Evaluation of diagnostic efficacy and severity of necrotizing enterocolitis in premature infants by intestinal regional oxygen saturation and fecal calprotectin
Evaluation of diagnostic efficacy and severity of necrotizing enterocolitis in premature infants by intestinal regional oxygen saturation and fecal calprotectin
方凌毓 1陈江滨 1刘志勇 1王赫 1陈冬梅 1张薇
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作者信息
1. 泉州市儿童医院新生儿科 362000
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摘要
目的 测量肠组织氧饱和度（rSO2）和粪便钙卫蛋白水平，探讨其在早产儿坏死性小肠结肠炎（NEC）发生和病情严重性的诊断价值。 方法 采用前瞻性观察性研究，选取2019年10月至2022年12月泉州市儿童医院收治的早产儿，在诊断NEC 2 h内监测肠rSO2，以及进行粪便钙卫蛋白测定。 结果 纳入NEC及非NEC患儿各30例，内科NEC 14例，外科NEC 16例，死亡患儿8例。NEC组患儿肠rSO2低于非NEC组[49（30，60）% 比 66（60，69）%]，钙卫蛋白水平高于非NEC组[479（297，886）μg/g比203（113，275）μg/g]，差异均有统计学意义（P均＜0.01）。外科NEC组肠rSO2低于内科组，死亡组低于存活组，差异均有统计学意义（P均＜0.01），但钙卫蛋白未发现类似差异。ROC 曲线分析显示，肠rSO2及粪便钙卫蛋白联合诊断NEC的曲线下面积为0.91（95%CI 0.80 ~0.97）最大，其敏感度和特异度分别为73%和100%。当肠rSO2最佳截断值为31%时，预测NEC死亡的曲线下面积为0.99，敏感度100%，特异度95%。 结论 肠rSO2和粪便钙卫蛋白能有效识别NEC的发生，二者联合检测可以提高对新生儿NEC的诊断效能。肠rSO2可以对NEC的严重程度有良好预测，而不是粪便钙卫蛋白。 Objective To evaluate the diagnostic value of intestinal regional oxygen saturation（rSO2）and fecal calprotectin in the occurrence and severity of necrotizing enterocolitis（NEC）in premature infants. Methods A prospective observational study was conducted among premature infants admitted to Quanzhou Children's Hospital from October 2019 to December 2022. Intestinal rSO2 was monitored within two hours of diagnosis of NEC，and fecal calprotectin was measured. Results A total of 60 patients were included, including 30 cases with NEC and 30 cases without NEC, 14 cases of medical NEC, 16 cases of surgical NEC, and eight infants died due to NEC. Infants with NEC had lower intestinal rSO2 [49（30，60）% vs. 66（60，69）%] and higher calprotectin levels [479（297，886）μg/g vs. 203（113，275）μg/g] than those in infants without NEC (P<0.01). The levels of intestinal rSO2 were lower in surgical NEC than those in medical NEC，and were lower in the death group than that in the survival group (P<0.01)，but no similar difference was found in the levels of calprotectin. ROC curve analysis showed that intestinal rSO2 combined with calprotectin had a sensitivity of 73%，a specificity of 100%，and the largest area under curve of 0.91 in the diagnosis of NEC. Intestinal rSO2 had an optimal cut-off value of 31% in predicting death in infants with NEC，with a sensitivity of 100%，a specificity of 95%，and an area under curve of 0.99. Conclusion Intestinal rSO2 and fecal calprotectin can effectively identify the presence of NEC，and their combined detection can improve the diagnostic efficiency. Intestinal rSO2 is a good predictor of the severity of NEC，but not fecal calprotectin.
Abstract
Objective To evaluate the diagnostic value of intestinal regional oxygen saturation（rSO2）and fecal calprotectin in the occurrence and severity of necrotizing enterocolitis（NEC）in premature infants. Methods A prospective observational study was conducted among premature infants admitted to Quanzhou Children's Hospital from October 2019 to December 2022. Intestinal rSO2 was monitored within two hours of diagnosis of NEC，and fecal calprotectin was measured. Results A total of 60 patients were included, including 30 cases with NEC and 30 cases without NEC, 14 cases of medical NEC, 16 cases of surgical NEC, and eight infants died due to NEC. Infants with NEC had lower intestinal rSO2 [49（30，60）% vs. 66（60，69）%] and higher calprotectin levels [479（297，886）μg/g vs. 203（113，275）μg/g] than those in infants without NEC (P<0.01). The levels of intestinal rSO2 were lower in surgical NEC than those in medical NEC，and were lower in the death group than that in the survival group (P<0.01)，but no similar difference was found in the levels of calprotectin. ROC curve analysis showed that intestinal rSO2 combined with calprotectin had a sensitivity of 73%，a specificity of 100%，and the largest area under curve of 0.91 in the diagnosis of NEC. Intestinal rSO2 had an optimal cut-off value of 31% in predicting death in infants with NEC，with a sensitivity of 100%，a specificity of 95%，and an area under curve of 0.99. Conclusion Intestinal rSO2 and fecal calprotectin can effectively identify the presence of NEC，and their combined detection can improve the diagnostic efficiency. Intestinal rSO2 is a good predictor of the severity of NEC，but not fecal calprotectin.
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