粪便高迁移率蛋白B1在早期诊断和评估新生儿坏死性小肠结肠炎病情中的价值

摘要

Objective To evaluate the value of fecal high mobility group box-1 (HMGB 1 ) in early diagnosis and prediction of the severity of neonatal necrotizing enterocolitis (NEC). Methods From July 2013 to June 2015 , the neonates who had distention, vomit, or gross blood in stool and were suspected of NEC were recruited as NEC group while hospitalized children without abdominal distension, vomiting, bloody diarrhea, or other gastrointestinal symptoms were recruited as the control group. Stool samples were collected on day 1 , 3 , 5 and 7 after admission. The level of HMGB 1 was measured by enzyme linked immunosorbent assay (ELISA). Results In the end, there were 46 cases in NEC group and 15 cases in control group. In NEC group, 29 cases were conifrmed of stageⅠof NEC by abdominal radiograph within 24 h after hospitalized, all of them were deteriorated to stageⅡphase in 4 days, and 10 cases were deteriorated to stageⅢ. Seventeen cases were conifrmed of stageⅡby abdominal radiograph within 24 h after hospitalized, 7 cases were deteriorated to stageⅢ. In 17 stageⅢcases, 11 cases received surgical treatment and 6 cases gave up. Eight cases survived and 3 died after surgery. The levels of HMGB 1 in NEC group on day 1 , 3 , 5 and 7 after hospitalized were higher than those in control group (P< 0 . 05 ). With the exacerbation of NEC from stage I toⅢ, the levels of HMGB 1 increased gradually (P< 0 . 05 ). Conclusions With the exacerbation of NEC, the level of HMGB 1 is gradually increased, which indicates that it has certain clinical value in early diagnosis and prediction of severity of NEC.%目的：探讨粪便高迁移率蛋白B 1（HMGB 1）在早期诊断和评估新生儿坏死性小肠结肠炎（NEC）病情严重程度中的价值。方法2013年7月至2015年6月纳入有腹胀、呕吐或肉眼血便，疑似NEC新生儿；以及同期住院无腹胀、呕吐、血便等消化道症状的住院患儿，分别为NEC组和对照组。收集患儿入院后1、3、5、7 d粪便标本，采用酶联免疫吸附法测定HMGB 1水平。结果最终纳入分析的有46例NEC患儿和15例对照组。NEC组中，29例在入院24 h内腹部平片证实为Ⅰ期，全部在入院后4 d内恶化为Ⅱ期，其中10例进一步恶化到Ⅲ期；17例在入院24 h内腹部平片证实为Ⅱ期，其中7例恶化为Ⅲ期；17例Ⅲ期NEC患儿中，11例手术治疗、6例放弃手术治疗，手术患儿中8例存活、3例死亡。NEC患儿入院后第1、3、5、7 d HMGB 1水平均高于对照组，差异有统计学意义（P< 0.05）；随着NEC患儿病情由Ⅰ期恶化至Ⅲ期，粪便HMGB 1含量逐渐增高，差异有统计学意义（P< 0.05）。结论随着NEC患儿病情恶化，粪便HMGB 1含量逐渐增高， HMGB 1对于早期诊断NEC，以及在评估NEC患儿病情严重程度方面具有一定的临床价值。