Corebima Brigitta I R V, Rohsiswatmo Rinawati, Santosaningsih Dewi, Barlianto Wisnu, Handono Kusworini
Doctoral Program in Medical Science, Faculty of Medicine, Brawijaya University, Indonesia.
Department of Pediatrics, Faculty of Medicine, Brawijaya University/Saiful Anwar General Hospital, Indonesia.
Arch Med Sci. 2023 Nov 16;20(2):444-456. doi: 10.5114/aoms/173390. eCollection 2024.
Necrotizing enterocolitis (NEC) poses a significant threat to preterm infants, with nonspecific early manifestations complicating timely diagnosis. Therefore, this study aimed to develop a novel scoring system for early diagnosis of NEC, incorporating clinical and laboratory data with urinary caveolin-1 levels.
A single-center prospective cohort study was conducted at a tertiary hospital in East Java, Indonesia. NEC diagnosis was established by Bell's criteria and proven gut dysbiosis. Urinary levels of claudin-2, caveolin-1, and epidermal growth factor (EGF) were assessed as potential indicators of tight junction disruption. The selected urine biomarker cutoff value was determined using symbolic classification analysis and combined with clinical and laboratory parameters from Bell's criteria to create an NEC scoring system, validated with the Aiken index. Sensitivity and specificity analyses were performed.
Thirty-four neonates, comprising NEC, preterm non-NEC, and term infants, were included. qPCR analysis highlighted elevated , , , and levels in NEC patients, indicating a gut dysbiosis trend. Among 3 biomarkers, caveolin-1 ≥ 17.81 ng/dl on day 3 demonstrated 72.86% negative predictive value and 87.50% positive predictive value. The combined scoring system which comprised abdominal cellulitis, distension, radiology, advanced resuscitation at birth, prematurity or low birthweight, platelet count, sepsis, orogastric retention, metabolic acidosis and caveolin-1 findings exhibited an AUC of 0.922 (95% CI: 0.81-1.00, < 0.001), with ≥ 1.81 as the cutoff, offering 93% sensitivity and 94% specificity.
Urine caveolin-1 on day 3 signifies enterocyte tight junction damage and the acute phase of NEC in premature infants. The proposed scoring system demonstrates good performance in predicting NEC incidence in preterm infants.
坏死性小肠结肠炎（NEC）对早产儿构成重大威胁，其早期表现不具特异性，这使得及时诊断变得复杂。因此，本研究旨在开发一种用于NEC早期诊断的新型评分系统，将临床和实验室数据与尿中窖蛋白-1水平相结合。
在印度尼西亚东爪哇的一家三级医院进行了一项单中心前瞻性队列研究。NEC诊断依据贝尔标准并经肠道菌群失调证实。评估了紧密连接破坏的潜在指标，即尿中闭合蛋白-2、窖蛋白-1和表皮生长因子（EGF）的水平。使用符号分类分析确定所选尿生物标志物的临界值，并将其与贝尔标准中的临床和实验室参数相结合，创建了一个NEC评分系统，并用艾肯指数进行验证。进行了敏感性和特异性分析。
纳入了34例新生儿，包括NEC患儿、早产非NEC患儿和足月儿。定量聚合酶链反应分析突出显示NEC患者中[此处原文缺失具体基因名称]、[此处原文缺失具体基因名称]、[此处原文缺失具体基因名称]和[此处原文缺失具体基因名称]水平升高，表明存在肠道菌群失调趋势。在3种生物标志物中，第3天窖蛋白-1≥17.81 ng/dl时，阴性预测值为72.86%，阳性预测值为87.50%。由腹部蜂窝织炎、腹胀、放射学检查、出生时高级复苏、早产或低出生体重、血小板计数、败血症、胃潴留、代谢性酸中毒和窖蛋白-1检查结果组成的联合评分系统的曲线下面积为0.922（95%置信区间：0.81 - 1.00，P<0.001），临界值≥1.81，敏感性为93%，特异性为94%。
第3天的尿窖蛋白-1表明早产儿肠上皮细胞紧密连接受损及NEC急性期。所提出的评分系统在预测早产儿NEC发生率方面表现良好。
