Department of Surgery, Institute of Child Health, WCIN IEH London, UK.
J Pediatr Surg. 2010 Apr;45(4):735-40. doi: 10.1016/j.jpedsurg.2009.09.024.
Urinary intestinal fatty acid-binding protein (i-FABP), a marker of intestinal mucosal cell damage, has recently been proposed as a clinically useful measure in the early detection of necrotizing enterocolitis (NEC). However, there are no data on urinary i-FABP in more advanced (Bell stage II /III) NEC. The aim of this study was to test the use of urinary i-FABP in surgical NEC.
Urine was collected every 24 hours from infants with Bell stage II/III NEC admitted to a surgical Neonatal Intensive Care Unit. Clinical, laboratory, and surgical data were collected concurrently. Urinary i-FABP was quantified by enzyme-linked immunosorbent assay and expressed as picograms per nanomole creatinine (median [range]). Results are presented as median (range) and compared by Mann-Whitney test and by linear regression.
There was a trend toward an increase in i-FABP:Cr in infants with NEC (controls, 1.0 [0.4-1.3], vs NEC, 2.1 [0.39-35.1], P = .055). Urinary i-FABP:Cr was significantly higher in infants with extensive disease (7.4 pg/mmol [2.1-35.0 pg/mmol]) than in those with focal disease (1.1 pg/mmol [0.3-1.7 pg/mmol]), P = .002. In addition, i-FABP:Cr was less than the previously suggested 2 pg/mmol cutoff in 6 of 16 infants with NEC, 5 of whom had focal disease. Urinary i-FABP:Cr decreased during both successful nonoperative management (P < .0001) and after surgery in the operated group.
In this pilot study, urinary i-FABP was associated with extensive disease in infants with NEC requiring surgery. Further work, in a larger number of patients, is required to investigate the applicability of urinary i-FABP as a marker of intestinal damage and as an adjunct to current indications for surgical intervention in infants with NEC.
尿肠脂肪酸结合蛋白（i-FABP）是肠黏膜细胞损伤的标志物，最近被提议作为一种在坏死性小肠结肠炎（NEC）早期检测中具有临床应用价值的指标。然而，在更严重的（Bell 分期 II/III 期）NEC 中，尚无关于尿 i-FABP 的数据。本研究旨在检验尿 i-FABP 在外科 NEC 中的应用。
收集入住外科新生儿重症监护病房的 Bell 分期 II/III 期 NEC 婴儿的每 24 小时尿液。同时收集临床、实验室和手术数据。通过酶联免疫吸附试验定量测定尿 i-FABP，并以纳摩尔肌酐每皮克（中位数[范围]）表示。结果以中位数（范围）表示，采用 Mann-Whitney 检验和线性回归进行比较。
NEC 婴儿的 i-FABP：Cr 呈上升趋势（对照组 1.0 [0.4-1.3]，NEC 组 2.1 [0.39-35.1]，P =.055）。广泛疾病患儿的尿 i-FABP：Cr 明显高于局限性疾病患儿（7.4 pg/mmol [2.1-35.0 pg/mmol] 比 1.1 pg/mmol [0.3-1.7 pg/mmol]，P =.002）。此外，在 16 例 NEC 婴儿中，有 6 例的尿 i-FABP：Cr 低于之前建议的 2 pg/mmol 临界值，其中 5 例为局限性疾病。在成功的非手术治疗期间（P <.0001）和手术组手术后，尿 i-FABP：Cr 均降低。
在本初步研究中，尿 i-FABP 与需要手术的 NEC 婴儿的广泛疾病相关。需要进一步在更多患者中进行研究，以检验尿 i-FABP 作为肠道损伤标志物的适用性，并作为当前 NEC 婴儿手术干预适应证的辅助指标。
