Ragazzi Simone, Pierro Agostino, Peters Mark, Fasoli Lorella, Eaton Simon
Department of Paediatric Surgery, Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK.
Pediatr Surg Int. 2003 Jul;19(5):376-9. doi: 10.1007/s00383-003-1014-5. Epub 2003 May 17.
Thrombocytopaenia occurs during necrotizing enterocolitis (NEC), and nadir platelet count is associated with extent of disease. In paediatric meningococcal disease, the product of neutrophil and platelet count at admission is prognostically useful. We therefore aimed to determine whether the first full blood count (FBC) after diagnosis of NEC is useful as a score for poor outcome and severity of disease. Between 1987 to 2001, neutrophils (N), platelets (P) and their product (PN) was available in 187 neonates treated for NEC at our institution. Neonates with NEC were grouped according to the extent of disease (no gangrene, focal, multifocal and pan-intestinal). Data were not normally distributed so Mann-Whitney U test or analysis of variance (ANOVA) on logged data were used ( p<0.05 was considered significant). Receiver operating characteristics (ROC) curves were used to examine the relationship between specificity and sensitivity. A perfect test would have an ROC curve area of 1. Initial P count and PN product of non-survivors were both significantly lower than in survivors ( p<0.0001), whereas N was not different ( p<0.08). Low Log(10)PN was significantly associated with greater extent of disease (ANOVA; no gangrene vs multifocal, p<0.01, vs panintestinal, p<0.0005), suggesting that the initial FBC could be prognostically useful. Area under the ROC survival curve for neutrophils was 0.58, for platelets 0.75 and for PN product 0.71; thus, although no test performed extremely well, initial platelet count and NP product could be useful in evaluating disease severity in neonates with NEC and for further monitoring.
坏死性小肠结肠炎（NEC）期间会出现血小板减少，血小板计数最低点与疾病严重程度相关。在儿童脑膜炎球菌病中，入院时中性粒细胞与血小板计数的乘积对预后有一定参考价值。因此，我们旨在确定NEC诊断后的首次全血细胞计数（FBC）是否可作为疾病不良预后和严重程度的评分指标。1987年至2001年间，在我们机构接受NEC治疗的187例新生儿有中性粒细胞（N）、血小板（P）及其乘积（PN）的数据。患有NEC的新生儿根据疾病严重程度分组（无坏疽、局灶性、多灶性和全肠道性）。数据呈非正态分布，因此采用Mann-Whitney U检验或对对数数据进行方差分析（ANOVA）（p<0.05被视为有统计学意义）。采用受试者工作特征（ROC）曲线来检验特异性和敏感性之间的关系。理想的检验方法ROC曲线面积应为1。非存活者的初始血小板计数和PN乘积均显著低于存活者（p<0.0001），而中性粒细胞计数无差异（p<0.08）。低Log(10)PN与更严重的疾病程度显著相关（ANOVA；无坏疽组与多灶性组相比，p<0.01，与全肠道组相比，p<0.0005），这表明初始FBC对预后评估可能有帮助。中性粒细胞的ROC生存曲线下面积为0.58，血小板为0.75，PN乘积为0.71；因此，虽然没有一项检验表现得非常完美，但初始血小板计数和NP乘积可能有助于评估患有NEC的新生儿的疾病严重程度并进行进一步监测。
