	分娩方式			妊娠期合并症		开始喂食时间/d
组别	顺产		剖宫产	高血压	糖尿病	开始喂食时间/d
对照组	25（27.78）		65（72.22）	19（21.11）	21（23.33）	3.15±1.23
NEC组	19（21.11）		71（78.89）	22（24.44）	24（26.67）	3.36±1.05
χ²	1.083			0.284	0.267	1.233

组别		n	性别（男/女）	胎龄/周	出生体质量/kg	羊水污染
对照组		90	49/41	28.19±2.48	1.62±0.41	19（21.11）
NEC组		90	46/44	27.94±2.31	1.57±0.33	24（26.67）
χ²或t			0.201	0.708	0.840	0.764
组别	分娩方式			妊娠期合并症		开始喂食时间/d
组别	顺产		剖宫产	高血压	糖尿病	开始喂食时间/d
对照组	25（27.78）		65（72.22）	19（21.11）	21（23.33）	3.15±1.23
NEC组	19（21.11）		71（78.89）	22（24.44）	24（26.67）	3.36±1.05
χ²	1.083			0.284	0.267	1.233

组别	n		围产期缺氧史		感染征象		喂养不当		输血史
对照组	90		5（5.56）		3（3.33）		4（4.44）		3（3.33）
NEC组	90		28（31.11）		62（68.89）		29（32.22）		21（23.33）
χ²			19.629^＊＊		29.829^＊＊		23.191^＊＊		15.577^＊＊
组别		CRP/（mg/L）		PCT/ （μg/L）		IL-6/ （ng/L）		SAA/ （mg/L）
对照组		14.34±3.03		0.18±0.06		27.24±5.31		102.68±42.67
NEC组		23.01±8.59		1.39±0.58		111.36±24.14		312.28±70.21
t		9.027^＊＊		19.736^＊＊		32.289^＊＊		24.202^＊＊

组别	n		围产期缺氧史		感染征象		喂养不当		输血史
对照组	90		5（5.56）		3（3.33）		4（4.44）		3（3.33）
NEC组	90		28（31.11）		62（68.89）		29（32.22）		21（23.33）
χ²			19.629^＊＊		29.829^＊＊		23.191^＊＊		15.577^＊＊
组别		CRP/（mg/L）		PCT/ （μg/L）		IL-6/ （ng/L）		SAA/ （mg/L）
对照组		14.34±3.03		0.18±0.06		27.24±5.31		102.68±42.67
NEC组		23.01±8.59		1.39±0.58		111.36±24.14		312.28±70.21
t		9.027^＊＊		19.736^＊＊		32.289^＊＊		24.202^＊＊

指标	AUC	AUC 95%CI	特异度/ %	敏感度/ %	约登指数	截断值
CRP	0.883	0.798~0.941	77.55	87.80	0.654	21.76 mg/L
SAA	0.863	0.774~0.926	87.76	75.61	0.634	364.52 mg/L
联合预测	0.960	0.896~0.990	93.88	87.80	0.817