Department of Surgery, Division of Pediatric Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 RB Groningen, the Netherlands.
Department of Neonatology, Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
J Pediatr Surg. 2021 Mar;56(3):476-482. doi: 10.1016/j.jpedsurg.2020.11.020. Epub 2020 Nov 26.
Levels of plasma citrulline (citrulline-P), a biomarker for enterocyte function, might be useful for the monitoring the course of necrotizing enterocolitis (NEC). Our aim was to evaluate whether citrulline-P levels during the first 48 h (h) after NEC onset were associated with need for surgery, survival, and intestinal recovery.
In preterm infants with NEC (Bell's stage ≥2) we measured citrulline-P levels during the first 48 h after NEC onset. Categorizing the measurements into 0-8 h, 8-16 h, 16-24 h, 24-36 h, and 36-48 h, we determined the course of citrulline-P using linear regression analyses. Next, we analyzed whether citrulline-P levels measured at 0-24 h and 24-48 h differed between conservative and surgical treatment, survivors and nonsurvivors, and equal/below and above total group's median time to full enteral feeding (FEFt).
We included 48 infants, median gestational age 28.3 [IQR:26.0-31.4] weeks, birth weight 1200 [IQR:905-1524] grams. Citrulline-P levels decreased the first 48 h (B per time interval: -1.40 μmol, 95% CI, -2.73 to -0.07, p = 0.04). Citrulline-P was not associated with treatment, nor with survival. Citrulline-P at 0-24 h, but not 24-48 h, was higher in infants with FEFt ≤20 days than in infants with FEFt >20 days (20.7 [IQR:19.9-25.3] µmol/L (n = 13) vs. 11.1 [IQR:8.4-24.0] µmol/L (n = 11), p = 0.049), with a citrulline-P cut-off value of 12.3 μmol/L.
Citrulline-P levels decreased the first 48 h after NEC onset, suggesting on-going intestinal injury. In survivors, measuring citrulline-P in the first 24 h after NEC onset may provide an indication for intestinal recovery rate.
血浆瓜氨酸（瓜氨酸-P）水平可作为肠细胞功能的生物标志物，可能有助于监测坏死性小肠结肠炎（NEC）的病程。我们的目的是评估 NEC 发病后 48 小时内（h）的瓜氨酸-P 水平是否与手术需要、存活率和肠道恢复有关。
我们在患有 NEC（Bell 分期≥2）的早产儿中测量了 NEC 发病后 48 小时内的瓜氨酸-P 水平。将测量值分为 0-8 h、8-16 h、16-24 h、24-36 h 和 36-48 h，我们使用线性回归分析确定瓜氨酸-P 的变化过程。接下来，我们分析了在 0-24 h 和 24-48 h 测量的瓜氨酸-P 水平是否在保守治疗和手术治疗、存活者和非存活者以及达到完全肠内喂养（FEFt）的时间中位数相等/低于和高于总组之间存在差异。
我们纳入了 48 名婴儿，中位胎龄 28.3 [IQR：26.0-31.4] 周，出生体重 1200 [IQR：905-1524] 克。瓜氨酸-P 水平在发病后的前 48 小时内下降（每时间间隔的 B：-1.40 μmol，95%CI：-2.73 至 -0.07，p=0.04）。瓜氨酸-P 与治疗方法无关，也与存活率无关。0-24 h 的瓜氨酸-P，但不是 24-48 h 的瓜氨酸-P，在 FEFt≤20 天的婴儿中高于 FEFt>20 天的婴儿（20.7 [IQR：19.9-25.3] μmol/L（n=13）与 11.1 [IQR：8.4-24.0] μmol/L（n=11），p=0.049），瓜氨酸-P 截断值为 12.3 μmol/L。
NEC 发病后前 48 小时内瓜氨酸-P 水平下降，提示持续的肠损伤。在存活者中，在 NEC 发病后 24 小时内测量瓜氨酸-P 可能可以提供肠道恢复速度的指示。
