摘要
目的探讨C-反应蛋白(CRP)、降钙素原(PCT)在新生儿坏死性小肠结肠炎(NEC)患儿的水平变化及意义。方法 142例NEC新生儿根据修正Bell分期分为Ⅰ期组(40例)、Ⅱ期组(72例)和Ⅲ期组(30例)。手术治疗的18例均为Ⅲ期,保守治疗的124例中Ⅲ期12例、余为Ⅰ、Ⅱ期。各组于治疗前、治疗后次日及恢复期检测CRP和PCT。结果治疗前、治疗后次日及恢复期的Ⅲ期组CRP高于Ⅰ、Ⅱ期组,Ⅱ、Ⅲ期组治疗后次日的CRP高于治疗前,Ⅲ期组治疗后次日的PCT高于治疗前(P<0.05);Ⅱ、Ⅲ期组恢复期的CRP、PCT低于Bell同期的治疗前、治疗后次日(P<0.05)。Ⅲ期组的呼吸衰竭发生率和机械通气使用率高于Ⅰ、Ⅱ期组(P<0.05),Ⅲ期组的脓毒症发生率高于Ⅱ期组(P<0.05);仅Ⅲ期患儿发生消化道穿孔(10例)和肠狭窄(8例)。治疗后次日的CRP对Ⅲ期NEC的发生有预测价值(P<0.05);治疗前及治疗后次日的CRP对于NEC手术具有预测价值(P<0.05)。结论 CRP、PCT水平变化监测有助于Ⅱ、Ⅲ期NEC的早期诊断,CRP可能作为预测Ⅲ期NEC发生及手术的辅助指标。
Objective To study the changes in C-reactive protein（CRP）and procalcitonin（PCT）levels in neonates with necrotizing enterocolitis（NEC）and their clinical significance.Methods According to the modified Bell’s staging criteria,142 neonates with NEC were divided into stage Ⅰ group（n=40）,stage Ⅱ group（n=72）,and stage Ⅲ group（n=30）.All the 18 neonates who underwent surgical treatment had stage Ⅲ NEC,and among the 124 neonates who underwent conservative treatment,12 had stage Ⅲ NEC and the others had stage Ⅰ or Ⅱ NEC.CRP and PCT were measured before treatment,on the next day after treatment,and during the recovery stage.Results Before treatment,on the next day after treatment,and during the recovery stage,the stage Ⅲ group had a higher level of CRP than the stage Ⅰ and stage Ⅱ groups（P〈0.05）.On the next day after treatment,the stage Ⅱ and stage Ⅲ groups had an increase in CRP（P〈0.05）,and the stage Ⅲ group had an increase in PCT（P〈0.05）.The stage Ⅱ and stage Ⅲ groups had lower CRP and PCT in the recovery stage than before treatment and on the next day after treatment（P〈0.05）.The stage Ⅲ group had higher incidence rate of respiratory failure and rate of mechanical ventilation than the stage Ⅰ and stage Ⅱ groups（P〈0.05）,and the stage Ⅲ group had a higher incidence rate of sepsis than the stage Ⅱ group（P=0.010）.Gastrointestinal perforation and intestinal stenosis were observed in 10 and 8 neonates respectively in the stage Ⅲ group.CRP on the next day after treatment had a value in predicting stage Ⅲ NEC（P〈0.05）,and CRP before treatment and on the next day after treatment had a value in predicting the need for surgery（P〈0.05）.Conclusions Levels of CRP and PCT and their changes can help with the early diagnosis of Bell stage Ⅱ/Ⅲ NEC,and CRP can be used to predict the development of stage Ⅲ NEC and the need for surgery.
作者
汪莉
倪申旺
朱克然
周登余
王杨
王琍琍
WANG Li;NI Shen-Wang;ZHU Ke-Ran;ZHOU Deng-Yu;WANG Yang;WANG Li-Li(Department of Neonatology,First Affiliated Hospital of Anhui Medical University,Hefei 230032,China)
出处
《中国当代儿科杂志》
CAS
CSCD
北大核心
2018年第10期825-830,共6页
Chinese Journal of Contemporary Pediatrics
基金
安徽省科技厅2017年公益性技术应用研究联动计划项目(1704f0804018)
安徽省高等学校省级自然科学研究项目(KJ2013A167)
安徽省2016年卫生计生适宜技术推广项目(2016-RK01)
