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目的探讨血浆肠脂肪酸结合蛋白(I-FABP)水平变化在指导新生儿坏死性小肠结肠炎(NEC)诊断及治疗中的意义。方法选择2011年5月至2012年12月我院新生儿科收治的患儿,按入院先后顺序,以明确诊断NEC的50例新生儿为NEC组,其中NECⅡ期30例,NECⅢ期20例,以非NEC新生儿50例为对照组。NEC组在确诊后24 h内、对照组在相应日龄取血,采用酶联免疫吸附法(ELISA)检测血浆I-FABP水平,根据NEC患儿病情转归分为存活组及病死组,按治疗方法分为保守治疗组和手术治疗组,比较不同组间血浆I-FABP水平、新生儿危重病例评分(NCIS)分值、脓毒症的发生率及病死率。结果 NECⅡ期组、NECⅢ期组和对照组血浆I-FABP水平分别为(95.6±18.5)μmol/L、(151.2±10.8)μmol/L和(1.2±2.3)μmol/L,组间比较差异有统计学意义(P<0.05);NECⅡ期组和NECⅢ期组NCIS评分明显低于对照组,脓毒症发生率和病死率均高于对照组,差异有统计学意义(P<0.05),NECⅡ期组和NECⅢ期组差异无统计学意义(P>0.05)。病死组血浆I-FABP水平、脓毒症发生率高于存活组,NCIS评分低于存活组;保守治疗组I-FABP水平低于手术治疗组,NCIS评分高于手术治疗组,差异均有统计学意义(P<0.05)。结论血浆I-FABP水平可较敏感地反映NEC患儿的病情变化,可作为预测NEC病情严重程度及指导采取内外科治疗的指标之一。
Objective To investigate the significance of the change of plasma intestinal fatty acid binding protein (I-FABP) level in the diagnosis and treatment of neonatal necrotizing enterocolitis (NEC). Methods From May 2011 to December 2012 in our hospital neonates admitted to the hospital, according to hospital admission order to confirm the diagnosis of NEC in 50 neonates for the NEC group, of which 30 cases of NEC Ⅱ, 20 cases of NEC Ⅲ 50 cases of non-NEC newborns as control group. The NEC group within 24 hours after diagnosis, the control group at the corresponding day of age, using enzyme-linked immunosorbent assay (ELISA) to detect plasma levels of I-FABP, according to the NEC children’s condition is divided into survival and death groups, according to Treatment methods were divided into conservative treatment group and surgical treatment group. Plasma I-FABP levels, NCIS score, sepsis incidence and mortality were compared between different groups. Results The plasma levels of I-FABP in NECⅡgroup, NECⅢgroup and control group were (95.6 ± 18.5) μmol / L, (151.2 ± 10.8) μmol / L and (1.2 ± 2.3) μmol / L respectively (P <0.05). The NCIS scores of NECⅡgroup and NECⅢgroup were significantly lower than those of the control group. The incidence of sepsis and mortality were higher than those of the control group (P <0.05) There was no significant difference between stage group and NEC stage group (P> 0.05). The plasma I-FABP level in the dead group was higher than that in the survival group and NCIS score was lower than that in the survival group. The I-FABP level in the conservative group was lower than that in the surgical group, and the NCIS score was higher than that in the surgical group Significance (P <0.05). Conclusion The plasma I-FABP level can reflect the changes of the disease in NEC patients more sensitively, and can be used as one of the indexes to predict the severity of NEC and guide the surgical treatment.