极低出生体重儿粪便钙卫蛋白水平变化及临床意义  

The level and clinical value of fecal calprotectin in very low birth weight infants

作　　者：许景林 连冰冰 王瑞泉 吴联强 陈冬梅 吴斌[2] Xu Jinglin;Lian Bingbing;Wang Ruiquan;Wu Lianqiang;Chen Dongmei;Wu Bin(Department of Neonatology,Teaching Hospital of Fujian Medical Univeristy,Quanzhou Woman and Children′s Hospital,Quanzhou 362000,China;Department of Pediatrics,the First Affiliated Hospital of Fujian Medical University,Fuzhou 350005,China)

机构地区：[1]福建医科大学教学医院泉州市儿童医院新生儿科,362000 [2]福建医科大学附属第一医院儿科,福州350005

出　　处：《中国小儿急救医学》2021年第10期890-894,共5页Chinese Pediatric Emergency Medicine

基　　金：泉州市科技计划项目(2018N089S);北京仁泽公益基金会"关爱"早产儿疾病科研基金项目(K018)。

摘　　要：目的了解极低出生体重儿粪便钙卫蛋白(fecal calprotectin,FC)水平的变化趋势及其影响因素,探讨FC检测在极低出生体重儿坏死性小肠结肠炎(necrotizing enterocolitis,NEC)诊断中的应用价值。方法选择2018年6月至2019年5月泉州市儿童医院新生儿科收治住院的极低出生体重儿为研究对象,进行前瞻性研究。连续收集出生后第1、7、14、21、28、35天的粪便标本,以及发生NEC急性期及恢复期的粪便标本,采用免疫荧光法定量测定FC含量。结果(1)生后1~35 d非NEC极低出生体重儿FC水平为143.5(47.8,391.2)μg/g。单因素分析显示,FC水平随日龄波动,21 d日龄时FC水平最高,随后下降;配方奶喂养、胎膜早破、新生儿败血症、喂养不耐受及孕母产前没有应用糖皮质激素者,FC水平明显升高,差异有统计学意义(P<0.05)。(2)多元协方差分析结果显示,产前应用糖皮质激素(F=10.550,P=0.001)、胎膜早破(F=13.311,P<0.001)、新生儿败血症(F=8.001,P=0.005)、喂养不耐受(F=4.751,P=0.030)、NEC(F=54.566,P<0.001)对FC水平影响差异有统计学意义。在控制产前应用糖皮质激素、胎膜早破、新生儿败血症及喂养不耐受影响后,NEC组和非NEC组患儿FC水平边缘估计均值及其95%CI分别为3162.3(1412.5~7244.4)μg/g、141.3(125.9~162.2)μg/g,差异有统计学意义(t=-7.541,P<0.001)。NEC组患儿急性期及恢复期FC水平分别为3166.9(1745.1,6806.4)μg/g、130.9(97.4,273.9)μg/g,差异有统计学意义(t=10.304,P<0.001);而NEC组轻度与中重度FC水平分别为2347.9(1404.4,5893.4)μg/g、4114.7(2764.5,9208.4)μg/g,差异无统计学意义(t=1.131,P=0.280)。结论极低出生体重儿FC水平随日龄波动,并受众多因素的影响。对极低出生体重儿进行FC水平检测,可协助NEC诊断及疗效评估。Objective To understand the change trend and influencing factors of fecal calprotectin(FC)in very low birth weight(VLBW)infants,and to explore the application value of FC detection in the diagnosis of necrotizing enterocolitis(NEC)in VLBW infants.Methods VLBW infants hospitalized in the neonatal department at Quanzhou Children′s Hospital from June 2018 to May 2019 were selected as research object for a prospective study.Fecal samples from the 1st,7th,14th,21st,28th and 35th days after birth and fecal samples from the acute and recovery stages of NEC were collected continuously.The content of FC was determined quantitatively by immunofluorescence assay.Results(1)The FC level of non NEC VLBW infants from 1 to 35 days after birth was 143.5(47.8,391.2)μg/g.Univariate analysis showed that the level of FC fluctuated with the postnatal age,the level of FC was the highest at 21 days,and then decreased.The level of FC increased significantly in formula feeding,premature rupture of membranes,neonatal sepsis,feeding intolerance and pregnant mothers without glucocorticoid before delivery(P<0.05).(2)Multivariate covariance analysis showed that prenatal application of glucocorticoid(F=10.550,P=0.001),premature rupture of membranes(F=13.311,P<0.001),neonatal sepsis(F=8.001,P=0.005),feeding intolerance(F=4.751,P=0.030)and NEC(F=54.566,P<0.001)had significant effects on FC level.After controlling the effects of prenatal corticosteroid,premature rupture of membranes,neonatal sepsis and feeding intolerance,the levels of FC in NEC group and non-NEC group were 3162.3(1412.5-7244.4)μg/g and 141.3(125.9-162.2)μg/g,respectively.In NEC group,the levels of FC in acute stage and recovery stage were 3166.9(1745.1,6806.4)μg/g and 130.9(97.4,273.9)μg/g,respectively,with significant difference(t=10.304,P<0.001).While the levels of FC were 2347.9(1404.4,5893.4)μg/g in the mild NEC and 4114.7(2764.5,9208.4)μg/g in the moderate or severe NEC,respectively,with no significant difference(t=1.131,P=0.280).Conclusion The levels of FC fluctuat

关 键 词：粪便钙卫蛋白 坏死性小肠结肠炎 极低出生体重儿 早产儿 

分 类 号：R722.1[医药卫生—儿科]