动脉血气分析、PLR及NLR在新生儿坏死性小肠结肠炎的变化及临床意义  

Changes and significance of arterial blood gas analysis,platelet/lymphocyte ratio and neutrophil/lymphocyte ratio in neonatal necrotizing enterocolitis

作　　者：胡路遥 尚彪[1] 明欣 明虹均 谢先知 HU Luyao;SHANG Biao;MING Xin;MING Hongjun;XIE Xianzhi(Department of Neonatology,The Second Clinical Medical College of to North Sichuan Medical College,Beijing Anzhen Nanchong Hospital of Capital Medical University,Nanchong 637000,Sichuan,China)

机构地区：[1]川北医学院第二临床医学院·首都医科大学附属北京安贞医院南充医院新生儿科,四川南充637000

出　　处：《西部医学》2025年第3期431-435,共5页Medical Journal of West China

基　　金：南充市应用技术研究与开发专项项目(19YFZJ0037)。

摘　　要：目的探讨新生儿坏死性小肠结肠炎(NEC)动脉血气中pH、碱剩余(BE),血清中血小板/淋巴细胞比值(PLR)及中性粒细胞/淋巴细胞比值(NLR)的水平变化,及其对NEC的早期诊断的临床意义。方法选择2020年1月—2023年1月我院收治的新生儿139例为研究对象,根据出院是否诊断为NEC分为NEC组89例(NEC患儿)、非NEC组50例(未患有肠道疾病的黄疸患儿),NEC组根据修正Bell-NEC诊断标准分为Ⅰ期14例、Ⅱ期64例、Ⅲ期11例。比较两组患儿动脉血pH、BE、血清中的PLR及NLR的差异,并应用受试者工作特征(ROC)曲线分析各项指标诊断效能。采用多因素Logistic回归分析影响NEC的危险因素。结果两组新生儿发病时体质量、早产发生情况比较,差异有统计学意义(P<0.05)。NEC组BE水平明显低于非NEC组,血清中的PLR及NLR水平明显高于非NEC组(P<0.05)。Ⅲ期NEC患儿pH明显低于Ⅱ期患儿,BE水平低于Ⅰ、Ⅱ期患儿,PLR水平高于Ⅰ、Ⅱ期患儿(P<0.05)。ROC曲线分析结果显示,BE、PLR及NLR联合检测诊断NEC的曲线下面积(AUC)为0.694,灵敏度为57.3%,特异度为80%,大于3项指标单独检测。多因素Logistic回归分析结果显示,早产儿和BE是患儿发生NEC的独立危险因素(P<0.05)。结论BE、PLR、NLR联合检测对NEC患儿的诊断价值优于单独检测,Ⅲ期NEC患儿pH明显下降。Objective To retrospectively analyze the changes of pH,alkali surplus(BE)in arterial blood gas,platelet/lymphocyte(PLR)and neutrophil/lymphocyte ratio(NLR)in serum of 139 cases of neonatal necrotizing enterocolitis(NEC),and to explore their early diagnostic value for NEC.Methods A total of 139 newborns admitted to our Hospital from January 2020 to January 2023 were selected as the study subjects.They were divided into a NEC group of 89 cases(NEC patients)and a control group of 50 cases(non NEC patients)based on whether they were diagnosed with NEC after discharge.The NEC group was divided into stage Ⅰ of 14 cases according to the modified Bell NEC diagnostic criteria;64 cases in Phase Ⅱ;11 cases in stage Ⅲ.The differences of arterial blood pH,BE,platelet/lymphocyte(PLR)and neutrophil/lymphocyte ratio(NLR)in serum between the two groups were analyzed.Multiple logistic regression analysis was used to identify the risk factors affecting NEC.Results Showed that there was a statistically significant difference(P<0.05)between the two groups in terms of body mass at onset and incidence of asphyxia during childbirth.The remaining alkaline levels in the NEC group were significantly lower than those in the control group,and the levels of platelet/lymphocyte(PLR)and neutrophil/lymphocyte ratio(NLR)in the serum of the NEC group were significantly higher than those in the control group,with statistical significance(P<0.05).The pH of stage Ⅲ patients was significantly lower than that of stage Ⅱ patients,the residual level of alkali in stage Ⅲ patients was lower than that of stage Ⅰ and Ⅱ patients,and the PLR level in stage Ⅲ patients was higher than that of stage Ⅰ and Ⅱ patients,with a statistically significant difference(P<0.05).The ROC curve analysis results showed that the area under the curve(AUC)for the combined detection of alkali residue,PLR,and NLR in the diagnosis of NEC was 0.694,with a sensitivity of 57.3% and a specificity of 80%,which was greater than the AUC detected separately for the thre

关 键 词：新生儿坏死性小肠结肠炎 血气分析 PH 碱剩余 血小板/淋巴细胞比值 中性粒细胞/淋巴细胞比值 

分 类 号：R574.5[医药卫生—消化系统]