Division of Neonatology, LAC+USC Medical Center/Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
Kaiser Permanente Panorama City and Woodland Hills Medical Centers, Los Angeles, California, USA.
Neonatology. 2020;117(3):349-357. doi: 10.1159/000509617. Epub 2020 Aug 4.
Data on laboratory markers of spontaneous intestinal perforation (SIP) and necrotizing enterocolitis (NEC) remain sparse.
To compare serum alkaline phosphatase levels in infants with bowel perforation secondary to SIP versus surgical NEC, and then investigate the possible role of serum alkaline phosphatase in differentiating infants with these conditions.
A retrospective case-control study of infants admitted with bowel perforation from 2005 to 2015. Demographic and prenatal data, postnatal exposures, and clinical, laboratory, and radiographic findings were extracted from inpatient medical records and analyzed using regression analysis.
Of 114 outborn infants included, 48 infants had SIP (cases) and 66 had NEC (controls). Upon admission from the referring hospital, the serum alkaline phosphatase level was significantly higher in infants with SIP, i.e., a median value of 782 versus236 U/L in NEC patients (p < 0.0001), with an adjusted odds ratio (OR) of 4.3 (p < 0.05) when the level was >500 U/L in multivariate regression model. Infants with SIP had significantly younger gestational age, presented earlier in life, primarily with pneumoperitoneum, and had greater exposure to steroids and indomethacin compared to infants with NEC. Alkaline phosphatase levels decreased rapidly in infants with SIP following admission.
A transient increase in serum alkaline phosphatase level is independently associated with SIP when compared to NEC. Studies to confirm the role of alkaline phosphatase in the diagnosis of SIP are necessary and have potentially significant clinical and prognostic implications.
关于自发性肠穿孔 (SIP) 和坏死性小肠结肠炎 (NEC) 的实验室标志物数据仍然很少。
比较继发于 SIP 的肠穿孔与手术性 NEC 的婴儿血清碱性磷酸酶水平，然后探讨血清碱性磷酸酶在鉴别这些疾病中的可能作用。
对 2005 年至 2015 年因肠穿孔入院的婴儿进行回顾性病例对照研究。从住院病历中提取人口统计学和产前数据、产后暴露情况以及临床、实验室和影像学发现，并使用回归分析进行分析。
在纳入的 114 名外出婴儿中，48 名婴儿患有 SIP（病例），66 名婴儿患有 NEC（对照）。从转诊医院入院时，SIP 婴儿的血清碱性磷酸酶水平显著升高，即 SIP 婴儿的中位数为 782 U/L，而 NEC 患者为 236 U/L（p < 0.0001），在多元回归模型中，当水平>500 U/L 时，调整后的比值比（OR）为 4.3（p < 0.05）。与 NEC 婴儿相比，SIP 婴儿的胎龄明显较小，更早出现，主要表现为气腹，且接受类固醇和吲哚美辛的暴露明显更多。SIP 婴儿入院后血清碱性磷酸酶水平迅速下降。
与 NEC 相比，血清碱性磷酸酶水平的短暂升高与 SIP 独立相关。需要进一步研究以确认碱性磷酸酶在 SIP 诊断中的作用，这可能具有重要的临床和预后意义。
