新生儿坏死性小肠结肠炎严重程度的影响因素分析  

High-risk factors affecting the severity of neonatal necrotizing enterocolitis

作　　者：缪欣欣 管欣娴[1] 俞生林[1] 赵赫 高沙沙[1] 舒丹丹 张雨生 Miao Xinxin;Guan Xinxian;Yu Shenglin;Zhao He;Gao Shasha;Shu Dandan;Zhang Yusheng(Department of Neonatology,Children's Hospital of Soochow University,Suzhou 215123,China;Pediatric Research Institute,Children's Hospital of Soochow University,Suzhou 215123,China;Department of Rehabilitation,Children's Hospital of Soochow University,Suzhou 215123,China;Department of Pediatric Internal Medicine,the Affiliated Suzhou Hospital of Nanjing University Medical School,Suzhou 215163,China)

机构地区：[1]苏州大学附属儿童医院新生儿科,苏州215123 [2]苏州大学附属儿童医院儿科研究所,苏州215123 [3]苏州大学附属儿童医院康复科,苏州215123 [4]南京大学医学院附属苏州医院儿内科,苏州215163

出　　处：《中华围产医学杂志》2025年第3期247-252,共6页Chinese Journal of Perinatal Medicine

基　　金：江苏省医学会医学科研项目[SYH-32034-0104(2024008)];苏州市科技计划项目(SKY2022181)。

摘　　要：目的探讨影响新生儿坏死性小肠结肠炎(necrotizing enterocolitis,NEC)严重程度的高危因素。方法回顾性选择2017年1月1日至2023年12月30日在苏州大学附属儿童医院新生儿科收治的153例NEC患儿。依据Bell分期判断NEC的病情严重程度,分成轻症组(BellⅡ期,n=70)和重症组(BellⅢ期,n=83)。收集患儿的一般情况、发生NEC前的临床治疗及疾病情况、实验室检查结果及患儿母亲围产期情况。通过单因素分析(秩和检验、χ^(2)检验)和多因素分析(logistic回归分析)探讨影响NEC病情严重程度的危险因素。结果(1)与轻症组比较,重症组胎龄<37周、出生体重<1500 g、抗生素应用、合并败血症、合并休克的比例更高,以及生后开奶时间延迟和经外周静脉置入中心静脉导管(peripherally inserted central catheter,PICC)留置时间、肠外营养时间更长[分别为91.6%(76/83)与75.7%(53/70)、55.4%(46/83)与34.3%(24/70)、85.5%(71/83)与71.4%(50/70)、55.4%(46/83)与17.1%(12/70)、30.1%(25/83)与8.6%(6/70)、2.00 d(1.00~2.00 d)与1.00 d(1.00~2.00 d)、0.00 d(0.00~18.00 d)与0.00 d(0.00~7.50 d)、14.00 d(5.00~21.00 d)与10.50 d(0.00~18.25 d),χ^(2)或Z值分别为7.22、6.84、4.57、23.64、10.91、-2.90、-1.98及-2.09,P值均<0.05]。(2)发生NEC前48 h内重症组白细胞计数降低、血小板计数降低、电解质紊乱和代谢性酸中毒比例,以及降钙素原、C-反应蛋白计数均高于轻症组[分别为53.0%(44/83)与14.3%(10/70)、49.4%(41/83)与10.0%(7/70)、38.6%(32/83)与14.3%(10/70)、37.3%(31/83)与14.3%(10/70)、2.31 ng/ml(0.26~11.71 ng/ml)与0.22 ng/ml(0.00~2.19 ng/ml)、58.50 mg/L(14.34~125.25 mg/L)与8.20 mg/L(0.23~34.56 mg/L),χ^(2)或Z值分别为24.94、27.38、11.23、10.30、-3.88及-5.02,P值均<0.05]。(3)多因素logistic回归分析显示,PICC留置时间延长、血小板计数减少、电解质紊乱、代谢性酸中毒及合并败血症是影响NEC病情严重程度的独立危险因素[OR值(95%CI)分别为1.104(1.020~1.ObjectiveTo explore the high-risk factors affecting the severity of neonatal necrotizing enterocolitis(NEC).MethodsThis study involved 153 NEC patients admitted to the Neonatology Department of the Children's Hospital of Soochow University from January 1,2017,to December 30,2023.Based on the severity of NEC determined by Bell's criteria,these patients were divided into two groups:mild group(Bell stageⅡ,n=70)and severe group(Bell stageⅢ,n=83).Clinical data including general conditions,clinical treatment and disease status before the onset of NEC,laboratory test results,and perinatal conditions of the mothers were retrospectively collected.Univariate analysis(rank-sum test and Chi-square test)and multivariate analysis(logistic regression analysis)were used to explore the risk factors affecting the severity of NEC.ResultsThe proportion of infants with gestational age<37 weeks or birth weight<1500 g,the rate of antibiotic usage,sepsis or shock were higher in the severe group than in the mild group[91.6%(76/83)vs.75.7%(53/70);55.4%(46/83)vs.34.3%(24/70);85.5%(71/83)vs.71.4%(50/70);55.4%(46/83)vs.17.1%(12/70);30.1%(25/83)vs.8.6%(6/70);withχ^(2) values of 7.22,6.84,4.57,23.64,and 10.91,respectively,all P<0.05].Furthermore,the severe group had a late initiation of breastfeeding and longer durations of peripherally inserted central catheter(PICC)placement and parenteral nutrition[2.00 d(1.00-2.00 d)vs.1.00 d(1.00-2.00 d);0.00 d(0.00-18.00 d)vs.0.00 d(0.00-7.50 d);14.00 d(5.00-21.00 d)vs.10.50 d(0.00-18.25 d),with Z values of-2.90,-1.98,and-2.09,respectively,all P<0.05].(2)Within 48 h before the onset,the severe group had higher proportions of infants with decreased white blood cell count,decreased platelet count,electrolyte imbalance,and metabolic acidosis than the mild group[53.0%(44/83)vs.14.3%(10/70);49.4%(41/83)vs.10.0%(7/70);38.6%(32/83)vs.14.3%(10/70);37.3%(31/83)vs.14.3%(10/70),withχ^(2) values of 24.94,27.38,11.23,and 10.30,respectively,all P<0.05].Besides,the levels of procalcitonin and C-reactive protein w

关 键 词：坏死性小肠结肠炎 新生儿 严重程度 高危因素 

分 类 号：R722.1[医药卫生—儿科]