Department of Pediatric Surgery, Japanese Red Cross Medical Center, Tokyo, Japan.
Department of Neonatology, Japanese Red Cross Medical Center, Tokyo, Japan.
J Pediatr Surg. 2019 Aug;54(8):1584-1589. doi: 10.1016/j.jpedsurg.2018.08.044. Epub 2018 Sep 13.
Early definitive diagnosis of necrotizing enterocolitis (NEC) based on Bell's staging criteria is difficult because there are few observable changes on abdominal imaging and blood chemistry tests at the onset of the disease.
To investigate whether prostaglandin E-2 major urinary metabolite (PGE-MUM) can be a useful surrogate marker reflecting the disease state and severity of NEC in infants.
Infants were enrolled in this study between January 2014 and December 2016. NEC diagnosis was based on Bell's staging criteria > Stage II or necrotic bowel observed at surgery. After diagnosis, PGE-MUM level was measured and compared with that of the other disease and healthy infant groups.
Median PGE-MUM value was highest in the NEC group (576 [65-3672] μg/g•Cre/BSA × 1000), followed by the other disease group (94 [57-296] μg/g•Cre/BSA × 1000) and the healthy infant group (19 [10-44] μg/g•Cre/BSA × 1000) (sensitivity: 92.3%, specificity: 81.5%, accuracy: 85.0%; p < 0.01). PGE-MUM level correlated with improved status of NEC, length of necrotic intestine, and Bell's staging criteria.
PGE-MUM level may be a useful surrogate biomarker reflecting the disease state of NEC. The method of urine sample collection is also advantageous, being noninvasive for infants. This is the first study reporting PGE-MUM level in NEC.
Study of diagnostic test.
LEVEL II.
根据 Bell 分期标准，早期明确诊断坏死性小肠结肠炎（NEC）较为困难，因为在疾病发作时腹部影像学和血液化学检查几乎没有明显变化。
研究前列腺素 E-2 主要尿代谢产物（PGE-MUM）是否可以作为反映婴儿 NEC 疾病状态和严重程度的有用替代标志物。
本研究于 2014 年 1 月至 2016 年 12 月期间纳入患儿。根据 Bell 分期标准>Ⅱ期或手术中观察到的坏死肠管，对 NEC 进行诊断。诊断后，测量 PGE-MUM 水平并与其他疾病和健康婴儿组进行比较。
NEC 组 PGE-MUM 值中位数最高（576 [65-3672] μg/g·Cre/BSA×1000），其次是其他疾病组（94 [57-296] μg/g·Cre/BSA×1000）和健康婴儿组（19 [10-44] μg/g·Cre/BSA×1000）（灵敏度：92.3%，特异性：81.5%，准确性：85.0%；p<0.01）。PGE-MUM 水平与 NEC 改善状态、坏死肠管长度和 Bell 分期标准相关。
PGE-MUM 水平可能是反映 NEC 疾病状态的有用替代生物标志物。尿液样本采集方法也具有优势，对婴儿无创伤。这是首次报道 NEC 中 PGE-MUM 水平的研究。
诊断试验研究。
Ⅱ级。
