Department of Pediatrics, The First Affiliated Hospital of Jinan University, No. 613 West Huangpu Avenue, Tianhe District, Guangzhou, Guangdong, CN 510630, China.
Provincial Key Laboratory of Research in Structure Birth Defect Diseaseand, Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, No.9 Jinsui Road, Zhujiang New Town, Tianhe District, Guangzhou, Guangdong, CN 510623, China.
Eur J Pediatr. 2023 Nov;182(11):5203-5210. doi: 10.1007/s00431-023-05188-6. Epub 2023 Sep 16.
We aimed to assess whether autoantibodies can be used as biomarkers for necrotizing enterocolitis (NEC) and applied for its early diagnosis. A prospective observational study was conducted in neonates with suspected NEC abdominal distension (the developmental study), which consisted of 50 neonates finally divided into NEC (n = 24) and non-NEC (n = 26) cohorts based on follow-up results. Serum samples were collected within 48 h of illness onset and used for screening NEC-associated plasma autoantibodies by autoantigen microarray. Additionally, we validated anti-myosin autoantibodies by enzyme-linked immunosorbent assay (ELISA) in an independent validation study, for which we selected plasma samples within 48 h of onset of NEC (n = 38) and samples of gestational age- and weight-matched controls (n = 13). Autoantigen microarray revealed that both IgG and IgM anti-myosin autoantibodies in plasma from neonates with NEC were significantly higher than those in neonates with other diagnoses. ELISA showed that plasma anti-myosin autoantibodies increased in the NEC cohort, with 1.5-fold higher levels than in the non-NEC cohort. Anti-myosin autoantibodies were able to distinguish NEC from non-NEC, achieving an area under the curve (AUC) of 0.8856 (95% confidence interval (CI): 0.7918-0.9795), with sensitivity of 81.58% and specificity of 76.93%. Plasma anti-myosin autoantibodies were significantly higher in all three subtypes of NEC (P < 0.0001 for NEC I; P = 0.0018 for NEC II; P = 0.0011 for NEC III), especially in NEC stage I than that in the non-NEC controls.
Anti-myosin autoantibodies may be applied as a promising diagnostic marker for NEC, especially for NEC stage I.
• Intestinal damage and self-antigen exposure may lead to increased autoantibodies, and they are widely used as biomarkers for diagnosing inflammatory bowel disease. • Necrotizing enterocolitis (NEC) is a devastating disease with overwhelming inflammation and immune dysregulation.
• Increased autoantibodies were present in patients with NEC, even before typical X-ray manifestations. • Anti-myosin autoantibodies may be applied as a promising diagnostic marker for NEC.
评估自身抗体是否可作为坏死性小肠结肠炎（NEC）的生物标志物，并用于其早期诊断。
本前瞻性观察研究纳入疑似 NEC 腹胀的新生儿（发展研究），共纳入 50 例新生儿，根据随访结果最终分为 NEC 组（n=24）和非 NEC 组（n=26）。于发病后 48 小时内采集血清样本，采用自身抗原微阵列检测与 NEC 相关的血浆自身抗体。此外，我们还通过酶联免疫吸附试验（ELISA）在独立验证研究中验证了抗肌球蛋白自身抗体，在该研究中，我们选择了发病后 48 小时内的 NEC 血浆样本（n=38）和胎龄和体重匹配的对照组样本（n=13）。
自身抗原微阵列显示，NEC 患儿血浆中的 IgG 和 IgM 抗肌球蛋白自身抗体明显高于其他诊断患儿。ELISA 显示，NEC 组的血浆抗肌球蛋白自身抗体增加，其水平是对照组的 1.5 倍。抗肌球蛋白自身抗体能够区分 NEC 和非 NEC，曲线下面积（AUC）为 0.8856（95%置信区间：0.7918-0.9795），灵敏度为 81.58%，特异性为 76.93%。所有三种类型的 NEC（NEC I：P<0.0001；NEC II：P=0.0018；NEC III：P=0.0011）患儿的血浆抗肌球蛋白自身抗体均明显升高，且均高于非 NEC 对照组，特别是 NEC I 期患儿。
抗肌球蛋白自身抗体可能作为一种有前途的 NEC 诊断标志物，特别是对于 NEC I 期。
