Terrin Gianluca, Stronati Laura, Cucchiara Salvatore, De Curtis Mario
Department of Pediatrics, University "La Sapienza".
Department of Cellular Biotechnology and Hematology, Sapienza University of Rome, Rome, Italy.
J Pediatr Gastroenterol Nutr. 2017 Dec;65(6):e120-e132. doi: 10.1097/MPG.0000000000001588.
The aim of the study was to systematically review the diagnostic utility of serum biomarkers for the diagnosis of necrotizing enterocolitis (NEC).
We conducted an electronic and manual search of the available evidence. We included studies reporting data on the diagnostic accuracy of "serum" biomarkers for the diagnosis of NEC, available until January 2016.
We selected 22 studies from the 1296 articles retrieved. Only S100 A8/A9 protein and apolipoprotein-CII showed high sensitivity (100% and 96.4%, respectively) and specificity (90% and 95%, respectively) in the studies using Bell stage II NEC as target condition. High sensitivity and specificity were reported for interleukin-10 (100% and 90%), interleukin1-receptor antagonist (100% and 91.7%), intestinal fatty acid-binding protein (100% and 91%) and ischemia-modified albumin (94.7% and 92%), when tested to predict the evolution from definite to advanced NEC. Given the amount of uncertainty, the limited availability of data and heterogeneity among the populations in the different studies, we were unable to perform a meta-analysis. Major concerns about the applicability stemmed from the spectrum of patients enrolled and the inclusion of diseases different from Bell stage ≥2 NEC as target conditions.
We identified only few markers with good diagnostic accuracy and found an overall low quality of the studies on serum NEC biomarkers. In conclusion, data supporting their use are insufficient.
本研究旨在系统评价血清生物标志物在坏死性小肠结肠炎（NEC）诊断中的应用价值。
我们通过电子检索和手工检索获取现有证据。纳入截至2016年1月报道“血清”生物标志物诊断NEC诊断准确性数据的研究。
从检索到的1296篇文章中，我们筛选出22项研究。在以Bell II期NEC为目标疾病的研究中，只有S100 A8/A9蛋白和载脂蛋白CII显示出高敏感性（分别为100%和96.4%）和高特异性（分别为90%和95%）。在用于预测从明确型NEC进展为进展型NEC时，白细胞介素-10（100%和90%）、白细胞介素-1受体拮抗剂（100%和91.7%）、肠脂肪酸结合蛋白（100%和91%）和缺血修饰白蛋白（94.7%和92%）报告有高敏感性和特异性。鉴于存在大量不确定性、数据可用性有限以及不同研究人群之间的异质性，我们无法进行荟萃分析。对适用性的主要担忧源于所纳入患者的范围以及将不同于Bell ≥2期NEC的疾病作为目标疾病纳入研究。
我们仅鉴定出少数诊断准确性良好的标志物，且发现关于血清NEC生物标志物的研究总体质量较低。总之，支持其应用的数据不足。
