Sylvester Karl G, Moss R Lawrence
Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA.
Pediatr Surg Int. 2015 May;31(5):421-9. doi: 10.1007/s00383-015-3693-0. Epub 2015 Mar 26.
Necrotizing enterocolitis (NEC) remains a significant cause of morbidity and mortality in premature neonates. Despite decades of investigation, treating clinicians are still not able to determine which premature infants are at greatest risk of developing NEC and which of the affected infants will develop severe NEC requiring operation. A biomarker is a specific molecular indicator that can be used to identify or measure the progress of a disease. Many potential biomarkers have been studied for their potential relevance to NEC. Those showing promise include C-reactive protein, intestinal fatty acid-binding protein, platelet-activating factor and many others. None to date have achieved sufficient predictive value to be clinically useful. Distinguishing between the specific changes in NEC and the non-specific inflammation of sepsis has proven challenging. Urine is a particularly attractive site for potential biomarkers. It can be collected readily and non-invasively, and it is a rich source of both proteins and peptides. Preliminary work has revealed some promising biomarkers of NEC in urine. Combined with clinical data, they have been shown to be highly predictive in small series of patients. Advances in high-throughput molecular analysis have opened the door to finding biomarkers that may meaningfully improve the outcome of infants at risk for NEC.
坏死性小肠结肠炎（NEC）仍然是早产新生儿发病和死亡的一个重要原因。尽管经过了数十年的研究，但临床治疗医生仍无法确定哪些早产婴儿发生NEC的风险最高，以及哪些受影响的婴儿会发展为需要手术的严重NEC。生物标志物是一种特定的分子指标，可用于识别或衡量疾病的进展。许多潜在的生物标志物已针对其与NEC的潜在相关性进行了研究。显示出前景的包括C反应蛋白、肠脂肪酸结合蛋白、血小板活化因子等许多其他物质。迄今为止，尚无一种生物标志物具有足够的预测价值以用于临床。事实证明，区分NEC的特异性变化和败血症的非特异性炎症具有挑战性。尿液是潜在生物标志物的一个特别有吸引力的来源。它可以轻松且无创地收集，并且是蛋白质和肽的丰富来源。初步研究已经揭示了尿液中一些有前景的NEC生物标志物。与临床数据相结合，它们在一小部分患者中已显示出高度的预测性。高通量分子分析的进展为寻找可能有意义地改善有NEC风险婴儿结局的生物标志物打开了大门。
