Yu Lei, Liu Chao, Du Qingjing, Ma Lishuang
Children's Hospital, Capital Institute of Pediatrics, Department of Hospital Infection Administrative, Beijing, China.
Children's Hospital, Capital Institute of Pediatrics, Department of Neonatal General Surgery, Beijing, China.
Front Surg. 2022 May 17;9:889321. doi: 10.3389/fsurg.2022.889321. eCollection 2022.
The current indications based on the clinicopathological parameters for predicting the need for surgery in neonatal necrotizing enterocolitis (NEC) are still limited. This study retrospectively analyzes the characteristics of neonatal NEC and aims to identify the risk factors for surgical intervention in NEC.
Data of the NEC cases from 2015 to 2019 were collected from our institution and divided into two groups: surgical group ( = 41) and conservative treatment group ( = 143). Clinical, physical, and laboratory measures were analyzed by univariate analysis and multivariate logistic regression. The diagnostic values and receiver operative characteristic (ROC) curve were used for the assessment.
Univariate analysis identified significant differences between the surgical group and the conservative group in a series of clinical, physical, and laboratory measures (all < 0.05). The results of multivariate logistic regression analysis showed that procalcitonin (adjusted OR: 167.1, 95% CI, 3.585-7,788.758, = 0.009) and gestational age (adjusted OR: 0.85, 95% CI, 0.77-0.94, = 0.001) were independent surgical indications for NEC. The results from ROC curve and diagnosis values demonstrated that procalcitonin [the area under the curve (AUC) = 0.864], CRP (AUC = 0.783) and fibrinogen (AUC = 0.720) had good predictive performance for surgical NEC.
The level of procalcitonin and gestational age were found to be independent surgical indications for neonates with NEC.
目前基于临床病理参数预测新生儿坏死性小肠结肠炎（NEC）手术需求的指征仍然有限。本研究回顾性分析新生儿NEC的特征，旨在确定NEC手术干预的危险因素。
收集我院2015年至2019年NEC病例的数据，分为两组：手术组（n = 41）和保守治疗组（n = 143）。通过单因素分析和多因素逻辑回归分析临床、体格检查和实验室指标。采用诊断价值和受试者操作特征（ROC）曲线进行评估。
单因素分析显示手术组和保守组在一系列临床、体格检查和实验室指标上存在显著差异（均P < 0.05）。多因素逻辑回归分析结果显示，降钙素原（调整后OR：167.1，95%CI，3.585 - 7788.758，P = 0.009）和胎龄（调整后OR：0.85，95%CI，0.77 - 0.94，P = 0.001）是NEC独立的手术指征。ROC曲线和诊断价值结果表明，降钙素原[曲线下面积（AUC）= 0.864]、CRP（AUC = 0.783）和纤维蛋白原（AUC = 0.720）对NEC手术具有良好的预测性能。
降钙素原水平和胎龄被发现是NEC新生儿独立的手术指征。
