采用非侵入性血清淀粉样蛋白A（SAA）检测和血浆血小板计数准确预测重症坏死性小肠结肠炎（NEC）的手术干预时机。
Non-invasive serum amyloid A (SAA) measurement and plasma platelets for accurate prediction of surgical intervention in severe necrotizing enterocolitis (NEC).
作者信息
Reisinger Kostan W, Kramer Boris W, Van der Zee David C, Brouwers Hens A A, Buurman Wim A, van Heurn Ernest, Derikx Joep P M
机构信息
Department of Surgery, Maastricht University Medical Centre, and Nutrition and Toxicology Research Institute (NUTRIM), Maastricht, the Netherlands.
Department of Pediatrics, Maastricht University Medical Centre, and School for Oncology and Developmental Biology (GROW), School of Mental Health and Neurosciences, Maastricht, the Netherlands.
出版信息
PLoS One. 2014 Mar 6;9(6):e90834. doi: 10.1371/journal.pone.0090834. eCollection 2014.
OBJECTIVE
To evaluate the value of biomarkers to detect severe NEC.
SUMMARY BACKGROUND DATA
The time point of surgery in necrotizing enterocolitis (NEC) is critical. Therefore, there is a need for markers that detect severe NEC, because clinical signs of severe NEC often develop late. This study evaluated the value of biomarkers reflecting intestinal cell damage and inflammation to detect severe NEC.
METHODS
29 neonates with NEC were included. Two definitions of moderate versus severe NEC were analyzed: medical NEC (n = 12) versus surgical or fatal NEC (n = 17); and Bell stage II NEC (n = 13) versus stage III NEC (n = 16). Urinary intestinal fatty acid binding protein (I-FABP), serum amyloid A (SAA), C3a and C5a, and fecal calprotectin were measured. C-reactive protein (CRP), white blood cell count (WBC) and platelet count data were measured in blood.
RESULTS
In both definitions of moderate versus severe NEC, urinary SAA levels were significantly higher in severe NEC. A cut-off value of 34.4 ng/ml was found in surgical NEC versus medical NEC (sensitivity, 83%; specificity, 83%; LR+, 4.88 (95% CI, 1.37-17.0); LR-, 0.20 (95% CI, 0.07-0.60)) at diagnosis of NEC and at one day prior to surgery in neonates who were operated later on. Combination of urinary SAA and platelet count increased the accuracy, with a sensitivity, 94%; specificity, 83%; LR+, 5.53 (95% CI, 1.57-20.0); and LR-, 0.07 (95% CI, 0.01-0.48).
CONCLUSION
Urinary SAA is an accurate marker in differentiating severe NEC from moderate NEC; particularly if combined with serum platelet count.
目的
评估生物标志物在检测重症坏死性小肠结肠炎（NEC）中的价值。
总结背景数据
坏死性小肠结肠炎（NEC）的手术时间点至关重要。因此，需要能够检测重症NEC的标志物，因为重症NEC的临床体征往往出现较晚。本研究评估了反映肠道细胞损伤和炎症的生物标志物在检测重症NEC中的价值。
方法
纳入29例患有NEC的新生儿。分析了中度与重度NEC的两种定义：内科性NEC（n = 12）与外科或致死性NEC（n = 17）；以及贝尔II期NEC（n = 13）与III期NEC（n = 16）。检测尿肠道脂肪酸结合蛋白（I-FABP）、血清淀粉样蛋白A（SAA）、C3a和C5a以及粪便钙卫蛋白。检测血液中的C反应蛋白（CRP）、白细胞计数（WBC）和血小板计数数据。
结果
在中度与重度NEC的两种定义中，重症NEC患者的尿SAA水平均显著更高。在诊断NEC时以及后来接受手术的新生儿术前一天，外科性NEC与内科性NEC相比，发现截断值为34.4 ng/ml（敏感性，83%；特异性，83%；阳性似然比，4.88（95%CI，1.37 - 17.0）；阴性似然比，0.20（95%CI，0.07 - 0.60））。尿SAA与血小板计数联合可提高准确性，敏感性为94%；特异性为83%；阳性似然比为5.53（95%CI，1.57 - 20.0）；阴性似然比为0.07（95%CI，0.01 - 0.48）。
结论
尿SAA是区分重症NEC与中度NEC的准确标志物；特别是与血清血小板计数联合使用时。
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